Influenza and COVID-19 vaccination uptake among cancer survivors in the US.
Authors: Ted Akhiwu, Jincong Q. Freeman, May Gao, Nicolas Peruzzo, Shreyas Kalantri, Blake Kelley, Stanley Ifeanyi Ozogbo, Oluwatofunmi Olowoyo, Nosa Osazuwa-Peters
Journal: Journal of Clinical Oncology (2025)

11085 Background: Cancer survivors are at increased risk of comorbidity and mortality from respiratory viral infections including influenza (flu) and COVID-19 and therefore, vaccinations against these viruses are important for their health. Little is known about the receipt of these vaccines among cancer survivors in the post-COVID era. This study sought to evaluate the uptake of flu and COVID-19 vaccinations between cancer survivors and the general population in the US. Methods: We analyzed cross-sectional data from the 2023 National Health Interview Survey that used multistage probability sampling to interview US adults. Adults with a history of cancer were defined as cancer survivors, and those without a history of cancer were the general population. Flu vaccination receipt was defined as having had a flu shot in the past 12 months. COVID-19 vaccination receipt was defined as having received ≥2 doses of the COVID-19 vaccine. Weighted proportions were compared using Rao-Scott Chi-squared tests. Weighted logistic regression was conducted, adjusting for demographic and socioeconomic factors. Adjusted odds ratio (AOR) and 95% CIs were calculated. All analyses accounted for complex survey design and weights. Results: The total sample size was 29,522, representing a weighted sample of 258,237,552 adults in the US. The mean age was 48 years; 61.9% were White, followed by 17.5% Hispanic, 11.8% Black, and 8.8% Asian or Other; and 9.7% were cancer survivors. Overall, 73.7% (95% CI: 72.9-74.5%) received ≥2 doses of COVID-19 vaccinations, and 48.0% (95% CI: 47.1-48.8%) had a flu shot in the past 12 months. Compared to the general population, higher proportions of cancer survivors received COVID-19 vaccinations (84.8% [95% CI: 83.5-86.3%] vs 72.5% [95% CI: 71.6-73.4%], P &lt;0.001) and a flu shot (67.3% [95% CI: 65.5-69.1%] vs 45.8% [95% CI: 45.0-46.7%], P &lt;0.001). After covariate adjustment, cancer survivors had greater odds of having received COVID-19 vaccinations than the general population (AOR 1.38, 95% CI: 1.22-1.56). Cancer survivors also had greater odds of having had a flu shot than the general population (AOR 1.35, 95% CI: 1.23-1.49). Additionally, we found that male sex, lack of insurance or public insurance, and rural residence were associated with lower odds of having received either vaccine. Conclusions: In this US national adult sample, COVID-19 and flu vaccination uptakes were higher among cancer survivors than in the general population. Although this is encouraging, vaccination rates, particularly with the flu vaccine, remain below the 70% Healthy People 2030 goal. To achieve this goal, tailored interventions and policies are necessary to improve vaccine uptake and socioeconomic disparities across cancer survivors and the general population.Future research can explore how the receipt of the vaccines impact the quality of life and health outcomes of the growing population of cancer survivors.