Many people with cancer are wondering if it’s safe to get one of the approved COVID-19 vaccines. After all, we know that having an underlying medical condition, such as cancer or heart disease, puts you at greater risk for developing a serious illness from the virus.
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The short answer is that for most adults with cancer or a history of cancer, vaccination against COVID-19 is recommended, but there are factors for people with cancer to consider first.
In this article, oncologist Halle Moore, MD, discusses vaccine safety and what cancer patients and survivors should know.
Cancer is a high-risk condition
People with cancer are expected to be (if not already) in one of the earlier priority groups able to receive the vaccine, but this may vary depending on where you live and how much supply is available. You could fall into this priority group because of your cancer diagnosis, your age or both.
How do the vaccines work?
Currently, there are three COVID-19 vaccines approved under emergency use authorization:
- Pfizer-BioNTech. This vaccine is authorized for people 16 years or older and is given in two doses, 21 days apart.
- Moderna. This vaccine is authorized for people 18 years or older and is given in two doses, 28 days apart.
- Johnson & Johnson. This vaccine is authorized for people 18 years or older and is given in a single dose.
Both the Pfizer and Moderna vaccines use messenger RNA (mRNA), which is a molecule that contains instructions for making coronavirus’s infamous “spike protein.” Once you receive the vaccine, cells in your body are instructed to make copies of the fake spike protein. This reaction triggers an immune system response that acts as a fire drill. Then, if you’re exposed to the real coronavirus in the future, your cells are already well-equipped and trained to fight it.
Because the mRNA vaccines don’t contain a live or weakened version of the virus, there’s no risk of contracting the virus from these vaccines. The Pfizer-BioNTech and Moderna vaccines are not interchangeable, so you should receive two doses of the same kind.
The Johnson & Johnson vaccine works differently by delivering a piece of DNA from the COVID-19 spike protein into your body via an adenovirus (the kind of virus that typically causes colds). This modified adenovirus carries the DNA segment but won’t replicate inside the body and cause illness. The DNA then causes cells to make harmless versions of the spike protein, which prompts the body to create an immune response to it.
Speak with your healthcare provider before getting vaccinated
If you have cancer or are receiving cancer treatment, it’s important to speak with your healthcare provider before you get your first dose of either vaccine.
Your type of cancer and type of treatment will be a factor to consider. Your healthcare provider will be able to discuss risks, benefits, timeline and what you should know before receiving your first dose of the vaccine.
Side effects of the vaccine
Common side effects following vaccination are a sore arm, fatigue and muscle aches. Fever and chills may also occur, especially after the second dose.
Following vaccination, some people might develop enlarged lymph nodes. These most often occur in the underarm or in the neck on the side of the vaccination. Since cancer can also cause lymph node enlargement, it’s important that cancer patients realize this is a possible side effect and is usually not a sign that their cancer is growing (although we know it can be scary).
The enlarged lymph nodes may feel tender to the touch and should resolve on their own, but can sometimes last for several weeks. You should contact your healthcare provider if the enlarged lymph nodes do not start to improve within three to four weeks after your second dose.
Timing the vaccine and cancer treatment
If a vaccine is available to you, it may be appropriate to delay the start of some non-urgent cancer treatments until vaccination has been completed. Most cancer treatments, however, should not be delayed for vaccinations. Your healthcare provider can advise you regarding timing of vaccination with respect to your cancer treatment. Depending on the types of cancer treatment you may have had or are receiving, there may be other special considerations.
Here, Dr. Moore breaks down what to consider for many types of cancer treatment regarding the vaccine, although it’s advised to always speak with your own oncology team first and foremost:
- For patients receiving chemotherapy or other immune suppressing treatments: In general, receiving either vaccine during chemotherapy is recommended. But because the vaccines can cause a fever within the first 24 to 48 hours, it’s preferable to receive the vaccines at a time when your white blood counts are not expected to be low. This is because if a fever occurs when your blood counts are low, it may require hospitalization. In some circumstances, it may be appropriate to delay vaccination until after completion of very intensive chemotherapy treatments such as those given as induction therapy for acute leukemia.
- For patients receiving immunotherapy: For most patients receiving immunotherapy for cancer, it’s fine to proceed with vaccination and immunotherapy need not be interrupted.
- For patients receiving steroid medications: Corticosteroids may reduce the response to COVID-19 vaccination. If you require corticosteroids as a part of your cancer treatment, you should discuss the timing of vaccination with your healthcare provider.
- For patients receiving rituximab, blinatumomab, anti-thymocyte globulin, alemtuzumab and other lymphocyte-depleting therapies: These treatments can affect the lymphocytes, which are an important part of the immune response to the COVID-19 vaccines. Vaccination may be more effective if delayed for at least three months after completing these therapies. However, if COVID-19 rates are high in your community, the benefit of partial protection from vaccination during or soon after treatment should be considered.
- For patients receiving hormonal treatments: Endocrine or hormonal treatments for cancer including tamoxifen, aromatase inhibitors, LHRH analogs and anti-androgens are not expected to alter the safety or effectiveness of the vaccines.
- For patients receiving IVIG: For most patients receiving IVIG, it’s fine to proceed with vaccination and IVIG therapy need not be interrupted.
- For patients receiving radiation therapy: For most patients receiving radiation treatment, it’s recommended to proceed with vaccination and radiation treatment need not be interrupted.
- For patients receiving surgery: For most patients receiving cancer-related surgery, it’s recommended to proceed with vaccination. Since fever can occur in the first 24 to 48 hours after vaccination, it’s best to avoid scheduling your vaccination within a few days of planned surgery as a fever may result in cancellation of the surgery. For those undergoing splenectomy, you should receive the first vaccine dose at least two weeks or more before surgery if possible.
- For patients who have had axillary lymph node surgery: Patients who have had surgery to remove lymph nodes in the underarm area, including many patients with breast cancer, may wish to receive their vaccine in the opposite arm from the cancer surgery. It’s possible that lymph node enlargement resulting from the COVID-19 vaccination could exacerbate lymphedema (swelling of the arm). Some individuals may have had axillary lymph node surgery on both sides; in those cases, you may wish to discuss with your healthcare provider which side might be lower risk should lymph node enlargement occur.
- For patients who have undergone stem cell transplant or CART cell therapy: Patients who are within three months of an autologous stem cell transplant and those who have had allogeneic stem cell transplant or CART cell therapy should discuss with their healthcare provider timing of vaccination. In addition, those with severe acute graft versus host disease and those with low B-cell counts should discuss with their provider whether vaccination should be delayed.
- For patients undergoing extracorporeal photopheresis or plasmapheresis: There is a possibility that these treatments may interfere with a response to the COVID-19 vaccines. When feasible, it’s recommended that extracorporeal photopheresis and plasmapheresis be scheduled at least two weeks after COVID-19 vaccination.
- For patients who have had severe allergic reactions to chemotherapy or monoclonal antibody treatments: The vaccine ingredients polyethylene glycol and polysorbate may be found in a variety of chemotherapy and monoclonal antibody drugs. If you experienced anaphylaxis or other severe allergic reactions to cancer therapies, consultation with an allergist is recommended prior to receiving the vaccine.
- For patients with a history of other severe allergic reactions: Patients with immediate allergic reactions to the first dose of an mRNA COVID-19 vaccination should not receive the second shot unless evaluated by an allergist and cleared.
- For patients who have already had COVID-19: In general, it’s recommended that you receive the COVID-19 vaccine even if you were already infected with the virus, although you may choose to wait three to six months after your illness.
We all need to remain cautious about COVID-19, especially those with cancer
It’s important to be aware that some people with cancer tend to have weakened immune systems, which might make the vaccines less effective. Right now, the mRNA vaccines offer 94 and 95% protection from this virus while the Johnson & Johnson vaccine 66% effective in preventing moderate and severe COVID-19 disease 28 days after vaccination and 85% effective in preventing hospitalization. But it’s difficult to tell if cancer patients will have that same level.
It’s crucial that we all continue to follow safety recommendations for a while longer, including handwashing, following social and physical distancing guidelines and to continue wearing a face mask even after you’ve been vaccinated.