Should Cancer Patients get the COVID-19 Vaccine?

Before anything else, the most important reminder is this: “Ask your doctor.” I can share the information and advice that is currently available, but we know that everyone is different, and your circumstances may suggest something different is better.

The arrival and FDA approval of two-dose COVID-19 vaccines have been celebrated around the world. Availability is dependent on many factors, and every state has guidelines for the timeline of vaccination. Read about the Massachusetts COVID-19 vaccine guidelines.

The efficacy of a two-dose vaccine has been estimated at 95%; this is pretty remarkable and very good news. As is always the case in clinical trials, not all populations were included in the first groups to be vaccinated. People who are immunocompromised, and this includes some cancer patients and those on active cancer treatment, were not part of the test cohort. It is natural to be worried about the safety and efficacy for this population; these concerns are joined by the reality that these same people likely are at higher risk for becoming very ill should they be diagnosed with the virus.

During a recent special meeting of the American Society for Hematology (ASH), Dr. Anthony Fauci was specifically asked this question. He responded that people with compromised immune systems from a bone marrow transplant or from chemotherapy should plan to be vaccinated when the shots are available. I would add: After speaking with their doctor. Dr. Fauci said, "I think we should recommend that they get vaccinated. I mean, it is clear that, if you are on immunosuppressive agents, history tells us that you’re not going to have as robust a response as if you had an intact immune system that was not being compromised. But some degree of immunity is better than no degree of immunity.”

Let’s tease this apart a little. Remember that Dr. Fauci was speaking about people actively or very recently on some cancer treatments. Once you are some months past chemotherapy (and I don’t think anyone can tell you exactly how many months), your immune system has recovered, and you are considered to be back in the general risk pool. As long as the vaccines are not live attenuated ones, and these are not, they are not specifically risky to an immunocompromised person unless there are other medical contraindications. It likely will be somewhat less effective than it is in people with fully functioning immune systems, but that is not a reason to avoid it. Several experts have compared it to receiving an annual flu shot. Everyone agrees that our families, friends, and work contacts should be vaccinated when possible with no worries about harming the patient.

Note that neither the FDA nor the CDC has yet released guidelines about vaccinating individuals who are immunocompromised. The FDA has made the important point that patients should speak first with their doctors to understand their individual situation. The CDC’s Advisory Committee on Immunization Practices has said that clinicians will need more guidance to understand how best to use the vaccine in pregnant or nursing women, those with a history of allergies to vaccines, and people who are immunocompromised.

In Massachusetts, I suspect that most of us will be offered the vaccine in late winter or early spring. By then, there will be more information available as more people will have been vaccinated. Personally, I can’t wait to roll up my sleeve and begin to transition to a more normal life.

Find additional COVID-19 resources from Beth Israel Lahey Health.