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Disparities with influenza vaccine use in long-term survivors of metastatic breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Elderly women diagnosed with metastatic breast cancer (MBC) are living longer, however their primary care management may be sub-optimal. Influenza results in preventable hospitalizations and deaths. Guidelines recommend the influenza vaccine for those > 65 years and those with cancer but use is unknown.

Methods

A retrospective analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. Patients were included if they were diagnosed with MBC from 1/1/2008–12/31/2017 and were ≥ 65 years of age. The primary outcome was influenza vaccine use among patients surviving ≥ 3-years. We conducted multivariable analyses using demographic and clinical factors to identify associations with vaccine use. We compared utilization to cancer-free controls.

Results

We identified 1,970 patients with MBC that survived for ≥ 3 years. The median age at diagnosis was 73 years. Furthermore, 1,742 (88%) patients were White, and 153 (8%) patients were Black. Only 1,264 (64%) received an influenza vaccine at least one time and 51% received the vaccine at least two times. A multivariable model found lower odds of vaccine receipt for Black patients (OR = 0.48; 95% CI 0.34–0.68, p < 0.001) and higher odds for patients that saw primary care in the year prior to diagnosis (OR = 1.91, 95% CI 1.57–2.33, p < 0.001). Patients with MBC had lower odds of vaccine use compared to cancer free controls (OR = 0.85, 95% CI 0.74–0.97, p < 0.001).

Conclusion

Over 1/3 of long-term MBC survivors in our cohort did not receive the influenza vaccine. Black patients are about half as likely to be vaccinated. Given the known benefit of the vaccine, improving uptake could be an important strategy to improve outcomes.

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Data Availability

The data that support the findings of this study are available from Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of the SEER program.

Abbreviations

MBC:

Metastatic breast cancer

SEER:

Surveillance, Epidemiology, and End Results

HMO:

Health maintenance organization

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Acknowledgements

The funder did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Sect. 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

Funding

This work was supported by the Breast Cancer Research Foundation (DLH) and the American Cancer Society (DLH). Support for data acquisition provided by the Herbert Irving Comprehensive Cancer Center (P30CA013696).

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sahil D. Doshi

  2. Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA

    David DeStephano, Melissa K. Accordino, Rohit R. Raghunathan, Jason D. Wright & Dawn L. Hershman

  3. Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Melissa K. Accordino

  4. Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA

    Elena Elkin & Dawn L. Hershman

  5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA

    Jason D. Wright

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  1. Sahil D. Doshi
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  4. Elena Elkin
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  7. Dawn L. Hershman
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sahil Doshi, David DeStephano, and Dawn Hershman. The first draft of the manuscript was written by Sahil Doshi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sahil D. Doshi.

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The authors of this manuscript do not have any relevant conflicts of interest to disclose.

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This is an observational study. The Columbia University Irving Medical Center Institutional Review board has confirmed that no ethical approval is required.

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Doshi, S.D., DeStephano, D., Accordino, M.K. et al. Disparities with influenza vaccine use in long-term survivors of metastatic breast cancer. Breast Cancer Res Treat 203, 111–119 (2024). https://doi.org/10.1007/s10549-023-07109-5

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