NCCN Guidance on Safety and Effectiveness of COVID-19 Vaccines for Cancer Patients

NCCN Guidance on Safety and Effectiveness of COVID-19 Vaccines for Cancer Patients from Patient Empowerment Network on Vimeo.

Is the COVID-19 vaccine recommended for people living with cancer? Dr. Erin Roesch shares recommendations from the National Comprehensive Cancer Network (NCCN) for those undergoing cancer treatment, including guidance on mask wearing and advice for family members.

Dr. Erin Roesch is a breast medical oncologist at the Cleveland Clinic. Learn more about Dr. Roesch here.


Transcript:

Katherine: 

Many cancer patients have questions about the COVID vaccine. Is it safe? Do we need to continue wearing masks? Here to address these questions is cancer expert, Dr. Erin Roesch. Dr. Roesch, would you introduce yourself?

Dr. Roesch: 

Hello. And thank you for inviting me to participate in this very important conversation. My name is Erin Roesch. I am a breast medical oncologist at Cleveland Clinic.

Katherine: 

Excellent. Thank you so much for joining us today. I’d like to run through a list of concerns that cancer patients have about vaccines in general and the COVID vaccine specifically.

So, let’s start with a basic question. Should people get vaccinated if they have cancer?

Dr. Roesch: 

Yes. All individuals diagnosed with cancer should get the COVID-19 vaccine as recommended by the National Comprehensive Cancer Network or NCCN.

An immunocompromised state makes many people with cancer at higher risk of serious COVID-19 illness. Those who are vaccinated are less likely to become sick with COVID-19. And, also, vaccinated people who do get COVID-19 are much less likely to become seriously ill.

I would also mention that those living in the same household as a person diagnosed with cancer and caregivers or other close contacts should also get vaccinated.

Katherine: 

Another common question is whether people with cancer should wait for any reason to get the COVID-19 vaccine.

Dr. Roesch: 

Most people with cancer should get the vaccine as soon as they can with a few exceptions according to NCCN.

People in the process of receiving stem cell transplant or cellular therapy should wait at least three months after they finish treatment to get vaccinated.

Those diagnosed with certain forms of leukemia should also wait a few weeks after receiving treatment to allow their immune system to recover so the vaccine can be effective.

It’s not been clearly defined exactly how chemotherapy affects responses to COVID-19 vaccines. But some data suggests that immune responses may not be as robust. However, it is still recommended that those receiving chemotherapy and also immunotherapy and radiation should get vaccinated whenever they can.

Katherine:

I think a lot of people are concerned too about whether one vaccine is better than another. What would you say to them?

Dr. Roesch:

And that is a common question that I often get in my clinic. And I advise my patients to receive or take whatever vaccine they are offered.

We don’t really have any studies or data at this point suggesting one being better than another in cancer patients.

Katherine: 

Some people are wondering if the vaccine can give a person COVID-19. How would you address that?

Dr. Roesch: 

I would say that as none of the currently available vaccines are made with a live virus, the vaccine itself can’t give a person COVID-19. By getting vaccinated, actually, those who are immunocompromised are really helping society to prevent the spread of COVID-19. Immunocompromised people who get COVID-19 may be more likely to infect others due to prolonged shedding of the virus after infection.

Katherine:

What about side effects? Are the vaccine’s side effects worse for people with cancer?

Dr. Roesch:  

No. Side effects do not appear to be worse for those diagnosed with cancer. Results to date suggest that the vaccine’s side effects in people with and without cancer are really no different.

These side effects, as we have seen, may include arm soreness, rash, fatigue, chills, fever, headache, for example.

Katherine: 

And, finally, can cancer patients stop wearing a mask after they’ve been vaccinated?

Dr. Roesch:

Cancer patients should continue to wear a mask post-vaccination. Many people with cancer may have a harder time actually fighting infections and may not respond as well to vaccines. So, people diagnosed with cancer and their close contacts should get vaccinated and then continue to follow precautions, which include wearing masks, social distancing, hand hygiene.

Katherine:

Is there a certain length of time that people need to continue wearing a mask after being vaccinated?

Dr. Roesch:  

At this time, I would recommend patients continue to follow the CDC guidelines that are currently in place. And at this point, I don’t think we have a projected end time for that yet.

Katherine:    

Is there anything else you’d like to share with cancer patients who may be concerned about vaccinations?

Dr. Roesch:    

I would encourage those diagnosed with cancer to not only themselves get vaccinated but to also really voice and stress the importance of vaccination to those that surround them, including, again, members of their household, close contacts, and even beyond their inner circle.

I would also advise people to try and avoid letting the concern of possible side effects related to the shot deter them from getting it. The symptoms of COVID-19 can be much worse and potentially serious for some compared with the relatively minor side effects that we’ve seen with the vaccine itself.

I also would mention I’ve had personal patients that have expressed concern about functioning of their immune system while receiving chemotherapy and how this might affect their response to the vaccine. I do emphasize to them that even though responses might not be as strong as they may be in the absence of active treatment, I feel like the potential benefits of the vaccine still outweigh the risks in my mind.

Katherine:   

Thanks so much for joining us today, Dr. Roesch.

Dr. Roesch:

Thank you for having me.

What Factors Help Guide Metastatic Breast Cancer Treatment Decisions?

What Factors Help Guide Metastatic Breast Cancer Treatment Decisions? from Patient Empowerment Network on Vimeo.

What treatment is best for your metastatic breast cancer? Dr. Halle Moore of Cleveland Clinic reviews important considerations when choosing a therapy, including the role of molecular testing.

Dr. Halle Moore is Director of Medical Breast Oncology at the Cleveland Clinic. Learn more about Dr. Moore, here.

See More From Engage Breast Cancer

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Transcript

Dr. Halle Moore:

For patients with advanced breast cancer, some of the major factors that affect our treatment decisions are first the receptor results. This includes the ER and PR, which are the hormone receptors, as well as HER2. These receptors really guide the initial treatment options.

In addition, the patient’s overall health status is an important factor in treatment decisions. And then the prior treatment history, what the patient has previously received, either in an earlier stage of disease or previously for their advanced cancer.

Molecular testing for metastatic breast has gone from something that was primarily used only in the research setting to something that is now quite valuable in making treatment decisions every day in the clinic.

The results of molecular testing may indicate whether our patients are eligible to receive certain treatments, such as immunotherapy or certain targeted cancer treatments. We also have an increasing number of clinical trials that are testing treatments targeted to the molecular drivers of an individual’s cancer.

I would say one of the most interesting new approaches in the treatment of metastatic breast cancer is the use of antibody drug conjugates. These combine an antibody against a target that’s likely to be present on cancer cells more so than on normal cells in the body.

And, typically, a very potent chemotherapy drug is combined with the antibody. The antibody then allows for delivery of a high concentration of this chemotherapy drug preferentially to the cancer cells allowing for very effective treatment of the cancer while limiting toxicity from the treatment to the rest of the body.

COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know?

COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know? from Patient Empowerment Network on Vimeo.

Is it safe to get the COVID-19 vaccine if you have breast cancer? Dr. Halle Moore of Cleveland Clinic provides valuable insight, including a discussion of side effects and the importance of staying up-to-date with visits and screenings.

Dr. Halle Moore is Director of Medical Breast Oncology at the Cleveland Clinic. Learn more about Dr. Moore, here.

See More From Engage Breast Cancer

Related Programs:

What Factors Help Guide Metastatic Breast Cancer Treatment Decisions?

What Do Breast Cancer Patients Need to Know About COVID?

Are You Prepared for Your Breast Cancer Appointment? Expert Tips.


Transcript

Dr. Halle Moore:

For most adults with cancer or with a history of cancer, vaccination against COVID-19 with one of the newly approved vaccines is definitely recommended.

Common side effects after the COVID vaccinations are a sore arm, which is probably one of the most common side effects that we see. Fatigue and muscle aches can occur. Also, some patients will experience fever and chills, and that seems to be especially after the second dose of the vaccine. Rarely, severe allergic reactions can occur. And also, some people will experience enlargement of lymph nodes, typically in the underarm area or in the neck on the side of the vaccination.

This is particularly important for cancer patients to be aware of since enlarged lymph nodes could also be seen with cancer, and that might be alarming to some patients if they experience this side effect without knowing that that is a normal immune response to the vaccine.

In addition, cancer patients who are getting imaging, either a CAT scan or even a routine mammogram, if they get that imaging soon after the vaccine, the lymph nodes could be seen on imaging, and that might raise a concern as well. So, it’s important that patients let their provider know if they’ve had a recent vaccine and they’re getting any kind of imaging or mammogram.

So, breast cancer patients who are on chemotherapy or other treatments that could affect the immune system should definitely discuss with their oncology team the timing of vaccination with respect to their treatments.

This often needs to be individualized based on the planned duration of the cancer treatment as well as how much that treatment actually affects the immune system. In general, it is safe to get the vaccine during chemotherapy. It’s just that there may be a potential for reduced immune response during certain types of chemotherapy.

On the other hand, some chemotherapies are given more long term. And we don’t generally advise interrupting the chemotherapy for vaccination. So, oftentimes, we will recommend vaccination even in the setting of cancer treatment. Certainly, anti-estrogen treatments, hormonal treatments for breast cancer, or radiation treatment for the breast cancer should not alter either the safety or the effectiveness of these vaccines.

So, some of the ingredients in the various vaccinations that have led to these allergic reactions that we’ve heard about are also present in certain chemotherapy drugs. So, for people who have had a life-threatening reaction to chemotherapy, for instance, an anaphylactic reaction, it would be a good idea to discuss with your oncologist whether you should see an allergist prior to vaccination. This is something that we’re recommending for patients who’ve had severe allergic reactions to try to determine what component the reaction was to and whether vaccination with any of the individual vaccines might be safest.

Delaying care for non-COVID-related health concerns has been a major concern over the past year. It’s important for people to know that hospitals and medical clinics have numerous safety precautions in place. And we are really strongly encouraging everyone to continue to address all of their healthcare needs and to receive important treatments, particularly cancer treatments.