Cancer Patients Are at Increased Risk of Complications From the Flu and Should Receive Flu Shots, but Not the Nasal Spray

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Mollie deShazo, MD

"If cancer patients get some immune protection from the flu shot, it could shorten the caurse of their illness if they do get the flu, and it may keep them out of the hospital."

— Mollie deShazo, MD

Widespread influenza activity continues to be reported by the Centers for Disease Control and Prevention (CDC), with a recent increase in flu-related hospitalizations.1,2 Patients with cancer are at increased risk from flu complications and should receive the flu shot, but not the flu nasal spray vaccine, which contains live flu viruses.

“We do not know if cancer patients are at greater risk for infection with the flu,” the CDC acknowledged. “However, we do know that cancer patients and survivors are at higher risk for complications from flu, including hospitalization and death.”3

 Cancer patients who are actively being treated for cancer can safely receive flu shots, Mollie deShazo, MD, told The ASCO Post. “It is not going to be dangerous for them. The question is how effective it will be.” Dr. deShazo is Associate Professor of Medicine in the Division of Hematology and Oncology and Medical Director of Inpatient Oncology at the University of Alabama at Birmingham.

Reduce Hospitalizations

“The debate is over how effective the flu shot is really going to be in patients who are undergoing active chemotherapy,” Dr. deShazo said. “The way the flu shot works is basically to train the immune system to react to the flu if it does get exposed to it. With cancer patients, you don’t know how effectively their immune system is going to react to the flu shot,” she explained.

“But my belief is that a little effect is better than none, and if cancer patients get some immune protection from the flu shot, it could shorten the course of their illness if they do get the flu, and it may keep them out of the hospital. People can debate endlessly about how effective the shot is, and there is just no proof either way. Most people believe there is probably some activity and some effect, so that is why we recommend it.”

Dr. deShazo added that flu shots are not usually administered to inpatients. “That goes back to the immune system question. If patients are in the hospital and have been acutely ill, that would decrease their chances of mounting the appropriate immune system response,” she said, although the shot “wouldn’t make them worse.”

In the past, she has advised patients to follow up a week or so after they are discharged from the hospital to see about getting the flu shot later. “But we are getting so late in the season, and the flu rates have risen so much lately. So we really are encouraging people to get it now and not wait much longer because of the risk of being exposed without having the flu shot on board.”

It’s Not Too Late

Although it is late in the season, it is not too late to get a flu shot. “Flu activity most commonly peaks in the United States in January or February. However, seasonal flu activity can begin as early as October and continue to occur as late as May,” according to a CDC information sheet on the current flu season.4

In a recent update, the CDC noted, “Thirty-five states are now experiencing widespread activity, and 20 states are reporting high levels of influenza-like illness. H1N1 viruses continue to predominate across the country. Anyone aged 6 months and older who has not gotten a flu vaccine yet this season should get one now. All flu vaccines are designed to protect against H1N1 viruses.”1

The flu season “was kind of a late starter this year, but the rates have definitely increased much more rapidly in the last couple of weeks,” Dr. deShazo said. “A lot of the severe flu cases that are ending up in the hospital are the H1N1. The flu this year is having severe complications for younger people—those in their late 20s and 30s—which is more unusual, and they think that is due to H1N1.”

She added that she is glad that the issue of flu shots “is staying in the news, because it is very important.”

Additional Precautions

Dr. deShazo listed a number of other precautionary steps that patients with cancer can take to decrease their chances of getting the flu. “Staying away from sick people” topped the list. “My rule of thumb is that patients should stay at least 6 feet from someone who is coughing. They don’t have to put themselves in a bubble, but they do have to be reasonable,” she said.

“Small children are just walking bacteria,” she added. “If you are actively undergoing treatment, be very cautious around small children, especially those who are in group settings like day care or school, where they are exposed to germs all the time.”

Other common-sense approaches include washing your hands often and having all family members and other caregivers receive flu shots. Caregivers getting flu shots should “absolutely” include hospital staff, Dr. deShazo said. ■

Disclosure: Dr. deShazo reported no potential conflicts of interest.


1. Centers for Disease Control and Prevention: Situation Update: Summary of Weekly FluView, updated January 10, 2014. Available at Accessed January 15, 2014.

2. Centers for Disease Control and Prevention: U.S. Flu Season Is Here, CDC Urges Vaccination, updated January 3, 2014. Available at Accessed January 15, 2014.

3. Centers for Disease Control and Prevention: Cancer, the Flu, and You, updated December 20, 2013. Available at Accessed January 15, 2014.

4. Centers for Disease Control and Prevention: What You Should Know for the 2013-2014 Influenza Season. Updated January 8, 2014. Available at Accessed January 15, 2014.

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