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Published on May 27, 2021
Are Cancer Patients High Risk for COVID?
This is the third 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.
Are people who have cancer now, or have had it in the past, more likely to get COVID-19 or become severely ill from the virus? The answer is a qualified yes. While anyone can get COVID-19, become very sick, or even die from it, this virus definitely poses more risk for many people, including those with cancer.
Patient Power spoke with Elizabeth A. Griffiths, MD, associate professor of medicine in the Leukemia Section at Roswell Park Comprehensive Cancer Center in Buffalo, New York, to ask some key questions about risk for people with cancer, and what to do to increase protection from COVID-19.
Results from the COVID-19 and Cancer Consortium Study, which was published in March 2021, show a clear association between having a hematologic (blood) cancer or recent chemotherapy, for example, and more severe COVID-19 disease. The CDC defines severe disease as requiring hospitalization, intensive care, ventilation, or causing death.
This same study found a higher severity risk for males, people who are older, obese, those with other medical problems, and Hispanic and Black populations.
Dr. Griffiths described the two main reasons why cancer leads to increased risk – either the disease itself or the treatments may cause suppression of the immune system. This is a particular issue with blood cancers because the bone marrow, which makes the cells that fight infections, is suppressed. For example, people with chronic lymphocytic leukemia (CLL) and lymphoma (B-cell cancers) may have a lack of immunoglobulins, needed to protect from infections. To complicate the situation even more, the treatment for blood cancers kills the very cells (B cells and T cells) needed to respond to a vaccine. So, while the COVID-19 vaccine may certainly be helpful, the response may not be as strong in these people as it is in others. Similarly, patients on cytotoxic drugs, such as 5-fluorouracil, platinum drugs, or taxanes, may be less able to respond to the vaccine.
Cancer Treatment and COVID Vaccine Response
It is not clear yet whether patients on targeted therapies, such as tyrosine kinase inhibitors, may have a less robust response to the vaccine.
People who have had solid organ transplants and are on immunosuppressant drugs also may not have a full response to the vaccine. Dr. Griffiths explained that transplant recipients and patients on steroids or other immunosuppressants, such as people with rheumatoid arthritis or psoriasis, “are logically at increased risk, just like people getting chemotherapy are.”
However, quite reassuringly, Dr. Griffiths said that for many other cancers, if the disease is under good control and the patient is in long-term remission and in good shape, preliminary research indicates they will likely have an adequate response to the COVID-19 vaccine. Similarly, people taking hormonal therapies for breast or prostate cancer may have a good response as well.
Dr. Griffiths explained that vaccines work by creating a “set of educated soldiers, who know the weaknesses of the enemy. After being exposed to the vaccine, these soldiers know how to fight effectively the next time they see that enemy and can quickly suppress it.”
There are several studies in progress to measure the response to the COVID-19 vaccine among those with different types of cancer and to see how long that response lasts. Researchers are measuring responses to the vaccine by looking at titers (levels of antibodies in the blood) against COVID-19, as well as evaluating other blood cell immune responses.
However, the research in this area is at an early stage. She explained, “We don’t really know if people who have low or no antibody titers are protected or not.” And while other blood tests look at T cells, for example, none of these titers or tests are currently recommended outside of a clinical research study. “The reason is that we don’t have data now to tell us what to do with the results,” Dr. Griffiths said. It is also important to know that even a low level of immunity may be very protective, she said.
Recent studies are just beginning to tell us more about how having cancer affects the risk and potential severity of COVID-19. This is a complicated topic, and it is always best to discuss your unique situation with your own oncologist.
However, there is certainly general agreement that the most important step people with cancer can take is to get vaccinated against COVID-19 as soon as possible. Even if you have a particular cancer or are on treatments that may suppress your immunity, the vaccine will likely offer some helpful protection.
Additionally, it is important for people with cancer to be surrounded by those who have received the vaccine. Continue to wear a mask if you are around anyone who is unvaccinated, minimize indoor gatherings, wash hands frequently, and adhere to social distancing guidelines. This is especially important for people with cancer who are older and/or have additional medical conditions beyond cancer, such as heart disease, lung disease, kidney disease, or diabetes.
~Susan Yox, RN, EdD
- Research on COVID-19 and Cancer: Annals of Oncology. (2021). “Association of Clinical Factors and Recent Anticancer Therapy with COVID-19 Severity Among Patients with Cancer: A Report from the COVID-19 and Cancer Consortium.”
- CDC Guidance: Centers for Disease Control and Prevention. (2021): “COVID-19. People with Certain Medical Conditions.”
- COVID-19 Fact Sheet: National Cancer Institute. (2021) “Coronavirus: What People with Cancer Should Know.”
- COVID and Cancer Resources: American Society of Clinical Oncology. (2021). “ASCO Coronavirus Resources”
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