Online first
Review paper
Published online: 2024-06-19

open access

Page views 144
Article views/downloads 76
Get Citation

Connect on Social Media

Connect on Social Media

Infectious diseases prophylaxis and treatment in cancer patients, with particular emphasis on COVID-19. Interdisciplinary Polish experts' position statement

Piotr Rutkowski1, Bożena Cybulska-Stopa23, Jacek Jassem4, Adam Płużański1, Krzysztof Tomasiewicz5, Lucjan Wyrwicz1, Piotr Wysocki6, Jacek Wysocki7, Robert Flisiak8


Infectious diseases constitute a significant burden in cancer patients, which has become particularly evident during the COVID-19 pandemic. Due to cancer itself and its treatment, the course of infectious diseases in oncology patients is often unpredictable and may negatively affect   . Preventing infectious diseases through a wide range of vaccinations may help maintain the continuity of treatment and constitute an element of holistic patient care. Testing patients with symptoms or suspected infection allows proper treatment and may avoid unfavorable consequences. More education on preventing and treating infectious diseases is necessary to improve the standard of cancer care.

Article available in PDF format

View PDF Download PDF file


  1. Henley SJ, Dowling NF, Ahmad FB, et al. COVID-19 and Other Underlying Causes of Cancer Deaths - United States, January 2018-July 2022. MMWR Morb Mortal Wkly Rep. 2022; 71(50): 1583–1588.
  2. Echavarria I, Carrión Galindo JR, Corral J, et al. SEOM clinical guidelines for the prophylaxis of infectious diseases in cancer patients (2021). Clin Transl Oncol. 2022; 24(4): 724–732.
  3. Fattore GL, Olivos NS, Olalla JE, et al. Mortality in patients with cancer and SARS-CoV-2 infection: Results from the Argentinean Network of Hospital-Based Cancer Registries. Cancer Epidemiol. 2022; 79: 102200.
  4. Burgos J, Luján M, Larrosa MN, et al. The problem of early mortality in pneumococcal pneumonia: a study of risk factors. Eur Respir J. 2015; 46(2): 561–564.
  5. Zembower TR. Epidemiology of infections in cancer patients. Cancer Treat Res. 2014; 161: 43–89.
  6. Chavez-MacGregor M, Lei X, Zhao H, et al. Evaluation of COVID-19 Mortality and Adverse Outcomes in US Patients With or Without Cancer. JAMA Oncol. 2022; 8(1): 69–78.
  7. Anantharaman A, Dusendang JR, Schmittdiel JA, et al. SARS-CoV-2 Clinical Outcomes in Patients with Cancer in a Large Integrated Health Care System in Northern California. Oncologist. 2021; 26(3): e500–e504.
  8. Giannakoulis VG, Papoutsi E, Siempos II. Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data. JCO Glob Oncol. 2020; 6: 799–808.
  9. Li J, Zhang D, Sun Z, et al. Influenza in hospitalised patients with malignancy: a propensity score matching analysis. ESMO Open. 2020; 5(5): e000968.
  10. Klein EY, Monteforte B, Gupta A, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2016; 10(5): 394–403.
  11. Gaudin J, Thayalakulasingam T. Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect. Cureus. 2023; 15(9): e44869.
  12. Sagar AES, Evans SE. Pneumonia in the Cancer Patient. In: Nates J, Price KE. ed. Oncologic Critical Care. Springer, Cham 2020.
  13. Papakonstantinou E, Dragoumani K, Efthimiadou A, et al. Haematological malignancies implications during the times of the COVID-19 pandemic. Oncol Lett. 2021; 22(6): 856.
  14. Langerbeins P, Hallek M. COVID-19 in patients with hematologic malignancy. Blood. 2022; 140(3): 236–252.
  15. Rolston KVI. Infections in Cancer Patients with Solid Tumors: A Review. Infect Dis Ther. 2017; 6(1): 69–83.
  16. Kuderer NM, Choueiri TK, Shah DP, et al. COVID-19 and Cancer Consortium. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020; 395(10241): 1907–1918.
  17. Sharafeldin N, Bates B, Song Q, et al. Outcomes of COVID-19 in Patients With Cancer: Report From the National COVID Cohort Collaborative (N3C). J Clin Oncol. 2021; 39(20): 2232–2246.
  18. Wang Lu, Sun Y, Yuan Ye, et al. Clinical challenges in cancer patients with COVID-19: Aging, immunosuppression, and comorbidities. Aging (Albany NY). 2020; 12(23): 24462–24474.
  19. Russell B, Moss CL, Shah V, et al. Guy’s Cancer Real World Evidence. Risk of COVID-19 death in cancer patients: an analysis from Guy's Cancer Centre and King's College Hospital in London. Br J Cancer. 2021; 125(7): 939–947.
  20. Venkatesulu B, Chandrasekar V, Girdhar P, et al. A Systematic Review and Meta-Analysis of Cancer Patients Affected by a Novel Coronavirus. JNCI Cancer Spectr. 2021; 5(2).
  21. Czyżykowski R, Płużański A. Supportive care. Prophylaxis and treatment of infections. Oncol Clin Pract. 2020; 16: 143–149.
  22. Rapoport BL. Management of the cancer patient with infection and neutropenia. Semin Oncol. 2011; 38(3): 424–430.
  23. Flisiak R, Zarębska-Michaluk D, Dobrowolska K, et al. Change in the Clinical Picture of Hospitalized Patients with COVID-19 between the Early and Late Period of Dominance of the Omicron SARS-CoV-2 Variant. J Clin Med. 2023; 12(17).
  24. Potter AL, Vaddaraju V, Venkateswaran S, et al. Deaths Due to COVID-19 in Patients With Cancer During Different Waves of the Pandemic in the US. JAMA Oncol. 2023; 9(10): 1417–1422.
  25. Cortellini A, Tabernero J, Mukherjee U, et al. OnCovid study group. SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry. Lancet Oncol. 2023; 24(4): 335–346.
  26. Dagher H, Chaftari AM, Subbiah IM, et al. Long COVID in cancer patients: preponderance of symptoms in majority of patients over long time period. Elife. 2023; 12.
  27. Fankuchen O, Lau J, Rajan M, et al. Long COVID in Cancer: A Matched Cohort Study of 1-year Mortality and Long COVID Prevalence Among Patients With Cancer Who Survived an Initial Severe SARS-CoV-2 Infection. Am J Clin Oncol. 2023; 46(7): 300–305.
  28. Davis HE, McCorkell L, Vogel JM, et al. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023; 21(3): 133–146.
  29. Cortellini A, Salazar R, Gennari A, et al. On Covid study group. Persistence of long-term COVID-19 sequelae in patients with cancer: An analysis from the OnCovid registry. Eur J Cancer. 2022; 170: 10–16.
  30. Shoham S, Batista C, Ben Amor Y, et al. Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force. Vaccines and therapeutics for immunocompromised patients with COVID-19. EClinicalMedicine. 2023; 59: 101965.
  31. Abbasi J. Researchers Tie Severe Immunosuppression to Chronic COVID-19 and Virus Variants. JAMA. 2021; 325(20): 2033–2035.
  32. Rahmani A, Dini G, Leso V, et al. Duration of SARS-CoV-2 shedding and infectivity in the working age population: a systematic review and meta-analysis. Med Lav. 2022; 113(2): e2022014.
  33. Pérez-Lago L, Aldámiz-Echevarría T, García-Martínez R, et al. Different Within-Host Viral Evolution Dynamics in Severely Immunosuppressed Cases with Persistent SARS-CoV-2. Biomedicines. 2021; 9(7).
  34. Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020; 21(8): 1023–1034.
  35. Recommendations of the National Comprehensive Cancer Network (NCCN) COVID-19 Vaccination Advisory Committee. Version 8.0 03/06/2023 Internet: National Comprehensive Cancer Network; 2023. (16.02.2024).
  36. Reimann H, Kremer AN, Blumenberg V, et al. Cellular and humoral immune responses to SARS-CoV-2 vaccination in patients after CD19.CAR T-cell therapy. Blood Adv. 2023; 7(10): 2066–2069.
  37. Mahalingam S, Peter J, Xu Z, et al. Landscape of humoral immune responses against SARS-CoV-2 in patients with COVID-19 disease and the value of antibody testing. Heliyon. 2021; 7(4): e06836.
  38. Kamboj M, Bohlke K, Baptiste DM, et al. Vaccination of Adults With Cancer: ASCO Guideline. J Clin Oncol. 2024; 42(14): 1699–1721.
  39. Hus I, Piekarska A, Roliński J, et al. Szczepienia ochronne u dorosłych chorych na nowotwory hematologiczne oraz u chorych z asplenią – zalecenia PTHiT i sekcji do spraw zakażeń PALG. Acta Haematologica Polonica. 2018; 49(3): 93–101.
  40. Furer V, Rondaan C, Heijstek M, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020; 79(1): 39–52.
  41. Antczak A, Nitsch-Osuch A, Balcerzak M, et al. Coalition Shaping the Vaccination Landscape. Vaccines (Basel). 2022; 10(12).
  42. ASCO COVID-19 Registry Data Dashboard Internet: ASCO; 2023.
  43. The ASCO Post Staff. COVID-19 Vaccination Rates May Be Lower in Patients With Cancer Who Have Comorbidities, Certain Types of Cancer, and Specific Sociodemographic Factors Internet: ASCO; 2023.
  44. KUCHAR E, ANTCZAK A, SKOCZYŃSKA A, et al. Pneumococcal vaccination among adults – updated Polish recommendations. Family Medicine & Primary Care Review. 2022; 24(3): 285–291.
  45. Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol. 2018; 36(30): 3043–3054.
  46. Prevention and treatment of cancer-related infections (version 2.2023) Internet: National Comprehensive Cancer Network; 2023. (12.02.2024).
  47. Prabani KIP, Weerasekara I, Damayanthi HD. COVID-19 vaccine acceptance and hesitancy among patients with cancer: a systematic review and meta-analysis. Public Health. 2022; 212: 66–75.
  48. Yong CW, Robinson A, Hong C. Dental Evaluation Prior to Cancer Therapy. Front Oral Health. 2022; 3: 876941.
  49. Visweshwar N, Rico JF, Ayala I, et al. Insights into the Impact of Hesitancy on Cancer Care and COVID-19. Cancers (Basel). 2023; 15(12).
  50. Rubin LG, Levin MJ, Ljungman P, et al. Infectious Diseases Society of America, Infectious Diseases Society of America. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014; 58(3): e44–100.
  51. Bersanelli M, Verzoni E, Cortellini A, et al. FICOG group (Federation of Italian Cooperative Oncology Groups). Impact of influenza vaccination on survival of patients with advanced cancer receiving immune checkpoint inhibitors (INVIDIa-2): final results of the multicentre, prospective, observational study. EClinicalMedicine. 2023; 61: 102044.
  52. Severe Viral Respiratory Illness Internet: Centers for Diseases Control and Prevention; 2024. (09.02.2024).
  53. Ściubisz. M. Ważne zmiany w refundacji szczepionek Internet: Medycyna Praktyczna; 2023.,wazne-zmiany-w-refundacji-szczepionek (16.02.2024).
  54. Nowy program szczepień w Warszawie Internet: Polska Agencja Prasowa; 2023.
  55. Opinia Prezesa Agencji Oceny Technologii Medycznych i Taryfikacji nr 166/2018 z dnia 17 sierpnia 2018 r. o projekcie programu polityki zdrowotnej pn. „Zapobieganie ciężkim zapaleniom płuc u chorych onkologicznych z najczęstszymi nowotworami litymi i hematologicznymi” realizowanego przez: województwo świętokrzyskie Internet: Agencja Oceny Technologii Medycznych i Taryfikacji; 2018. (13.02.2024).
  56. Program wieloletni pn. Narodowa Strategia Onkologiczna na lata 2020-2030. Ministarstwo Zdrowia, Warszawa 2020.
  57. Sobierajski T, Rzymski P, Małecka I, et al. Trust in Physicians in the Context of HPV Vaccination of Children from the Perspective of Social Exchange Theory: A Representative Study of Polish Parents. Vaccines (Basel). 2023; 11(10).
  58. GRYPA / RSV / COVID-19 – antygenowy test combo Internet: Zwrotnik Raka; 2023. (16.02.2023).
  59. Guidelines for the clinical management of severe illness from influenza virus infections Internet: World Health Organization; 2022. (27.03.2024).
  60. Therapeutics and COVID-19. Living Guideline. 10 November 2023. World Health Organization, Geneva 2023.
  61. Hayden MK, Hanson KE, Englund JA, et al. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Antigen Testing (January 2023). Clin Infect Dis. 2024; 78(7): e350–e384.
  62. Frediani J, Parsons R, McLendon K, et al. The New Normal: Delayed Peak SARS-CoV-2 Viral Loads Relative to Symptom Onset and Implications for COVID-19 Testing Programs. Clinical Infectious Diseases. 2023; 78(2): 301–307.
  63. Charakterystyka Produktu Leczniczego Paxlovid. Data ostatniej aktualizacji 11.01.2024. Internet: European Medicines Agency; 2022 (16.02.2024).
  64. Flisiak R, Horban A, Jaroszewicz J, et al. Management of SARS-CoV-2 infection: recommendations of the Polish Association of Epidemiologists and Infectiologists as of February 23, 2022. Pol Arch Intern Med. 2022; 132(3).
  65. Lagevrio (molnupiravir) Internet: European Medicines Agency; 2023. (16.02.2024).
  66. Wniosek o objęcie refundacją leku Paxlovid (nirmatrelvirum + ritonavirum) we wskazaniu: COVID-19 u pacjentów dorosłych, którzy nie wymagają tlenoterapii, i u których występuje zwiększone ryzyko progresji do ciężkiej postaci COVID-19. Agencja Oceny Technologii Medycznych i Taryfikacji, Warszawa 2023.
  67. Liverpool COVID-19 Interactions Internet: University of Liverpool; 2023. (16.02.2024).
  68. Havers FP, Pham H, Taylor CA, et al. COVID-19-Associated Hospitalizations Among Vaccinated and Unvaccinated Adults 18 Years or Older in 13 US States, January 2021 to April 2022. JAMA Intern Med. 2022; 182(10): 1071–1081.
  69. WHO roadmap on uses of COVID-19 vaccines in the context of Omicron and high population immunity Internet: World Health Organization; 2023. (27.03.2024).
  70. Wysocki J, Siewert B, Mastalerz-Migas A, et al. Vaccinations against COVID-19 in adults in the 2023/2024 season. Recommendations of the Polish Society of Vaccinology, the Polish Society of Family Medicine, the Polish Society of Epidemiology and Physicians of Infectious Diseases and the Polish Society of Gynecologists and Obstetricians. Lekarz POZ. 2024; 10: 23–34.
  71. Kalendarze szczepień dorosłych Internet: Polskie Towarzystwo Wakcynologii; 2024. (27.03.2024).
  72. Sender V, Hentrich K, Henriques-Normark B. Virus-Induced Changes of the Respiratory Tract Environment Promote Secondary Infections With . Front Cell Infect Microbiol. 2021; 11: 643326.
  73. Timing and Spacing of Immunobiologics Internet: Centers for Disease Control and Prevention; 2023. (27.03.2024).
  74. Considerations for Coadministering COVID, Flu and/or RSV Vaccines this Fall Internet: Infectious Diseases Society of America; 2023. (27.03.2024).
  75. Kiedy najlepiej zaszczepić się przeciw grypie? Internet: Narodowy Instytut Zdrowia Publicznego PZH - Państwowy Instytut Badawczy; 2023. (27.03.2024).
  76. COVID-19, influenza, and other respiratory viruses – 2023-2024 autumn and winter season Internet: World Health Organization; 2023. (27.03.2024).
  77. Hamid S, Winn A, Parikh R, et al. Seasonality of Respiratory Syncytial Virus - United States, 2017-2023. MMWR Morb Mortal Wkly Rep. 2023; 72(14): 355–361.
  78. Frequently Asked Questions About RSV Vaccine for Adults Internet: Centers for Disease Control and Prevention; 2024. (27.03.2024).
  79. Nitsch-Osuch A, Antczak A, Barczyk A, et al. Rekomendacje grupy ekspertów w zakresie szczepień przeciw wirusowi RS osób dorosłych. Lekarz POZ. 2023; 9: 301–308.
  80. Obwieszczenie Ministra Zdrowia z dnia 11 grudnia 2023 r. w sprawie wykazu refundowanych leków, środków spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobów medycznych na 1 stycznia 2024 r. . Dz. Urz. Min. Zdr. 2023.112: Ministerstwo Zdrowia; 2023.
  81. Charakterystyka Produktu Leczniczego Comirnaty. Data ostatniej aktualizacji 05.12.2023 Internet: European Medicines Agency; 2021. (16.02.2024).
  82. Charakterystyka Produktu Leczniczego Prevenar 13. Data ostatniej aktualizacji 01.10.2021. Internet: European Medicines Agency; 2010. (16.02.2024).
  83. Charakterystyka Produktu Leczniczego Apexxnar. Data ostatniej aktualizacji 09.10.2023. Internet: European Medicines Agency; 2022.
  84. Charakterystyka Produktu Leczniczego Nimenrix. Data ostatniej aktualizacji 17.05.2022. Internet: European Medicines Agency; 2012. (16.02.2024).
  85. Charakterystyka Produktu Leczniczego Neisvac C. Data ostatniej aktualizacji 17.06.2022. Internet: Pfizer; 2009. (16.02.2024).
  86. Charakterystyka Produktu Leczniczego Trumenba. Data ostatniej aktualizacji 19.10.2023. Internet: European Medicines Agency; 2017. (16.02.2024).
  87. Charakterystyka Produktu Leczniczego Abrysvo. Data ostatniej aktualizacji 23.08.2023. Internet: European Medicines Agency; 2023. (16.02.2024).