V CAN intervention: Quality improvement initiative to increase and sustain vaccination rates among adult patients with cancer.
Authors: Lin Ji , Chan Kok Hoe , Farmer Ally , Chu Victoria , Mittal Nitish , Cabautan Ursula , Sharma Akanksha , Rowe Julie Haewon , Maithel Neha 
Published: October 2023

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Background: ASCO, NCCN, and CDC recommend vaccination of patients who are immunocompromised as a result of receiving cancer therapy. Nonetheless, the uptake for vaccination utilization among cancer patients is poor. We explored patient perceptions of vaccination to develop an implementable plan to improve vaccination uptake. Methods: Perception Questionnaire and (ii) interviews to explore patients’ vaccination experience. Based on the results of the situation analysis, we developed a theory-driven complex-based intervention called V CAN (Vaccination among adult CANcer patients) to increase vaccination uptake. Results: For the situation analysis, a total of 60 patients completed the assessments. Median age was 59 (range, 26-94) years, and were 28% men. Thirty-eight patients conducted the survey while on cancer treatment and 22 during survivorship. The most common vaccine that patients had received was the COVID vaccine (83%), with a median 2 doses. Only 52% of patients had received the influenza vaccine, and only 43% patients had received it yearly. Most patients agree that it is important to get up to date with vaccines (73%), but only 58% reported a willingness to take a vaccine if offered to them. There were 32% patients who mentioned that they were never told the importance of vaccination, and 41.6% patients reported a problem understanding their cancer diagnosis and care. Qualitative analysis found that at the initial diagnosis of cancer, most patients were not aware of the importance of vaccination. Patients were more psychologically affected by cancer diagnosis. Patients also expressed that they were not educated by the oncologist about the importance of vaccination. Most patients reported a willingness to get vaccinated and adhere to the vaccination schedule. From these results, our V CAN intervention was developed based on the theory of the planned behavior and health belief models. The theory of planned behavior is a well-defined psychological model that connects one's beliefs and behavior. The health belief model is a psychological health-behavior change model that is used to explain and predict health-related behavior, particularly the uptake of preventive healthcare. In this intervention, various measures will be taken, including educating healthcare providers on our results and their role in emphasizing the importance of vaccination to patients, evidence-based knowledge assessments, initiation of training, and education events (e.g., vaccination schedule display in clinic, training, and biannual lectures). Conclusions: Most cancer patients have a poor perception of vaccination. Health awareness about vaccination remained poor, with a lack of education and reinforcement from primary care providers and oncologists. Psychological support and education via the V CAN intervention is needed to increase vaccination rates among cancer patients.