Covid Vaccination and Cancer 

- Dr Niti Raizada, Director - Medical Oncology and Hemato-Oncology

Cancer patients have increased exposure due to frequent hospital visits and so prioritization of vaccination is imperative. Not only the cancer patient but it is important that caregivers, the household members and close contacts take the vaccination. Individuals with cancer sadly have a higher risk of severe Covid infection because of their age, the disease, cancer treatment and medical comorbidities.  Cancer has had substantial disruption of diagnosis and treatment in many parts of the world. The low economic and middle economic countries have unequal access to these COVID-19 vaccines and therefore they have suffered more. The generalised assumption is that the benefits of covid vaccination overweigh the risk and they are no major side effects demonstrated. A shorter duration between the initial dose and booster dose (like 21 days dose schedule) is also recommended in some parts of the world. 
 

Patient prioritization is the key - What Cancer Patient Should Know Before You Take The Vaccine.

Patients on active cancer therapy: Chemotherapy and Myelosuppressive treatment -it is recommended to have a gap of 5 to 7 days from the last session so that WBC and platelets are not low. It is advised to do a CBC check before vaccination. 

Patients with Leukaemia –Intensive treatment like induction therapy of acute leukaemia requires vaccination to be delayed. In chronic leukaemias vaccination is permissible.

Patients with Stem Cell Therapy – cases who have had autologous bone marrow transplant, allogeneic bone marrow transplant within the past 3 months required to consult their oncologist before vaccination. If there is graft versus host disease(GVHD) or low WBC count then vaccination is delayed.

Cancer patients on Clinical Trial- Covid Vaccination is strongly encouraged in this situation as most of the patients would have advanced cancer or may be frail. Informing the sponsor of the clinical trial can be a part of it. 

Surgery or Radiotherapy – Most patients should consult their doctor for risk factors, benefits and timelines to understand their vaccination. However, most patients on Radiotherapy alone can proceed with vaccination.
 
Breast Cancer cases-  Vaccination is recommended in the opposite arm of the breast cancer. Sometimes immediately after vaccination they could have swollen lymph nodes and your doctor needs to be informed. 

Cancer Survivors-  Vaccination is encouraged in all such patients 

Mammogram or Ultrasound breast-  Can be delayed around Covid vaccination due to enlarged lymph nodes in some cases.

What is the type of vaccination I should take? 

Most of the times this cannot be a choice one can make, so it is recommended you take any available vaccine. There has been a suggestion of the possibility of using booster shots in future to protect newer covid variants. 

The main question here is not whether covid vaccination is safe but whether covid vaccination is effective. As cancer can affect the immune system we don't have specific information about the efficacy of vaccination in cancer subjects and we need further data to substantiate the same.  Remember that even after vaccination you need to take all precautions to prevent exposure to Covid infection.

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