A vaccine is a priority
Currently, the only plausible option to overcome the COVID-19 pandemic is vaccination. In the first phase, the campaign is prioritized for people at increased risk – frontline healthcare workers, people over 65 and people with pre-existing health problems (people with cancer, obesity heart or lung disease). Social media is teeming with communication between laypersons speculating on COVID-19 vaccination for cancer patients. When should cancer patients under active treatment be vaccinated? What if they are on immunotherapy? What if they have suffered from COVID-19 in the past? What if they have protective antibodies against COVID-19? Should they take extra precautions during or after vaccination? Should they be worried because long term results are not available? How long will vaccine immunity last? The bottom line is that the benefits of the vaccine far outweigh the known risks.
Nature of cancer treatment and COVID-19
Cancer patients are vulnerable to COVID-19, perhaps more than the general population. Also, if they do get an infection with COVID-19, its severity will likely be higher. This could be because cancer patients are immunocompromised – partly because of the underlying disease itself and partly because of their cancer treatments. International oncology organizations are encouraging all cancer patients to take the COVID-19 vaccine as soon as possible. Any non-living vaccine is safe for them. In the event that they are currently suffering or have recently recovered from a COVID-19 infection, the vaccination may be postponed for a few weeks. If the cancer patient is on immunotherapy, has a significant infection, or is neutropenic, the vaccine should be delayed until recovery. Cancer patients have not shown a higher incidence of side effects from the COVID-19 vaccine.
MRNA – An important component of some licensed vaccines
Currently, several vaccines have received emergency authorization. This includes those made using the mRNA technique, those prepared against S (spike protein), and those developed against dead virus. Of these, the mRNA technique is the most recent and therefore very controversial. This technique makes the vaccine fragile and therefore requires special handling – especially at very low temperatures. For example, the Pfizer vaccine should be stored at minus 70 degrees centigrade. Fortunately, all vaccines have a similar efficacy (protective effect of about 90%). In most countries, patients do not have the option of choosing between the available vaccines. It is recommended that people take whatever vaccine is available – making sure that the next vaccine is of the same type as well (most vaccines require two doses 15 to 28 days apart).
The right time for a vaccine
Cancer patients have an increased risk of severe COVID-19 and therefore should be vaccinated as soon as possible, regardless of age or other factors. During active cancer treatment, the strategy should be to vaccinate between cycles of treatment. In special circumstances, the treating oncologist will need to decide the right time for a cancer patient to be vaccinated.
Care and Precautions
It is important to share the history of pre-existing illnesses, past allergies, and current medications with the doctor before taking the COVID-19 vaccine. When in doubt, help from the vaccine hotline should be taken. It’s a good idea to take a paracetamol tablet right before the COVID-19 vaccination, 12 hours later, and twice a day the next day. This is not necessary, but it will help reduce or prevent common side effects like fever, body aches, and pain. Taking the vaccine does not magically protect the recipient from COVID-19 immediately. Therefore, it is necessary to continue to strictly follow the recommended precautions for use of face masks, to wash the hands frequently and to maintain physical distance for up to 30 days after the last dose of the vaccine.
Cancer patient subgroups and COVID-19 vaccination
It’s good to remember that cancer patients have been excluded from the COVID-19 vaccine trials. It is not unusual. In almost all clinical trials of new drugs, patients with serious illnesses are excluded. This also applies to pregnant women and children under 15. The majority of patients over 55/65 were also excluded. This does not mean that the COVID-19 vaccine should not be given to the elderly. Currently, the COVID-19 vaccine should not be given to people who are allergic to any component of the vaccine, to people with a history of anaphylaxis, and to pregnant women.
Although more than a lakh people have been vaccinated and studied in various clinical trials, we are still learning a lot about COVID-19 and the vaccines currently available. For example, which vaccine will give the longest immunity? Which vaccine is best against more virulent strains of COVID-19, like the British and South African strain? As we have longer follow-up and more information, these doubts will become clearer. The important point is that technological advances have made it possible to manufacture, test and make available COVID-19 vaccines in a matter of months – a true modern wonder in this fight against the pandemic.
We recommend that all cancer patients get the COVID-19 vaccine. This is also in line with the recommendations of major international oncology societies. The vaccination should be taken even by patients who have been previously exposed to the virus or who have protective antibody titres. The timing of vaccination can be variable and should be decided on a case-by-case basis for cancer patients on active chemotherapy, those with compromised performance status, or those with uncontrolled comorbidity. Currently, we recommend that the COVID-19 vaccine not be given to pregnant or breastfeeding mothers.
Dr Purvish M Parikh, Medical Oncologist, Clinical Advisor – Esperer Onco Nutrition (EON), Mumbai