title: Vaccination of chemotherapy patients--effect of guideline implementation.
abstract: OBJECTIVE
  Despite substantial morbidity and mortality of influenza and pneumococcal infections in cancer patients treated with chemotherapy, vaccination against both illnesses is infrequent. We evaluated the impact of implementation of clinical guidelines on vaccination of chemotherapy patients treated in our institute.
  
  
  METHODS
  We performed a prospective audit before (2012) and after (2013-2014) the introduction of immunisation guidelines for chemotherapy patients in a UK tertiary cancer centre.
  
  
  RESULTS
  Guideline implementation was associated with a significant increase in the rate of pneumococcal vaccination compared to the 2012 baseline (47 vs. 25 %, P = 0.0018), though this was not sustained the following year (34 %, P = 0.13, vs. baseline). Influenza vaccine coverage was high (∼ 70 %) throughout. There was a marked disparity between patients aged ≤ 65 and those >65 years in the rate of pneumococcal vaccination in both 2013 and 2014 (38 vs. 68 % and 17 vs. 53 %, respectively, both P < 0.001), and, to a lesser extent, in the rate of influenza vaccination in the same period (64 vs. 82 %, P < 0.1, and 63 vs. 85 %, P = 0.009, respectively).
  
  
  CONCLUSIONS
  The implementation of clinical vaccine guidelines was associated with a significant increase in pneumococcal vaccination, though continued effort appears required to deliver persistent improvement. Initiatives to increase vaccination uptake in patients aged ≤ 65 are merited.
authors.affiliation: Oxford Cancer Centre, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford, OX3 7LE, UK.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Toleman
authors.affiliation: Oxford Cancer Centre, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford, OX3 7LE, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Herbert
authors.affiliation: Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
authors.forename: Noel
authors.initials: N
authors.lastname: McCarthy
authors.affiliation: Oxford Cancer Centre, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford, OX3 7LE, UK. dchurch@well.ox.ac.uk.|The Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN, UK. dchurch@well.ox.ac.uk.
authors.forename: David N
authors.initials: DN
authors.lastname: Church
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D054869:Clinical Audit; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000628:therapy; D011008:Pneumococcal Infections; D011446:Prospective Studies; D014611:Vaccination / Q000379:methods; D017410:Practice Guidelines as Topic
chemical_list: D007252:Influenza Vaccines
keywords: Cancer; Chemotherapy; Immunisation; Influenza; Streptococcus pneumoniae; Vaccination