Do Cancer Patients Want the COVID-19 Vaccine?

Finally we have three vaccines, Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen, that have received emergency approval from the FDA and are being widely distributed in our country. The Centers for Disease Control and Prevention (CDC), the National Comprehensive Cancer Network (NCCN) and other important oncology-focused organizations all say that cancer patients should be a high priority group to receive the vaccinations. In December 2020, the American Association for Cancer Research (AACR) issued a plea that people with cancer receive the vaccines as soon as possible. Their review of medical research found that cancer patients were twice as likely to die from COVID-19 as were people without cancer. In Massachusetts, cancer patients are currently fairly far down the list in Phase 2 of distribution, although cancer is at the top of the list for co-morbidities or pre-existing conditions.

The details of where any one group falls on the list change, and it is clear that powerful competing forces are at work as decisions are made. A change in policy, for example President Biden’s recent directive that educators should all be vaccinated by the end of March, moves one group higher on the list — and pushes another further down. Some hospitals and cancer centers have supplies of vaccines, but not all do. Some patients who are being treated at one of the supplied hospitals have received calls or emails to register for a vaccine, but those invitations are usually limited to people who fall into the other approved groups (e.g. over 65).

If you are following the news at all, you are well aware of the complications and difficult logistics of finding and registering for an available vaccine. We hear many stories of very distressed and frustrated people who have been unable to sign up and many other stories about under-served communities that feel ignored or forgotten. There are also many reports of Americans who don’t want the shot. Different studies have reported between a quarter and a half of the population want to delay or never receive the vaccine.

One of my colleagues asked about my experience with my own patients’ plans. Do they want the vaccine or not? In order to enlarge the admittedly small and unscientific study, I talked with my husband, a medical oncologist, about what he's been noticing. Both of us work with people who are currently being treated for cancer as well as with people who have completed active cancer treatment and are considered to be in the same risk pool as the rest of the population. Patients who have recently had a stem cell or bone marrow transplant or who have received CAR T-cell therapy, are directed to wait at least three months after completing therapy. People who are receiving aggressive chemo or other cancer therapy are advised to speak with their doctors and probably wait until their cell counts/blood counts have normalized.

Given the reported numbers of people who are reluctant to be vaccinated, I find it very interesting that we personally aren't hearing of cancer patients expressing this concern. Instead, they all want to get the vaccine ASAP. I think of a single father and widower who was diagnosed with cancer who is intent on staying alive for his children. One woman has asked to delay her mastectomy until after her second dose of the vaccine. She had already received her first dose at the time of her cancer diagnosis, and she could not envision returning for the second only a few days after surgery. Many of my patients have talked with me about the safety of getting vaccinated, especially if they are receiving chemo, and these concerns are natural. I always tell them to speak with their doctor and not to listen to the advice of well-meaning friends or family members.

Yes, many of my patients are concerned about side effects from the vaccines, especially the commonly reported stronger reaction to the second shot. They often comment that they are pretty experienced with feeling poorly and know how to spend a day or two in bed or on the couch. One woman with metastatic breast cancer was quite ill for a week after her first dose of the vaccine, and she is still planning to have the second one.

I have written many blog posts about the terrible confluence of living with cancer and living through this pandemic. When your life and your world have been constrained by a serious diagnosis and difficult treatment, it is even more painful to have COVID-19 close off even more possibilities. My patients talk about how they can’t ask for help from friends or family, whether that assistance be a ride to the hospital, childcare or a visit. If they're feeling down they can't get together with a friend for lunch or a movie. They can’t travel to visit those whom they love and have missed welcoming new grandchildren into the world. Especially if you worry that your time is more limited, it is terrible to have lost a year of experiences and choices. Even if you aren’t too worried about a cancer prognosis, we are all getting older, and may feel that our remaining good years are numbered.

There certainly may be cancer patients who don’t want to receive a vaccine, but I don’t know them.