Cancer Patients and COVID-19 Vaccination : A balanced view

Posted in covid-19, cancer; Comments 2 ; Posted 3 years ago by Andreas Obermair

Here, I answer some frequently asked questions about whether people affected by cancer should consider receiving the COVID-19 vaccine.

How do vaccines work?

Vaccines work by producing an immune response in the body, ideally without causing illness. The COVID-19 vaccination strengthens a person’s immune system by training it to recognise and fight against COVID-19.

The first vaccine was developed in the 18^th century when a 13 year old boy received a small  dose of a toxin (cowpox) and became immune. 200 years later, smallpox was declared eradicated.

What safety testing is completed?

In Australia and countries of the developed world, any vaccine will have shown its safety and effectiveness in multiple clinical trials and pass the Therapeutic Goods Administration’s (TGA) strict review and approval processes.

Are cancer patients at higher risk of COVID-19?

People with cancer are more vulnerable to contracting COVID-19 and are at an increased risk of more severe illness. Cancer patients who are diagnosed with COVID-19 are more likely to be admitted to intensive care units. Research found that cancer patients who were in remission or who had no evidence of disease were at a lower risk of death from COVID-19 than those who were currently receiving treatment.

Patients who have COVID and require surgery that cannot be postponed (e.g., car accident) face a massively increased risk of dying subsequent to the surgical procedure.

Is the COVID-19 vaccination safe for cancer patients?

The Australian Technical Advisory Group on Immunisation (ATAGI) recommend people who are immunocompromised (such as cancer patients) should be among the priority groups to receive the COVID-19 vaccines due to their increased risk of severe illness.

Is the COVID-19 vaccination as effective for cancer patients?

Results from studies found that cancer patients had lower levels of protection for COVID-19 following the first dose of the vaccine, compared to people without cancer. However, when cancer patients received their second dose at the recommended interval, protection against the virus considerably improved. This shows it’s important to receive both doses to receive the highest protection.

What are the side effects for cancer patients?

The side effects of people affected by cancer are similar to otherwise healthy people.

Most side effects occur within 2-3 days of receiving the vaccine. If possible, avoid scheduling immunotherapy or other chemotherapeutic infusions when vaccine side effects are expected. In clinical trials, the most reported adverse events in the first week after vaccination were: injection site pain (84.1%); fatigue (62.9%); headache (55.1%); muscle pain (38.3%); chills (31.9%; joint pain (23.6%); fever (14.2%); and injection site swelling (10.5%) (Source: Queensland Health).

There has been a link between the AstraZeneca vaccine and a syndrome called thrombosis in combination with thrombocytopenia (TTS). This is an extremely rare blood clotting syndrome and can cause long-term disability and death. It is currently estimated to affect about 1-2 per 100,000 people who are 60 years and over. For those under 60 years, the rate is estimated to be about 2-3 per 100,000 people. The below graph shows the risk of dying from a TTS blood clot after a dose of AstraZeneca vaccine in Australia versus the annual risk of death from other activities.

Graph Source: The Conversation

Allergic reactions are also rare and usually occur within 15 minutes of receiving a vaccine (called “anaphylaxis”), which is why your vaccination provider will ask you to wait and be monitored for 15-30 minutes after receiving the vaccine. Anaphylaxis can occur after any vaccine.

Age and recommended vaccine

From 13 September 2021, children aged 12 and over will be eligible for the COVID-19 vaccine in Australia. Currently, children and adolescents in the 12-18 years age group will be able to receive the Pfizer vaccine.

For those aged 18-59 years Pfizer or Moderna is recommended due to a very small risk of blood clotting with AstraZeneca in young people, as mentioned above.

ATAGI recommends people can choose to receive the AstraZeneca vaccine if they are unable to access Pfizer or Moderna.

In fact, a large study found that patients who contract COVID-19 face a much higher risk of developing blood clots, than those vaccinated with the AstraZeneca or Pfizer vaccines.

For those 60 years and over ATAGI continues to advise people to receive the AstraZeneca vaccine because the benefits outweigh risks associated with vaccination.

People with cancer are offered the same COVID-19 vaccines that are available to all eligible people in Australia.

Benefits versus risks: Making a decision

There are very clear benefits of the COVID-19 vaccine for everyone who is eligible and aged 12 years and over. Firstly, the vaccine is safe and means you are significantly less likely to contract the disease (i.e. become infected). Secondly, if you contract COVID, it is highly effective at preventing severe illness and reduces your chances of needing to be admitted to intensive care, being ventilated or the risk of dying. Getting yourself vaccinated also helps to protect the people around you. The more people who are vaccinated will mean less lockdowns, and a quicker return to activities from before the pandemic. Lastly, if a country has a large majority of people vaccinated, and people are less likely to require hospital care, the hospital can remain open for those who need care (e.g., cancer treatment).

Severe side effects are possible but rare and some of them can be potentially life-threatening, including allergic reactions, and the AstraZeneca blood clotting. We don't know at this point in time what individuals will be at higher risk to develop those side effects.

The decision about whether to receive the COVID-19 vaccination should be made on an individual basis. If you are a cancer patient and have questions you can seek advice from your GP.

My family and I as well as all of my practice staff are fully vaccinated, none of us had significant side effects (apart from feeling unwell for a few hours up to a couple of days) and we anticipate that we will receive booster shots in the months to come.

Even after receiving the vaccine, remember it is still important for people to continue other protective measures against COVID-19, including practising good hygiene and maintaining physical distancing.

In Queensland, you can register for the vaccination here.

Source: This information is sourced from Cancer Australia. For more information about the COVID-19 vaccine you can read their Frequently Asked Questions page.

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