New guidance from the Medical Oncology Group of Australia (MOGA) provides a strong recommendation for COVID-19 vaccination for all people with cancer, albeit with a few special considerations and areas of uncertainty.
In a position statement, MOGA says that all patients with solid tumours should receive COVID-19 vaccination at the earliest opportunity, except for those with a contraindication such as a history of allergic reaction to vaccine components.
The guidance notes that people with cancer are at greater risk of serious complications and death from SARS-CoV-2 infection compared to the general population, and that risk factors for serious complications include older age, male gender, smoking status, comorbidities and ECOG performance status.
“In general, the priority for vaccination should be for people with active cancer and people on cancer therapy (except if receiving hormonal therapy only).”
MOGA says the evidence shows that COVID-19 vaccines are effective and safe for patients with cancer, and vaccination should not be withheld because patients are receiving anti-cancer therapy such as cytotoxic chemotherapy or immunotherapy.
However it does acknowledge that there may be specific circumstances for tailoring the timing and selection of vaccines for patients with cancer who may be immunosuppressed.
For example, people with cancer should ideally receive COVID-19 vaccination at least two weeks prior to their commencement of a course of chemotherapy, it advises. And for people already receiving treatment, vaccination may be timed in between the chemotherapy cycle, to avoid the nadir period where possible.
“This is due to the expectation that that blood count recovery would parallel improved immune function and potentially greater immune response from vaccination,” it says.
Since COVID-19 vaccination side effects such as fever are expected at two-three days post vaccination – and with potential intensification of side effects following the second dose – systemic anti-cancer therapy should be avoided at this time.
Lymphadenopathy may develop after COVID-19 vaccination and this must be differentiated from disease progression in people with cancer, MOGA advises. Similarly, mammograms should be scheduled away from COVID-19 vaccination, where possible, to avoid false positive findings from vaccination induced lymphadenopathy.
The MOGA guidance acknowledges that there are still some uncertainties about immune response to vaccine and duration of response in immunosuppressed people, and it is not yet known whether boosters will be required.
“Given people with cancer have an attenuated response to immunisation, they should ideally be prioritised for the higher efficacy vaccines. However, the choice of vaccine candidate may ultimately be dictated by supply,” it states.
MOGA also provides guidance on vaccination for people with advanced incurable cancers with limited life expectancy, and also on how vaccination may affect clinical trial participation.