When the COVID-19 pandemic was first declared in March 2019, there was a lack of information about the virus. As time went on and more and more research was conducted, we were able to learn more about how the virus worked, who it was infecting, its symptoms and more. One of the pieces of information from this research was that cancer patients were more likely to have adverse outcomes if diagnosed. Although there was not enough evidence to pinpoint which cancers made individuals more susceptible or enough research to definitively say whether past and present patients had the same concerns, the few findings were enough to label individuals diagnosed with cancer as high-risk. Of course, one’s risk level is dependent on many different factors and varies from person to person.
With the arrival and approval of COVID-19 vaccines, you may have questions and concerns about receiving the COVID-19 vaccines as someone who may be high-risk. We have put this post together in collaboration with oncologists across Canada to provide you with more information on the COVID-19 vaccine as it concerns cancer patients. Here’s what you should know.
On Cancer and the COVID-19 Vaccines
- Cancer is a number of diseases all with one family name and it is not possible to give advice that is appropriate for all cancer patients. Not only do different cancers affect different organs but the medications that are used to treat cancer vary for different cancers and for different individuals. Some individuals with cancer have shown no evidence of disease and have a past history of cancer while others currently have cancer or are living with cancer, and this may affect their risk of getting COVID-19. As well, individuals may have comorbidities which may affect their risk of getting COVID-19 as well as their response or risk with vaccines.
- Some, but not all individuals diagnosed with cancer are immune compromised (or immunocompromised) which means that their immune system is weaker than the average person with a healthy immune system. The immune system is complex and made up of a number of different systems. The immune system helps fight infections and the immune system of an immunocompromised person may not fight infections as effectively as a healthy person which may put them at more risk of getting viral infections such as COVID-19. Some individuals with cancer and some medications that fight cancer directly affect the immune system which is why some cancer patients may be more at risk of getting the infection and having serious illness with complications. This risk differs on a case-to-case basis.
- The most common type of vaccine being used in preventing the COVID-19 virus is a messenger ribonucleic acid (mRNA). Using an mRNA vaccine means that individuals are not being injected with the actual virus but with a lab-made code for the virus’s spike protein. Once in the body, our cells produce the protein, and this helps the immune system recognize and get rid of the virus if infected. At the time of writing, there are 4 currently approved COVID-19 vaccines in Canada. Unless you have a contraindication or are recommended a specific vaccine from your doctor, the “best” vaccine to receive is the one that you have access to.
- Individuals currently diagnosed or living with cancer, as well as those receiving chemotherapy, were not part of clinical trials testing the safety and effectiveness of the vaccine. Countries that are already giving the vaccine are collecting information on how cancer patients respond to the vaccine, but it is not yet available.
- Most provinces and territories across Canada are creating priority lists of who should receive the vaccine first. You may or may not be on these lists as a cancer patient, but you may belong to another demographic and be on the priority list. Due to the general safety of the vaccines, it is strongly recommended that you take the vaccine, however, it is important that you speak to your healthcare team first or see if your cancer centre has a website with information.
- At this time, the only people who should not get either of the four COVID-19 vaccines approved in Canada are those who:
- Have an immediate or a severe allergic reaction after their first dose
- Are allergic to any of the ingredients in the vaccines
On Breast Cancer and the COVID-19 Vaccine
- In general, most breast cancer patients are not immunocompromised. Here is some general information for various breast cancer populations:
- If you are a breast cancer patient currently on follow up only, with no evidence of disease, or you are a patient on adjuvant hormone therapy, it is safe to receive the vaccine and you do not need to worry about risks occurring from breast cancer
- If you are currently undergoing chemotherapy it is safe to also receive the vaccine, but it is important to speak to your healthcare provider about the timing of when to receive the vaccine
- If you are currently on a CDK4/6 inhibitor, it is safe to get the vaccine and if you have a choice of timing, it is advisable to time it for just before you are restarting your pills. If you are limited in the timing of the vaccine, then take it whenever it is available
- If you are on other medications which affect your white blood cell count, talk to your oncologist about the timing of when it would be best to receive the vaccine
- If you are receiving radiation, it is safe to receive the vaccine, but it is highly recommended that you talk to your oncologist first
The COVID-19 vaccine is considered generally safe for breast cancer patients. There is no current evidence of a greater risk of “side effects” in cancer patients. The main concern with cancer patients, who may be immunocompromised, taking the vaccine is that it may not be as effective as it would be in other individuals. However, if immunocompromised, there is a higher risk of adverse outcomes or death from COVID-19. For virtually all cancer patients, the benefits of vaccination (to prevent serious infection) exceed any theoretical downside or limitation. In addition to receiving a vaccine for COVID-19, other ways to protect yourself, your family members, and others includes adhering to the public health guidance, wearing masks, avoiding indoor congregations, and hand washing. Should you still have concerns about the vaccine or are in a special circumstance, the next course of action should be to speak to your healthcare team.