Published on April 29, 2021
This is the first in a multipart series exploring important questions about COVID-19 and its unique impact on cancer patients. In this series, Patient Power went to the experts to get the facts about COVID-19 and how it affects prevention, screening, treatment, and research.
Many people with cancer have questions about the COVID-19 vaccines. The obvious one is “Should everyone with cancer get the vaccine as soon as possible?” Shmuel Shoham, MD, an expert in infectious diseases who is an Associate Professor of Medicine at Johns Hopkins University School of Medicine in Baltimore, tells us that, with very few exceptions, the answer is “absolutely yes.” People with active cancer are at higher risk if they get COVID-19, so the vaccine should be a priority for everyone with cancer, including the newly diagnosed, those in active treatment, and those who are long-term survivors.
Many people with cancer are older and have other health problems that would put them at even higher risk if they were to get a COVID-19 infection. Dr. Shoham also pointed out that even a mild case of COVID-19 infection could potentially delay vital cancer treatments.
As with any specific questions about care, it is important to discuss the timing of getting a COVID-19 vaccine with your oncologist. With certain treatments, it may make sense to delay a vaccine temporarily because the vaccine requires a strong immune response that may be suppressed by cancer or some of its treatments.
In March 2021, the National Comprehensive Cancer Network (NCCN) issued guidelines recommending that COVID-19 vaccination take place at least 3 months after a bone marrow or stem cell transplant or chimeric antigen receptor (CAR) T-cell therapy. These specialized therapies are often used in blood cancers, such as leukemia and lymphoma.
While Dr. Shoham pointed out that the current COVID-19 vaccines would not harm patients on these therapies, it is possible that the vaccines may not work as well. For that reason, some physicians may recommend holding off on getting the vaccine until a time when the patient may get a better antibody response.
The only other time when a person with cancer might be advised to wait to get vaccinated is when they are undergoing high-intensity chemotherapy. An example of this therapy would be cytarabine/anthracycline-based regimens for the initial treatment of acute myeloid leukemia. In that situation, the oncologist may want to wait until the absolute neutrophil count in the blood has returned to normal after therapy.
For those on other chemotherapies or radiation treatment, the recommendations from NCCN are to get the COVID-19 vaccine as soon as possible. This includes people with blood cancers who are on long-term maintenance therapies as well as those with solid tumors, such as cancers in the breast, colon, prostate, and liver.
There is one additional caveat. The vaccines from Pfizer and Moderna can both cause temporarily enlarged lymph nodes in the armpit in as many as 16% of people who receive them. For this reason, the Society of Breast Imaging suggests that women should consider scheduling breast screening exams before the first dose of a COVID-19 vaccination or 4-6 weeks following the second dose, as long as this does not delay needed care. Patients who have lymphedema (swelling) in their arm should get the vaccination in the opposite arm. If you have lymphedema in both arms, vaccination can be given in the thigh.
How the COVID Vaccine Affects Surgical Timing
What about surgery and vaccine timing? The current recommendation from NCCN is to avoid getting the vaccine for at least a few days before or after surgery. Again, the reason for this is not that the vaccine would be harmful to a patient undergoing surgery, but to clarify the cause of any symptoms that may occur. That way, your physician can link a fever, for example, to either the surgery or the vaccination.
What if you don’t have a strong response to the vaccine or you have to delay vaccination? Dr. Shoham said that’s where family members and close contacts can help add protection.
“The best advice I can give is to create a cloud of vaccination around people with cancer,” Dr. Shoham said. “Make sure that everyone who lives or comes into close contact with a patient with cancer is vaccinated because the most common place to get COVID-19 is in the home.”
Even once everyone is vaccinated, it is important that close contacts of people with cancer continue to wear masks, follow social distancing guidelines, and wash hands carefully, he said.
The current expert consensus is that the COVID-19 vaccine is essential for those with cancer. In some very specific situations, vaccination may be delayed temporarily, but everyone with cancer should strive to get a vaccine as soon as possible.
~Susan Yox, RN, EdD
- Recommendations of the NCCN COVID-19 Vaccination Advisory Committee
- National Cancer Institute. Coronavirus Vaccines and People with Cancer: A Q&A with Dr. Steven Pergam
- ASCO. Common Questions About COVID-19 and Cancer: Answers for Patients and Survivors
- CDC. How to Protect Yourself and Others
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