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Should cancer patients get the COVID-19 vaccine?

Washington University surgeon Ryan Fields, MD, delivers the COVID-19 vaccine to a colleague. Photo by Matt Miller Washington University surgeon Ryan Fields, MD, delivers the COVID-19 vaccine to a colleague. Photo by Matt Miller

In December 2020, U.S. Food and Drug Administration (FDA) issued emergency use authorizations (EUAs) for two COVID-19 vaccines, one developed by Pfizer-BioNTech and the other by Moderna. It is unknown when vaccines will be made available to patients or the public but as vaccinations have rapidly begun across the U.S., questions have arisen as to whether cancer patients should be given either vaccine.

We strongly recommend that patients discuss risks and benefits of the COVID-19 vaccine with their oncologist.

The information below represents a compilation of current opinions of physicians and other experts at Washington University School of Medicine in St. Louis, Siteman Cancer Center and BJC HealthCare related to COVID-19 vaccines for cancer patients.

Why should I consider getting the COVID-19 vaccine?

We’ve already seen in this pandemic that if cancer patients get COVID-19, they are at higher risk for complications, hospitalizations and even death compared to healthy people. That’s because cancer patients in active treatment can have a suppressed immune system, which makes it harder for them to fight off diseases such as COVID-19. Based on current consensus among physicians and other experts at Washington University School of Medicine in St. Louis, Siteman Cancer Center and BJC HealthCare, we recommend that cancer patients who have completed their course of treatment get the vaccine. Cancer patients who have not completed their treatment should discuss risks and benefits with their oncologist.

Should I be concerned about the COVID-19 vaccine?

Cancer patients and those with compromised immune systems were not included in the large clinical trials that demonstrated the safety and effectiveness of the two approved COVID-19 vaccines. In studies on other vaccines, such as influenza and pneumonia, however, it was found that those vaccines offered a degree of protection that warrant their use by cancer patients.

Do the COVID-19 vaccines contain a live virus?

No. These two vaccines use a synthetic version of messenger RNA, or mRNA, to produce an immune response. These mRNA vaccines are a new class of vaccines, but they have been rigorously studied for more than a decade. The vaccines do not contain a live virus and do not interact with your DNA. We do not recommend that cancer patients receive any vaccine that has a live virus. Such live virus vaccines include measles-mumps-rubella (MMR) and varicella (chickenpox) vaccines as well as the nasal mist version of the flu vaccine. The standard flu shot does not contain live virus and is safe for cancer patients to receive.

What if I’m just about to start cancer treatment?

The decision in this case should be made in consultation with your oncologist because the answer will be determined by when and how fast your cancer treatment needs to start.

Should I get the vaccine if I’m in the middle of my cancer treatments?

It depends on what type of cancer treatment you are receiving, which is why we strongly recommend talking with your oncologist. But, in general, these are our recommendations for patients undergoing:

  • Chemotherapy – We recommend that patients who are completing their chemotherapy in the next two to three months delay getting their COVID-19 vaccination until treatment is completed. For those who have longer-term regimens, there is some thought that it would be beneficial to receive the COVID-19 vaccine in between rounds of chemotherapy. That means you could get the first or second COVID-19 shot two weeks prior to a round of chemotherapy, which is the same recommendation for anyone receiving the flu vaccine.
  • Radiation Therapy – You should be able to receive the COVID-19 vaccine at any time, but we would recommend talking with your radiation oncologist first.
  • Bone Marrow/Stem Cell Transplant – We recommend that patients delay the COVID-19 vaccination until one to three months after transplant to maximize a good response to the vaccine. We would delay administering the COVID-19 vaccine further if there is a significant drop in immunosuppression in the near term if you are placed on steroids.
  • Immunotherapy – We recommend that you talk with your oncologist about the timing for receiving the COVID-19 vaccine.
  • Chronic Oral Immunosuppressive Medication – If you are not on active treatment but still take chronic oral immunosuppressive medications, we recommend that you get the COVID-19 vaccine.

How do I get the vaccine?

BJC HealthCare and Washington University Physicians are working quickly to make the COVID-19 vaccine available to those who are eligible in accordance with federal and state guidelines. You may pre-register for the vaccine at bjc.org/coronavirus/covid-19-vaccines. They will contact you when your eligibility window opens, and when vaccine supply and distribution capacity are available. It could be several weeks or longer before you are able to schedule. Counties and other health systems also have websites where you may pre-register.

You may pre-register on multiple sites. We recommend that you accept the first opportunity provided to receive a vaccine – after you and your oncologist have discussed when you should receive it. For more information, visit physicians.wustl.edu/for-patients/caring-during-covid-19/covid-19-vaccines.

Should cancer patients who have recovered from COVID-19 receive the vaccine?

The vaccine is recommended in this setting once patients have recovered. For patients who have received convalescent plasma or monoclonal antibodies, we recommend they wait for three months after receiving convalescent plasma or monoclonal antibodies before they receive the vaccination. This is because COVID-19 antibodies are likely to impair vaccine response.

If my child is being treated for cancer, can he or she get the COVID-19 vaccine?

At this time, no COVID-19 vaccine is available for anyone younger than 16.

Should my family get the COVID-19 vaccine?

Yes. We recommend that family members in good health get the vaccine when it is available to them. This will better protect you while you are in treatment.

Should I still wear a mask and socially distance?

Yes. No vaccine is 100 percent effective. Therefore, it is important to minimize your risk of getting COVID-19 as much as possible. We recommend that you and those you are in close contact with wear a mask in public, wash your hands frequently, sanitize touched surfaces and try to maintain a small “bubble” of family members that you see.

Additional information for these recommendations comes from the Centers for Disease Control and Prevention (CDC), American Medical Association, American Society of Clinical Oncology (ASCO), American Society of Hematology (ASH) and Infectious Diseases Society of America.