COVID-19 Vaccines & Patients with Cancer: The latest updates from ASCO
12/03/2021, asco.org
This page was last updated on 12/3/2021. Please check back to ASCO's site frequently for updates.
At this time, patients with cancer may be offered vaccination against COVID-19 as long as components of that vaccine are not contraindicated. Appendices C, D, and E of the CDC’s Interim Clinical Considerations provide details on vaccine components and potential contraindications. These details are summarized in this document. See the question below “Should people who are immunocompromised received a third dose of the vaccine?” for information regarding people who are immunocompromised.
At this time, there are three COVID-19 vaccines authorized and recommended in the United States: the Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen vaccines. These vaccines are described on the US CDC’s vaccine page. Vaccination, including the use of booster doses and the use of different vaccines across doses, should take place according to current US CDC and FDA recommendations. Memorial Sloan Kettering Cancer Center has made available an interim guideline on vaccination for cancer patients. The National Comprehensive Cancer Network (NCCN) has made available preliminary recommendations as well. The recommendations in these documents are based on opinion and extrapolation from other vaccine studies and may change rapidly as new information becomes available. The New England Journal of Medicine also has a resource page that addresses a wide range of data on vaccination.
Should people undergoing active treatment for cancer be vaccinated against COVID-19?
At this time, patients undergoing treatment may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated. Oncologists have experience providing other types of vaccines to patients receiving treatment for cancer, including chemotherapy, immunotherapy, radiation therapy or stem cell transplantation. Strategies such as providing the vaccine in between cycles of therapy and after appropriate waiting periods for patients receiving stem cell transplants and immune globulin treatment can be used to reduce the risks while maintaining the efficacy of vaccination. Limited evidence is available regarding vaccination of patients with cancer receiving active treatment, but ASCO is aware of no study that has shown any safety concern for such patients with vaccination. See the question below “Should people who are immunocompromised received a third dose of the vaccine?” for information regarding people who are immunocompromised.
Should cancer survivors be vaccinated against COVID-19?
Cancer survivors may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated.
Are there people who should not be vaccinated?
At this time, only those with contraindications to a specific vaccine component should not be offered vaccination with that specific product. These contraindications are described in detail in CDC interim clinical guidance.
Should people who are immunocompromised received a third dose of the vaccine?
On August 13, 2021, the FDA reissued the Emergency Use Authorization for the Pfizer-BioNTech and Moderna mRNA vaccines to authorize a third dose of these vaccines in patients who have received solid organ transplants and for those considered to have an equivalent level of immunocompromise as solid organ transplant. Also on August 13, the CDC published new guidance recommending a third dose for patients who are moderately or severely immunocompromised, and includes (as of August 16) patients who have “been receiving active cancer treatment for tumors or cancers of the blood”.
ASCO recommends that patients with cancer discuss with their physician whether a third dose of vaccine is appropriate. The resources provided by Memorial Sloan Kettering Cancer Center are useful in determining levels of immunocompromise in patients with cancer and to help with prioritization for additional vaccine doses. The NCCN preliminary recommendations also provide some guidance on this topic.
What other concerns are there for people with cancer who are vaccinated?
There is some evidence that vaccination with mRNA vaccines prior to imaging may cause difficulties in the interpretation of the resulting images. A multidisciplinary group has published information on imaging in general in the context of COVID-19 vaccination: Becker et al, Radiology. The Society for Breast Imaging has published guidance on how these potential difficulties should be managed in patients with breast cancer.
The COVID-19 and Cancer Clinical Trials Working Group has published information on vaccination of patients who are seeking to participate in or enrolled in clinical trials (Desai et al, Nat Rev Clin Oncol).
The American Society of Hematology (ASH) has also released relevant information in “Immune Thrombotic Thrombocytopenia: Frequently Asked Questions.”
Dr. Julie Gralow, Chief Medical Officer of ASCO, answers common questions and concerns people with cancer have about the COVID-19 vaccines available in the United States.
CDC Advisory Committee on Immunization Practices
CDC is regularly updating the number of vaccines distributed and administered on their COVID-19 page. ACIP continues to convene emergency meetings as new information, evidence and clinical trial results are available. Materials from previous meetings and suggested dates and agendas for future meetings can be found on the CDC website.
HHS Expands Pool of Professionals Eligible to Administer COVID-19 Vaccines
On January 28, 2021, HHS added additional categories of qualified persons authorized to prescribe, dispense, and administer COVID-19 vaccines authorized by the FDA. This action authorizes any healthcare provider who is licensed or certified in a state to prescribe, dispense, and/or administer COVID-19 vaccines in any other state or US territory. It also authorizes any physician, registered nurse, or practical nurse whose license or certification expired within the past five years to prescribe, dispense and/or administer COVID-19 vaccines in any state or US territory so long as the license or certification was active and in good standing prior to the date it went inactive.
Please see this announcement for additional information, including training requirements and details on liability protections.
Resources from the American Medical Association
The American Medical Association (AMA) has produced several resources with helpful advice for clinicians regarding the COVID-19 vaccines. Please visit the links below for concise information on the vaccines as well as tips for how to discuss them with patients.
Resources from CDC
CDC has developed toolkits to assist clinicians providing or advising patients on the COVID-19 vaccine. Please visit the links below for additional resources:
Resources from the Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) COVID-19 page includes valuable information on coverage and reimbursement for vaccine administration. CMS’ Office of Minority Health (CMS OMH) has also developed a COVID-19 Vaccine Resources website of federal resources and organized them for health care professionals, partners, consumers, and for assistance in additional languages.
Disclaimer
Answers to questions about COVID-19 published herein are provided by the American Society of Clinical Oncology, Inc. (“ASCO”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ASCO provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ASCO website Terms of Use.
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