Covid-19, Cancer, and Vaccination

“Author : Dr. Vijay Agarwal, Lead & Sr. Consultant – Medical Oncology & Haematology, Aster CMI Hospital”

New Delhi, May 29, 2021:

1. Can cancer patients take covid-19 vaccines?    

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, continues to have a serious impact on many people, including cancer patients, their families, and caregivers. Due to frequent hospital visits and increased exposure, vaccination for cancer patients has become imperative now. Individuals with cancer sadly have a higher risk of severe Covid infection because of their age, the disease, cancer treatment and medical comorbidities.

Currently, the vaccination for cancer patients has been recommended for all people with cancer and blood malignancies. These vaccines can be taken as long as the components of the vaccine suits the patient even while their immunity is down. However, the following points to be noted –

• These vaccines should not be taken if they do not suit one’se body (e.g., known allergic reaction, which is a contraindication)
• There could be an unknown safety situation which can rarely cause a problem
• Effectiveness may not be as much as in the general population due to a less immune reaction. Here the vaccine is given to give whatever benefit possible and with the intent to reduce the severity of covid-19 infection if it happens.

2. When to start and which are the most preferred vaccines for cancer patients? Can the vaccination lead to a change of plans in the cancer treatment of the patients?  

While starting your programme of vaccination,  It is important to discuss with your oncologists and plan strategies for taking vaccines between the cycles of chemotherapy, targeted therapy and immunotherapy. It is recommended to take any of the available vaccines as long as the blood counts are acceptable.

Cancer patients who are undergoing a major surgery should ideally wait for a few days before going for vaccination. The best time for such patients to get vaccinated is before treatment, optimally 2 weeks before the start of chemotherapy. Furthermore, patients who have opted for radiotherapy can start their vaccination program anytime. Patients undergoing immunotherapy should opt. for vaccination at the earliest as toxicities and reaction can be severe if the covid infection happens along with chemotherapy/immunotherapy.

Other than the appropriateness and timing of the vaccination, there are no changes that the vaccination causes in the plan for cancer therapy. Vaccination can be recommended one week from the start of the chemotherapy cycle.

3. How long does immunity last?

 The expected immunity usually develops in 2-3 weeks after the second dose of vaccine and is  effective beyond six months. As the vaccines and vaccination programmes are relatively new. We are still awaiting further data on whether or not the immunity lasts beyond the six months. However, considering the current scenario, where comorbid patients are at an increased risk of contracting the covid virus, vaccination is strongly recommended for all such patients. Cancer patients who have also recovered from covid-19 can also undergo vaccination without the fear of any complications.

4. What are the concerns of vaccination with regards to cancer patients?

A major concern is uncertainty in the level of effectiveness of vaccination when immunity comes down during treatment. However, any level of effectiveness is better than status without covid-19 vaccination. Lymphoma patients can have lower vaccine responses as we do not know precisely the efficacy of the COVID vaccine for lymphoma when on active treatment. For cancer patients, despite the vaccination, it is ESSENTIAL to continue the practice of wearing a mask, social distancing, and maintaining hand hygiene as they are already immune-compromised and chances of re-infection are also high among them.

5. Is the Covid-19 vaccine safe in Bone Marrow Transplants?

Covid-19 vaccination is recommended at least two to four weeks before the planned transplant. We recommend most of the transplant patients to delay all vaccines for at least three months following a stem cell or bone marrow transplant.

6. What are the vaccine’s side effects?

Currently, serious side effects are rare, and compared to the benefit of protection, it would be negligible. However, common side effects of vaccines are pain at the injection site, tiredness, headache, muscle pain, and fever. Chills, joint pain, nausea, injection site redness and swelling, swollen lymph nodes.

7. Can one get ill with Covid-19 after vaccination?

It is possible that one can get sick post receiving a vaccine, but the good news is that it is likely to be less severe and people may not require hospitalisation in such cases.

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