Cancer Patients Should be a High Priority for COVID-19 Vaccines

Now that vaccines are being distributed and administered, there is a rising discussion about the timeline for cancer patients. As we all know, each state has developed its own guidelines, and there are big differences among them. Massachusetts has a clear schedule of groups, beginning with healthcare workers who care for COVID-19 patients and eventually growing to include everyone. As a contrast, both Florida and Texas are offering vaccines to anyone 65 and over, and there does not seem to be a distinction about work or co-morbidities.

With the ever-repeated caveat that this is a conversation you should be having with your doctor, and remembering that each and every situation is unique, there are recommendations from at least some that cancer patients should be high on the priority list.

The American Association for Cancer Research (AACR) has issued a plea that cancer patients should be considered a high priority group. Here is what they said: “The available evidence supports the conclusion that patients with cancer, in particular with hematological malignancies, should be considered among the high-risk groups for priority COVID-19 vaccination.” The COVID-19 fatality rates for people with cancer are double than those for people without cancer. This higher rate continued to trend upward, even after adjustments for age, sex, and comorbidities. Other groups have noted that people with lung cancer and people with Stage IV cancers should be included in the highest risk group for becoming severely ill if infected with the virus.

Both the AACR group and others have noted that it is less clear whether people with a past history of cancer, who are no longer being actively treated, can be considered to be at normal risk with others like them or whether their cancer history carries a longer shadow. Since there are nearly 17 million cancer survivors in the United States, it is important to understand whether we are all more at risk to contract the virus and/or to become seriously ill if we do. My understanding of the current belief is that once you are six or so months past active treatment (and please note that there is not a firm time guide), most researchers believe that you are back in the normal risk pool.

I am hearing about this a lot from everyone with whom I speak. Certainly, my patients who are currently receiving chemotherapy or have only recently concluded treatment feel that they are living with compromised immune systems and are more at risk. Most of them are being very careful about their choices and doing all they can to avoid possible exposure. It is interesting, however, that people who are years post-cancer often feel equally anxious and vulnerable. Whether or not there is any sound science to support their concerns, they have learned that bad things can happen in life, that we are not always in control of our circumstances, and they often feel that their bodies have changed since cancer. While many to most people believe that they have regained their pre-cancer level of energy and health after several years have passed, some people never have that belief.

Like so many things about living with and through cancer, our self-image has changed. We may feel that we can’t depend on our bodies as we used to and that we are ever exposed to possible new troubles. We have sadly learned that good diets, regular exercise and enough sleep do not promise good health.

The AACR task force also commented that not much is known about the effects of the COVID-19 vaccines in cancer patients. In the Pfizer-BioNTech trial of 43,540 individuals, only 3.7% were reported to have cancer. Everyone agrees that more studies and more data are needed before there can be firm recommendations. Doctors also agree that we have a lot of experience with other vaccines, such as annual flu shots, and that there have been good safety records. There is the noted concern that the vaccine, like any vaccine, may be somewhat less effective in someone with a compromised immune system, but there is consensus that even a bit less immunity is a lot better than no immunity. As increasing numbers of COVID-19 vaccines are distributed and available around the country, and around the world, we hope that consideration will be given to the higher need of cancer patients to be inoculated.

On a personal level, the best advice is to be in touch with your doctors.

Find additional COVID-19 resources from Beth Israel Lahey Health.