comscoreChemotherapy, Belly Fat, and Fitness Affect Vaccine Response in Breast Cancer Survivors

Chemotherapy, Belly Fat, and Fitness Affect Vaccine Response in Breast Cancer Survivors

Previous chemotherapy treatment, more belly fat, and being less physically fit led to a lower immune response to a typhoid vaccine in women who’d been treated for breast cancer.
May 18, 2022.

Previous chemotherapy treatment, more belly fat, and being less physically fit led to a lower immune response to a typhoid vaccine in women who’d been treated for breast cancer, according to a small study.

The research was published in the July 2022 issue of the journal Brain, Behavior, and Immunity. Read the abstract of “Breast cancer survivors’ typhoid vaccine responses: Chemotherapy, obesity, and fitness make a difference.”


Immune response, vaccines, and breast cancer treatment

Your immune system is the network of organs, tissues, and cells that protect your body from germs such as bacteria, viruses, and fungi. When these foreign substances find their way into the body — whether through a break in the skin, for example, or through your mouth or nose — your immune system’s response is the self-defense mechanism that works to keep you from getting sick.

Vaccines work by imitating an infection, usually without causing illness, though you may have minor symptoms such as a low-grade fever or body aches. Vaccines (and infections) make your immune system produce special white blood cells that help fight the illness, including macrophages, B-lymphocytes, and T-lymphocytes.

Infected and damaged cells release special chemicals that cause blood vessels to leak fluid into the tissues, causing swelling. This is called an inflammatory response. The swelling helps isolate the foreign substance from further contact with body tissues.

The chemicals also attract the immune system white blood cells.

As we age, our immune system declines and may not respond as robustly to foreign substances or to vaccines. Research shows that certain breast cancer treatments — including chemotherapy and radiation — may suppress the immune system, further reducing its ability to respond.

The researchers looked at previous studies suggesting that certain factors also may affect immune system response, including:

  • being less fit

  • having received treatment for cancer

  • having a large amount of belly fat

  • being depressed

In this study, the researchers wanted to see how these factors affected immune response to a typhoid vaccine in women who had received treatment for breast cancer.


About the study

This Ohio State University study included 158 post-menopausal women ages 36 to 78 who had been diagnosed with stage I to stage IIIA breast cancer. More than 92% of the women were white and about 6% were Black. The women had completed main breast cancer treatment one to nine years earlier, but some women were still taking hormonal therapy.


  • 108 women had received chemotherapy

  • 94 women had received radiation therapy

  • 128 women were currently taking hormonal therapy

The researchers measured the factors that could affect immune system response in each woman by:

  • taking a baseline blood sample

  • having the women ride a stationary bike and then measuring their fitness as peak oxygen consumption

  • measuring belly fat with a DEXA scan

  • assessing fatigue and depressive symptoms with standard survey tools

After these tests, the researchers randomly split the women into two groups:

  • the first group received a typhoid vaccine during the first day at the clinic and a placebo during the second day at the clinic

  • the second group received a placebo during the first day at the clinic and a typhoid vaccine during the second day at the clinic

The placebo was a saline injection that looked just like the typhoid vaccine and took the same amount of time to receive.

After the women received either the typhoid vaccine or the placebo, the researchers took blood samples from them every 90 minutes for 7.5 hours. In each sample, the researchers measured levels of inflammatory proteins and white blood cells. These levels were a measure of the women’s innate immune response: the body’s first immune reaction when an unrecognized substance enters the body.

Compared with the baseline blood samples, all the women’s bloodwork showed some immune response to the vaccine and a much lower response to the placebo.

After accounting for baseline differences in inflammation, the researchers found that three factors were linked to a lower immune response after the typhoid vaccine:

  • previous chemotherapy treatment

  • more belly fat

  • being less fit

The researchers also analyzed the relative size of the effect each factor had and found that previous chemotherapy treatment had the largest effect on immune response.

The baseline fitness levels of the women in the study were low. Still, it’s important to know that women who were even slightly more physically fit had a better immune response to the vaccine than women who weren’t very physically fit.

“As a group, breast cancer survivors, on average, have a lower level of fitness than their peers,” lead author Janice Kiecolt-Glaser, PhD, director of the Institute for Behavioral Medicine Research, professor of psychiatry, and member of the Comprehensive Cancer Center at Ohio State University, said in a statement. “In this study, women representing the average were in a low fitness category. Even within this group, moderate differences in fitness were associated with a better vaccine response.

“It’s important to tell breast cancer survivors, and others, that this doesn’t mean you have to be at an Arnold Schwarzenegger level of fitness to benefit innate immunity,” Dr. Kiecolt-Glaser continued. “Relatively mild fitness can make a difference in response to a vaccine, and probably in response to an infection in real life.”


What this means for you

This study, although small and not diverse, offers some interesting insights:

  • Chemotherapy treatment — even nine years earlier — reduced immune system response to the vaccine. As the COVID-19 pandemic continues, it’s important to know that your body may not respond as well to a vaccine if you’ve received chemotherapy, even if the treatment was many years ago.

  • Being active and fit can help you be as healthy as you can be. Even though most of the women in this study were considered to be out of shape, being just slightly physically fit improved their immune system response.

  • Being active also can help reduce belly fat, another factor that can hamper how your immune system responds to threats.

If you’ve been treated for early-stage breast cancer, it makes sense to do all you can to keep your overall health the best it can be, including:

  • eating a diet low in added sugar and processed foods and rich in unprocessed, nutrient-dense foods

  • exercising regularly at the highest intensity level you’re comfortable with

  • maintaining a healthy weight

  • avoiding or limiting alcohol

  • not smoking

Learn more about Exercise.

Written by: Jamie DePolo, senior editor

— Last updated on June 16, 2022, 9:28 PM

Reviewed by 1 medical adviser
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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