1. DiGiulio, Sarah

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Patients with cancer are at higher risk for more severe COVID-19 and complications. People with cancer often have weakened immune systems, they are often older, and many suffer other comorbidities, too. Because of these risks, oncology groups including the American Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), and the American Society for Radiation Oncology have all recommended patients with cancer get vaccinated. Now the National Comprehensive Cancer Network (NCCN) has published a similar guidance.

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Providers are getting asked questions daily from their patients about vaccine safety, said Steve Pergam, MD, Associate Professor in the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center and Director of Infection Prevention at Seattle Cancer Care Alliance.


"There was universal agreement from the entire committee that cancer patients should be prioritized to get vaccines. The goal was to make the recommendations as streamlined as possible to make it easier for patients to get vaccinated," said Pergam, who was co-leader of the NCCN COVID-19 Vaccine Committee.


The key recommendations in the guidance include the following:


* Patients with cancer should be prioritized for vaccination and should be immunized when vaccination is available to them.


* Immunization is recommended for all patients receiving active therapy with the understanding that there are limited safety and efficacy data in these patients.


* Vaccination should be delayed for at least 3 months following hematopoietic cell transplantation or engineered cellular therapy to maximize vaccine efficacy.


* Caregivers and household members or close contacts should be immunized when possible.



Additionally, the guidelines recommend that for patients with acute myelogenous leukemia who had just received induction chemotherapy (and who were neutropenic), vaccination should be delayed until neutrophil count recovery. And patients undergoing major surgery for cancer should separate vaccination and surgery by at least a few days.


Also included in the guidance is the recommendation that patients with cancer be prioritized when it comes to national administration efforts. "If protecting the most vulnerable is a primary goal of vaccine allocation, it should include and prioritize cancer patients," Pergam told Oncology Times in an interview.


"The NCCN, ASCO, and ASH advocate for policies that will prioritize vaccinations for all cancer patients, but this will be especially important for younger cancer patients," added Matt Kalaycio, MD, a hematologist at Cleveland Clinic and a member of the NCCN COVID-19 Vaccine Committee.


Update Guidelines as Needed

The new guidelines are fair and balanced, Michael Grossbard, MD, Chief of Hematology at Perlmutter Cancer Center at New York University Langone Health and Professor of Medicine at NYU Grossman School of Medicine, told Oncology Times in an interview. (Grossbard was not involved in the development of the guidelines.)


"They're unfortunately not based on a lot of evidence because there's just no experience with a large population of cancer patients who've been given COVID-19 vaccines," he said. Still, he agrees the recommendation that cancer patients should get vaccinated (in most cases) is the right one. "There's no reason to expect that they won't respond to the vaccines and they should be high-priority patients to be vaccinated," he noted.


Grossbard is involved in studies that will track the immune response in patients with cancer who have been vaccinated; he said other groups are working on similar projects. "But we don't have any data yet. We're just opening our study." He said they may have useful data in as few as 2-3 months from now.


Pergam added that, to date, cancer centers that are already vaccinating cancer patients have not reported concerns or adverse events. And the committee will continue to meet regularly to review any new data (like that from Grossbard's group and others) to modify the guidelines as needed.


"What we do expect is that vaccine efficacy may not be the same in these high-risk patients. Most of us predict that levels of protection among some cancer patients who receive the vaccine, particularly those with hematologic malignancies, will not be as robust as have been seen in the trials," Pergam noted. This reason is why the guidelines recommend caregivers, family members, and close contacts of patients with cancer also get vaccinated when they are able to, he said.


What Practicing Oncologists Need to Know

"The very clear risks of COVID-19 for cancer patients outweigh the very low risk of vaccination," Kalaycio said. Aside from the aforementioned exceptions, patients with cancer should get vaccinated.


It's also important for patients who are in clinical trials to talk to their providers before getting the vaccine, too, as sometimes clinical trials may have restrictions regarding when patients can receive vaccines, Pergam added.


Grossbard said he's already had the conversation with many of his patients. "I have explained: There's no reason to believe that patients inherently won't respond [to the vaccines]. And there's no reason to believe that the vaccine will be any less safe in a cancer patients than any other patient."


Sarah DiGiulio is a contributing writer.