Oncologists can alleviate concerns about COVID-19 vaccination in cancer patients and survivors

February 8, 2021 Read 6 minutes Source / Disclosure The issuer: Disclosure: Pergam reports grant support from Global Life Technologies and participation in research trials by Chimerix, Merck and Sanofi-Aventis. Eichler does not report disclosure of financial information. Add topic to email alert Receive an email when a new article is posted Please enter your email address to receive emails when new articles are posted .. "data-action subscribe> subscribe The request could not be processed. Please try again later.If you continue to have this issue, please contact us customerservice@slackinc.com.. Return to Healio According to experts, oncologists are in an important position to provide cancer patients with potentially life-saving information about the COVID-19 vaccine. To assist oncologists and their patients, the National Cancer Network and the American Society of Radiation Oncology publish clinical guidance on the safety and efficacy of the COVID-19 vaccine for cancer patients and recovery from cancer. Did.Timing and immunosuppression are factors to remember, but NCCN waits 1-2 weeks for patients undergoing major surgery and until absolute neutrophil counts recover for patients undergoing intensive chemotherapy. It is recommended that patients undergoing stem cell transplantation or patients receiving chimeric antigen receptor T cell therapy wait for 3 months — according to the guidance, most cancer patients should prioritize vaccination. Stephen Purgum "We want to provide vaccines to these high-risk patients. There is a risk of COVID-19 complications, " Stephen Purgham, MD, MPH, He told Helio, the director of infection prevention at the Seattle Cancer Care Alliance, an associate professor at Fred Hutchin's Vaccines and Infectious Diseases Division, and co-leader of the NCCN's COVID-19 Vaccine Commission. "The cancer community feels very strong. People with immunosuppression should be at the earliest possible stage of the allocation layer due to the risk of complications. According to the data, 13% to 15% of patients who develop cancer can die of COVID-19. " Still, Pergam said he believes it must be "really difficult" for the average cancer patient to chase after a somewhat elusive vaccine. "They are dealing with chemotherapy, they have pain problems, they are a lot on their dishes," he said. "They are awake in the middle of the night to take the drug. There is nausea and vomiting .... And for some reason, they visit these websites and constantly update to ensure that they get the vaccine. It's supposed to be. It doesn't seem to be acceptable. " Basis for vaccination priorities Both NCCN and ASTRO recommendations suggest that cancer patients who are actively receiving treatment should be vaccinated in a timely manner and, if vaccine supply is limited, these patients. We recommend that you give priority. "For the very clarity, there is no information that vaccination will have any effect on their cancer treatment, cause cancer, or something strange," Pergam said. This recommendation is based on data suggesting that patients with active and inactive cancers are at risk of exacerbating COVID-19 outcomes. In observational studies JNCI cancer spectrum, Sun et al. Analyzed the records of 328 people who were positive for COVID-19, 67 of whom had cancer. Most of these patients (80.6%) had solid tumors and 26.9% had active disease. The results showed that patients with cancer and COVID-19 had higher hospitalization rates (55.2% vs. 29%), ICU admissions (25.7% vs. 11.7%), and 30-day mortality (13.4% vs. 1.6) than patients without cancer. %) Was high. .. The adjusted model showed a greater risk of these results among patients with active cancer, but patients in remission also remained at risk. Therefore, providers should also follow the guidance and encourage patients with inactive cancer and those who are not currently treated to be vaccinated. Specifically, ASTRO's guidance states that "individuals with a history of cancer who have not been actively treated are encouraged to seek vaccination whenever it becomes available." I will. According to a previously published observational study, more than half (56.4%) of cancer survivors in the United States reported additional underlying disease associated with an increased risk of severe COVID-19 disease. National Cancer Institute Journal.. Jiang et al. Found that the prevalence of these conditions, including chronic obstructive pulmonary disease, heart disease, diabetes, chronic kidney disease, and obesity, was nearly 40% higher in cancer survivors than in the general population. .. Cancer survivors also report multiple conditions, nearly a quarter of which report more than one condition. "It's hard to draw a clear line in the sand," Pergam said of priorities for patients with active and inactive cancers. Because the treatments they may have received and the risks of each are widespread. “Many cancer survivors may continue to be affected by the cancer, but they must definitely be in the vaccinated group,” Pergam said. “Patients receiving aggressive and continuous treatment are at the highest risk and should be prioritized. Within that group, other factors such as age and comorbidities should be considered. . " Expected question Experts spoken by Healio said oncologists should discuss the importance of vaccination between cancer patients and survivors. In other words, you should be able to answer common questions such as whether the vaccine is effective. Thomas Eichler "Most of these patients have a weakened immune system," said the ASTRO chair. Thomas Eichler, MD, Told Healio. "that is Will my prostate cancer patient be as good as I am? The answer is probably not.But At one medical conference, "History teaches us that if immunity is suppressed, you will not have that much protective response, but there is something better than nothing. And I fully agree with him. A 70% response may not be as good as a 95% response, but it is much better than a zero response. " Oncologists should also be ready to be asked about side effects. Eichler said the patient might ask, "Does this make me feel worse than I am now?" "It's interesting. The most common side effect is pain at the injection site," he said. "I had a colleague who had more serious side effects such as body pain, fever, and headache. There was no problem at all. It was a pleasant surprise. " According to Pergam, it is also important for healthcare providers to remind patients that they need to continue to take precautions after vaccination. "We need to remind patients and their families that vaccines aren't like concert tickets to get out into the community and get started," he said. "Vaccination is another layer of protection, but the standard approach to prevention is still very important. Masks, social distances, washing hands, avoiding large numbers of people and closed spaces It's still very important. Vaccinations may protect you, but you're still at risk, and you really want to protect your patients as much as possible. " Many pre-vaccination COVID-19 prophylaxis will be applied until the country reaches herd immunity. "You'll probably need to wear a mask after next year," Eichler said. Increased access For communities at risk for cancer patients, the first step is to get a vaccine. Last month, the Council of the Community Oncology Alliance wrote to the National Governors Association, the then presidential election. alreadyseph R. Biden JuniorCOVID-19 Task Force, and other government officials, seek preferential approval for local independent oncology practices COVID-19 vaccine For immunocompromised patients with cancer and blood disorders. The association said the availability of vaccines at cancer centers will help strengthen national efforts and reach vulnerable communities. Pergam sincerely agreed, but knows that such centers are not well-supplied and practitioners must help guide patients to vaccination sites. "Some communities have larger vaccination sites than others. I'm always a little cautious," Pergam said. "" Talk to your healthcare provider about where is the best place to get vaccinated, when is the best time to get vaccinated, and what the risks are with this particular type of treatment. .. These are all conversations you can have. " According to Pergam, when talking to patients, healthcare providers also need to attend household members who care for them on a regular basis. Caregivers are in direct contact with people with cancer and should also be vaccinated. “The primary caregiver is important to help cancer patients,” Pergam said. "Protecting people around an individual from COVID-19 infection can also protect patients." reference: American Society of Radiation Oncology. COVID-19 Clinical guidance. available: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/Clinical-Guidance.. Accessed on February 4, 2021.Community Oncology Alliance. Oncologists request approval to carry out COVID-19 vaccination. available: https://communityoncology.org/coa-comments-on-oncologists-request-approval-to-administer-covid-19-vaccinations/.. Accessed on February 5, 2021.Jiang C et al. J Natl Cancer Inst.. 2021; doi: 10.1093 / jnci / djab012.National Comprehensive Cancer Network. NCCN: Cancer and COVID-19 vaccination. available: www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf.. Accessed on February 4, 2021.Sun L, et al. JNCI cancer Spectrum.. 2021; doi: 10.1093 / jncics / pkaa120. For more information: Thomas Eichler, MD, Tomas.eichler @ hcahealthcare.com. Stephen Pergum, MD, MPHYou can contact spergam @ fredhutch.org. Add topic to email alert Receive an email when a new article is posted Please enter your email address to receive emails when new articles are posted .. "data-action subscribe> subscribe The request could not be processed. 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