The National Comprehensive Cancer Network (NCCN) recommends that the COVID-19 vaccine should be given to cancer patients and survivors. Cancer patients and survivors should be included in priority group one and immunized as soon as the vaccine is available, with a few exceptions.
The authorities have jointly agreed that patients on active cancer treatment are at a higher risk of COVID-19 infection and complications. Hence, there is a necessity to prioritize patients with cancer for the COVID-19 vaccine. Patients with cancer require a highly efficacious vaccine to protect their lives. The Pfizer-BioNTech vaccine and Moderna vaccine are around 90% to 95% effective in patients with normal immunity, although we have no idea how effective they will be in those with cancer and cancer survivors.
Some of the guidance for the COVID-19 vaccine for patients with cancer includes:
- Patients with active cancer on treatment, those planning to start the treatment, and cancer survivors should be given the vaccine on priority when it is available.
- Although there are limited data on the safety and efficacy of the COVID-19 vaccine, patients with cancer should be given priority, especially because both vaccines are not live vaccines (don’t contain the weakened form of the coronavirus).
- Vaccination should be delayed in patients with cancer for the following reasons:
- Recent exposure to the COVID-19 virus
- Very high anti-COVID antibody titers
- Hematopoietic stem cell transplantation
- Engineered cellular therapy
- Simultaneous pregnancy
- Age younger than 16 years
- Additionally, caregivers of patients with cancer should be immunized early.
- While giving vaccination to patients with cancer, additional risk factors associated with the patients should also be taken into account, which includes:
- Social and demographic factors
The below table presents the COVID-19 vaccine recommendations for patients with cancer.
|Hematopoietic cell transplantation (HCT)/Cellular therapy|
|At least 3 months post-HCT/cellular therapy|
|Receiving intensive cytotoxic chemotherapy (cytarabine/anthracycline-based induction regimens for acute myeloid leukemia [AML])||Delay until absolute neutrophil count (ANC) increases to normal|
|Marrow failure from disease and/or therapy expected to have limited or no recovery||When the vaccine is available|
|Long-term maintenance therapy (targeted agents for chronic lymphocytic leukemia or myeloproliferative neoplasms [MPN])||When the vaccine is available|
|Solid tumor malignancies|
|Receiving cytotoxic chemotherapy||When the vaccine is available|
|Targeted therapy||When the vaccine is available|
|Checkpoint inhibitors and other immunotherapy||When the vaccine is available|
|Radiation||When the vaccine is available|
|Major surgery||Separate date of surgery from immunization by at least a few days|
|Caregivers and household/Close contacts (≥16 years of age)||When the vaccine is available/whenever they are eligible.|
If there is a limited supply of vaccines, prioritizing among patients with cancer is necessary. The following criteria can be considered while selecting patients with cancer:
- Prioritize patients who are on active cancer treatment, those planning to start treatment, and those immediately post-treatment (<6 months)
- Additional risk factors that need consideration include:
- Patients with advanced age (≥65 years of age)
- Patients with comorbidities (chronic pulmonary, cardiovascular, or renal disease)
- Social and demographic factors, which include:
- Limited access to healthcare
- Underrepresented minorities
Which COVID-19 vaccines are available?
As of now, two COVID-19 vaccines are available in the United States:
- The Pfizer-BioNTech vaccine is authorized for people who are 16 years of age or older. It is given in two doses 3 weeks apart.
- The Moderna vaccine is authorized for people who are 18 years of age or older. It is given in two doses 4 weeks apart.
Both the vaccines comprise messenger RNA (mRNA), which is a COVID-19 virus genetic material. The mRNA prompts the body cells to make copies of the virus’s spike protein. When the replicas of spike proteins are made, it triggers the immune system to learn to act against the virus if the body is exposed in the future.
Should cancer patients and survivors get the vaccine?
The answer is yes. Except for people with certain risk factors mentioned in the table above, COVID-19 vaccines should be prioritized in patients with cancer and cancer survivors. Current COVID-19 vaccines available in the United States do not contain live viruses; hence, they can be given to patients with cancer and cancer survivors.
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