Cancer patients and COVID vaccine

The Covid-19 pandemic has created major dilemmas for providers in all areas of health care delivery, including cancer centers. We are still fighting this global hazard. Now we are at a stage where COVID vaccine has emerged as an effective tool. Cancer is included in list of comorbidities which make any person vulnerable to COVID infection irrespective of age.  Here we try to resolve most of queries asked by cancer patients regarding COVID vaccines.

1.What are the types of vaccines available in India?

COVAXINE:  an inactivated vaccine which means that it is made up of killed coronaviruses. Bharat Biotech utilized sample of virus, isolated by India’s National Institute of Virology.

When administered, immune cells can still recognize the dead virus, prompting the immune system to make antibodies.

COVISHIELD: made from a weakened common cold virus, called as adenovirus from chimpanzees. It has been modified to look like coronavirus. When the vaccine is injected into a patient, it prompts the immune system to make antibodies.

2. What are high risk groups related to cancer?

Cancer patients on active treatment are included in clinically vulnerable group. These patients include those on chemotherapy, on radiation, undergone recent major surgery or splenectomy, elderly patients.

3. Should cancer patients  or survivors get COVID 19 vaccine?

Yes. All of the COVID-19 vaccines available in India are safe for their recommended use

People with cancer have a higher chance of severe symptoms if they get COVID-19 and vaccine is an effective protection.

4. Any guidelines regarding Vaccination in Cancer patients?

 NCCN COVID-19 Vaccination Advisory Committee recommend that Patients with active cancer and those on treatment should be prioritized for vaccination and should be immunized with any vaccine that has been authorized.

European Society of Medical Oncology (ESMO) guideline  states: “Patients with cancer have an increased risk of severe Covid-19, ie, haematological malignancy requiring chemotherapy or active, advanced solid tumour or history of solid tumour <5 years ago and should be vaccinated against SARS-CoV-2 regardless of any other indications (ie, age), and positioned at high prioritisation.”

5. Is the Vaccine Safe for Cancer patients?

People with cancer weren’t included in the clinical trials of the COVID-19 vaccines. While the COVID-19 vaccines are very safe, researchers do not know exactly how much protection they will give people with cancer compared to those who do not have cancer. 

However, the way the vaccines work means that there is a strong chance that your immune system will learn to protect you, to some degree, from COVID-19.

If you are on treatment or your treatment needs to start before you can get the vaccine, do not delay your cancer treatment.

6. Should COVID Vaccine be administered during active chemotherapy/ systemic treatment ?

Systemic Therapy: If you are on cyclical therapy, for example chemotherapy given every 3 weeks, try and book your vaccine around 1 week before your next treatment. Blood cell counts is checked beforehand.

  • If you are planned for a stem cell or bone marrow transplant or CAR-T cell therapy, try to book your vaccine at least 2 weeks before you start the chemotherapy that is given before the transplant or CAR-T cells. 

 7. Should COVID Vaccine be administered during Radiation Therapy ?   

  • If you are receiving radiation therapy to large areas of your body, you may need CBC before getting your vaccine. 
  • If you are having radiation close to one of your arms, you should get the vaccine in your other arm.
  • If you are going to start radiation therapy in the next 2-4 weeks, and you are currently eligible to get a vaccine (for example, your age group is eligible), try to get the vaccine as soon as possible within a few weeks and let the staff know the date of your vaccine appointment.

8. (Dr Kaushal) Should COVID Vaccine be administered in perioperative period of cancer Surgery?  

  • Immediate Cancer Surgery- should wait for 4 weeks for complete recovery
  • Waiting for Surgery: should be prioritize to receive vaccine before surgery if feasible.

Researchers says between 0.6% and 1.6% of patients develop COVID-19 infection after elective surgery. Patients who develop COVID-19 infection are 4-8-fold increased risk of death in the 30 days following surgery. For example, whereas patients aged 70 years and over undergoing cancer surgery would usually have a 2.8% mortality rate, this increases to 18.6% if they develop COVID-19 infection. Vaccination policy should consider this datas.

  • If axillary dissection has been done than take vaccine in opposite arm.

9. Can I choose The Type of vaccine which I receive?

Presently vaccination drive is to mass vaccinate the population as per government regulations and registration. It is more important to receive vaccine and have second dose same as first dose. Both vaccines are effective

10. Should I wear mask even after vaccination?

Yes, it very important to follow all routine measures like wearing a mask and social distancing. As a society it is also our responsibility of protect each other. Together we’ll overcome this problem.

Experts recommend to consider vaccination of all adult patients who had a cancer diagnosis within the last five years, whether on treatment or not, and irrespective of any age cut-offs

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