Many women with breast cancer, limited pharmacy access forgo flu shot
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Data show that the driving distance from a pharmacy could explain why many women with breast cancer forgo influenza vaccinations.
“Although pharmacies’ long hours and many locations suggest their potential to improve influenza vaccine uptake, there has been limited direct study of their potential to close vaccination gaps, particularly among higher-risk populations,” Joan Neuner, MD, MPH, a professor of internal medicine at the Medical College of Wisconsin, and colleagues wrote.
“Emerging evidence also suggests that some metropolitan areas have pharmacy deserts in low-income and nonwhite areas, raising concerns about whether pharmacies can influence access-related gaps in immunization for the diverse populations that make up the U.S.,” they added.
The researchers analyzed influenza vaccine uptake among 45,722 women aged 66 years and older with stage 0 to III breast cancer who were listed in the Surveillance, End Results and Epidemiology-Medicare cancer registry from 2011 to 2015 and lived in the lower 48 United States. The researchers also utilized Standard Industrial Classification codes to identify retail pharmacies and used geocoding software to develop a national census-tract measure of the women’s pharmacy access defined by CMS’ recommended driving distances (urban areas = 2 miles; suburban areas = 5 miles; rural areas = 15 miles).
“Our measure can be roughly interpreted as an equivalent to pharmacies per 10,000 residents, and our interquartile ranges suggest that in a population-based sample of cancer patients, the accessibility of subjects at the 75th percentile of accessibility is three times those at the 25%,” Neuner and colleagues wrote in the Journal of the American Pharmacists Association. “Our adaptation accounts for the longer travel distances undertaken by rural residents for health care services.”
The researchers reported that more than 11% of the entire cohort lived in census tracts where there was no retail pharmacy within the recommended driving distances from their population-weighted tract center.
Among the 11%, influenza vaccination in the year post-breast cancer diagnosis was less likely in these very low-access tracts (adjusted OR for all women = 0.92; 95% CI, 0.86-0.96; aOR for Black women = 0.55; 95% CI, 0.51-0.6; aOR for Hispanic women = 0.76; 95% CI, 0.7-0.83; and aOR for Medicaid recipients = 0.74; 95% CI, 0.69-0.79).
In addition, women with higher-stage breast cancer who received their diagnosis in the autumn months were less likely to be administered an influenza vaccine. Conversely, women who had previously received an influenza vaccine were much more likely to receive it again, according to the researchers. Results were similar in a smaller cohort of 41,325 women who were followed for 2 years after their breast cancer diagnosis.
“Vaccination was inversely associated with per capita income in the subject’s census tract, but there was no difference in the pharmacy effect by race, ethnicity or census tract income,” Neuner and colleagues wrote.
With previously published data indicating “early-stage breast cancer survivors are equally likely to die of noncancer causes as cancer,” Neuner and colleagues made several recommendations to close the influenza vaccination gap among these patients.
These included reminding patients who need an influenza vaccine that community pharmacies offer this service, creating and utilizing “standardized oncology nursing orders” and referring the patient to a primary care provider.
Perspective
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There are two simple, tangible things a primary care physician can do to help influenza vaccine uptake. This study highlights that these interventions may be most important for those who live in remote places without easy access to simple health care resources, but there are things that can help increase vaccine uptake for all populations.
The first thing is to simply mention the importance of receiving the vaccine at any otherwise unrelated visit occurring during the flu season. PCPs are in a unique position to speak to their patient’s entire clinical state and therefore can tailor a recommendation for vaccination to each patient, helping to make it clear that vaccination is not just a blanket recommendation but is something that will help that specific patient for a specific reason.
The second helpful thing a PCP can do is to have a supply of the vaccines in the office so that the patient does not need to make a separate trip to a secondary location to receive vaccination. The fewer barriers placed between a patient and her immunization, the more likely she is to become vaccinated.
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