Chemo and H1N1 Flu risks

Mimirod

I will probably be starting chemo in October or November, as my surgery is scheduled for mid-late September.  I am very worried about getting the flu during treatment.  I am also worried about sending my daughter to school and having her get sick while I am sick.  Anyone else concerned?  Have any of you spoken to your oncologists about this and possible precautions?  Can chemo be delayed for a time without risking recurrence?

Thanks,

Mimi

vhqh

Yes, most chemos can be delayed for a short time with no negative impact on your overall treatment.

twodogs

I started Chemo last month and have been having a hard time with my dose-dense reigiment.  I came down with the flu last week.  Not the H1N1, just your garden variety URI.  Let me tell you...NOT FUN!  The antibiotics that onc prescribed compounded my chemo nausea.  The battering of the flu compounded my Nuelasta pain.  The codeine in the cough syrup contraindicated my sleep meds.  What an Awful week.  I suppose we could wrap ourselves in a bubble to get thru the flu season? I am just making sure that anyone who comes to my house wash their hands immediately.  I have asked my friends with children not to bring them if they are showing any sign of sickness.  And, I have stressed the importance of good hygiene to my son.  It may be extreme, but I have him hop in the shower when he gets home from school.  Being a sweaty, 13-year-old boy, he usually does anyway!  I know that I do NOT want to have the flu again while going thru treatment!

bluedasher

I didn't get the flu during chemo, but I did get a cold. It was just starting before my 5th TCH treatment. They didn't delay the TCH. Perhaps they would for flu because with the fever they can't tell for sure whether you have an infection. It was no fun, but the progress of the cold was no worse than a typical cold for me not during chemo. The cold made chemo somewhat worse partly because I found it difficult to get hydrated enough with a yucky throad and they had to give me IV fluids but the chemo didn't make the cold worse.

They can delay chemo and do if they need to, but I really wanted to stay on schedule and get it over with. 

The precautions I took against colds and flu during chemo were mainly washing my hands often. I went on business trips during the thrid week of 3 of my 6 chemo cycles which in one case meant a meeting with over 1000 attendees and all of the trips had plane flights. The one cold I got was one that my husband and daugher-in-law came down with at the same time and our granddaughter had been under the weather about a week before so we may have all gotten it from her. So I guess that frequent hand washing did its job but when you are around a toddler with a cold it is difficult not to get exposed.

LRM216

Saw my onc last Thursday for my last taxotere and mentioned the H1NI shot.  She said while she recommends the regular flu shot, which I will have this Friday, she is not taking the H1NI, nor is her husband, an anesthesiologist at Emory, nor will she be allowing her two young daughters to get it.  She does not feel enough human testing has been done with it.  So now, I'm not sure what I'm going to do either.  Gave me pause for thought.  I am going to have my grand-daughter (14) get the regular flu shot this week, but I may pass on the H121 as well.  Not sure.  Hate making these decisions!

Linda 

Mimirod

Hi Linda; I am skeptical about the H1N1 vaccine as well.  I am going to ask my oncologist tomorrow to see what she thinks.   At least it looks like you are done with chemo for now.  That is great!  Wish me luck my surgery is next week and then I will hear whether or not I will need chemo and when.

Mimi

LRM216

Mimi - you certainly have all my best wishes and then some.  Let us know how you are right after the surgery.  We are here and cheering you on.  You will do well.

Hugs,

Linda

Titan

Good topic!  I am 6 weeks PFC and smack in the middle of rads.  My onc. said I needed a flu shot and the H1N1 shot also.  Interesting to hear that some oncs. are skeptical concerning the H1N1 shot.  I think I will talk to my onc. again and discuss this with him.  There is nothing wrong bringing up our concerns. 

Mom_of_boys

My onc said yes on the flu shot and no on the H1N1 shot.  I was questioning her line of thinking but evidently other oncs feel the same.

AlaskaAngel

I have a concern as a health care worker and consumer.

I have not seen much discussion anywhere in the breast cancer consciousness about the potential risks in regard to reduced immunity in this community as it relates to the novel H1N1 flu. I realize we still don't know how much of a threat this flu will actually be.

Should early stage breast cancer patients (the majority of whom are at low risk for recurrence of breast cancer if they do only surgery and perhaps radiation and possibly hormonal treatment, but who will be considered to be one of the group with "an underlying medical problem" if they do immunosuppressive treatment), be counseled about the risk of dying from the novel H1N1 2009 pandemic flu if they are considering chemotherapy? Especially breast cancer patients who are borderline for doing chemotherapy, as well as those hormone receptor positive patients who would not have an underlying medical problem and would be at low risk for dying from the novel H1N1 2009 pandemic flu if they were to choose ovarian ablation and hormonal treatment instead of chemotherapy?

Given that those diagnosed with cancer now are the ones who undergo prolonged treatment that reduces immunity (i.e., an "underlying medical problem"), their risk for mortality by novel H1N1 could be high. Yet there is no significant public discussion about it in discussions with the medical providers responsible for this group of patients. The length of treatment/induced poor immunity indicates a need for planning farther in advance for these patients in regard to the novel H1N1 flu.

I realize that breast cancer affects primarily older adults. The majority of the confirmed novel 2009 H1N1 cases and the hospitalized cases have been very young, and it appears that those over 65 are least affected. However, it is not clear to me whether that age distinction holds true for mortality.

Here is a brief bit of info from the CDC on May 28:

"Next I want to go through a little bit of information about some clinical observations. And you've heard us talking about the hospitalizations and the idea that the majority of hospitalizations that we're seeing are occurring in people who have underlying health conditions, pregnancy or various underlying medical problems. This is what we see in hospitalizations with seasonal flu. And so we are seeing that hospitalizations are more often occurring among people with these underlying conditions. When we look at our deaths, we have information on 11 of the 12 deaths that have been reported to us so far. And it appears that 10 of those fatalities occurred in people who had an underlying condition that put them at greater risk for severe complications of influenza. Some conditions like asthma can make it harder for a person to fight off an influenza infection. And we're seeing that kind of pattern, that the more severe complications, hospitalizations or deaths, tend to be disproportionately in people with underlying conditions. Whereas the actual cases out there in the community are often in people with no underlying conditions at all. So we think these patterns suggest to us that it's important for people who have chronic health conditions, or people who are pregnant, to have special attention to warning signs to regarding when to seek care or receive medical treatment for a respiratory illness like influenza."

The logical question that arises is this: Since early stage breast cancer patients are not at high risk unless therapies are used that significantly lower their immunity, and since the vast majority of those patients are not likely to have breast cancer recurrence in the first place, shouldn't there be medical discussion happening now about the possible change in RISK vs BENEFIT to patients for any treatments that change their immunity status?

Please keep in mind that in 1918, such a large group of patients was not put at immunologic risk by the medical profession, and especially not put at risk for such a prolonged period leading into the fall season.

It seems to me that the summer 2009 ASCO meeting presented a geuine opportunity for the medical professionals who are most responsible for therapies that affect immunity to demonstrate their awareness and commitment to their patients through a well-thought-out, proactive presentation or discussion about this issue. I didn't see anything presented at that conference of people who prescribe treatment for breast cancer patients in regard to my question. How is this group of patients being monitored, and how long would it take for any trend to be recognized?"

In a different presentation by the CDC, this statement was made:

..."The vast majority of the fatalities that we hear of or that are officially reported to us do occur in people with underlying conditions. It's not 100%. It's more on the on order of three-fourths of them at this point." ....

I also found this rough estimate of the number of persons in the population at any time who are immunocompromised (AIDS, chemo, etc.):

"Immunocompromised status, either through cancer chemotherapy or other compromising conditions is about 13%."

Because I am not seeing any professional discussion about the risk of chemotherapy-caused immunosuppression in regard to the novel 2009 H1N1, it appears to me that oncology is proceeding as if the novel 2009 H1N1 flu and immunosuppression from chemotherapy are mutually exclusive conditions.

Again my question is this: 

Should early stage breast cancer patients (the majority of whom are at low risk for recurrence of breast cancer with only surgery and perhaps radiation and possibly hormonal treatment, but who will be considered to be one of the group with "an underlying medical problem" if they do immunosuppressive treatment), be adequately counseled about the risk of dying from the novel H1N1 2009 pandemic flu if they are considering chemotherapy? Especially breast cancer patients who are borderline for doing chemotherapy, as well as those hormone receptor positive patients who would not have an underlying medical problem and would be at low risk for dying from the novel H1N1 2009 pandemic flu if they were to choose ovarian ablation and hormonal treatment?

How many are actually receiving this counseling as part of their risk assessment?

AlaskaAngel

swimangel72

Excellent excellent question AlaskaAngel! I'm so glad you brought it up! I finished my chemo 6 months ago, but still feel like my immune system isn't back to "normal" (even though all my blood tests appear normal.) I'm still coughing from a cold I got over 3 weeks ago.......I'm getting better but much more slowly. Yet I'm afraid to get the swine flu vaccine..........since some people are saying it contains a live virus! I've never had a problem with flu vaccine's in the past........but this is all so new and scary, especially for newly dx'd bc patients who are on-the-fence about chemo!

AlaskaAngel

Hi Swimangel72. I think people are afraid to ask the question because they don't want to scare other patients but the question is really important. It reminds me of when the herceptin trials ended and there was all kinds of publicity saying that "all" HER2 patients now had a miracle drug available to them, and yet at the same time, there was zero information available to those of us who had completed standard treatment, and then long after that, information dribbled out saying that the best guess was that only those who were no more than 6 months out from treatment were recommended to get the herceptin. The lack of timely information was horrible for us.

Anyway -- I know you already have seen the following information that hutchbk posted elsewhere, but I think it should also be posted here, so I will post it below for those who haven't seen it.

I got a response on another breast cancer forum regarding vaccination. Even though it doesn't answer the larger question of why those with breast cancer are not receiving counseling about RISKs in terms of whether early stage breast cancer patients are at greater risk of dying from the flu (from doing immunosuppressive therapy) than they are from dying from cancer.... it still provides some info about cancer patients and immunization (once the vaccination is available). Here it is:

"Chemotherapy can produce acute and profound immunosuppression in cancer patients and studies suggest that 21%-33% of cancer patients may be infected with influenza when admitted to a hospital with respiratory symptoms during a flu epidemic. Again, timing of flu vaccination may be crucial in cancer patients. The response to flu vaccination might be best between chemotherapy cycles or more than 7 days before chemotherapy starts.

"Patients receiving chemotherapy for cancer appear to be at heightened risk for influenza-related complications," Dr. Kunisaki said. "They also appear less likely to respond to influenza vaccine, but nevertheless, a fair proportion still responds. No formal guidelines exist for influenza vaccination of patients receiving chemotherapy, but the data suggest timing vaccination to either more than two weeks before receiving chemotherapy or between chemotherapy cycles."

(This info actually is part of an article about transplant patients.... apparently at least one of the doctors responsible for their care is actively being informative in their behalf....! )

http://www.renalandurologynews.com/Flu-Vaccine-Advised-for-Transplant-Patients/article/149345/

AlaskaAngel

A response by U of Penn's Oncolink:

http://www.oncolink.org/blogs/index.php/feed/

kimbly

I am curious as to whether or not having had cancer but being NED now is an underlying medical condition?  My chemo was complete in March of 2008 and herceptin complete in Jan 2009. I know that last year for sure i was considered high risk but what about now??  I have an onc appt in early November and i was planning on asking but now I am seeing case of Swine popping up at my kids schools.  Is it safe to get the nasal spray if you are this far out of chemo or no.. do we as survivors qualify for the shot right now??? AND I also question the vaccine too just overall.. aaaah too many questions. I have an eighteen and fifteen old son, and daughter.. what to do about them?