Should people with cancer be vaccinated against COVID-19?
Patients with cancer may be offered vaccination against COVID-19 as long as components of that vaccine are not contraindicated. Appendix B, Appendix C, and Appendix D of the CDC’s Interim Clinical Considerations provide details on vaccine components and potential contraindications. See the question below “Should people who are immunocompromised receive an additional dose of the vaccine?” for information regarding people who are immunocompromised.
The three COVID-19 vaccines authorized and recommended in the United States are: 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.
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 the 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 receive 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?
Only those with contraindications to a specific vaccine component should not be offered vaccination with that specific product as recommended by the CDC. These contraindications are described in detail in CDC interim clinical guidance.
Should people who are immunocompromised receive an additional dose of the vaccine beyond what is recommended for persons who are not immunocompromised?
The CDC has published guidance recommending an "additional primary" dose of some vaccines for patients who are moderately or severely immunocompromised. That includes patients who have “been receiving active cancer treatment for tumors or cancers of the blood”. This is supplemental to, and would precede, the “booster” dose that is currently recommended for nearly everyone who received primary vaccination, regardless of immune status. These recommendations can change rapidly and should be reviewed regularly. As of February 4, 2022, the CDC guidance would allow for at least some immunocompromised individuals to receive four total doses of vaccine, depending on the vaccine used and context.
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 this concern can be managed, available on their COVID resource page.
The COVID-19 and Cancer Clinical Trials Working Group has published information on the vaccination of patients who are seeking to participate in or enrolled in clinical trials (Desai et al, Nat Rev Clin Oncol).
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.
Resources from CDC
CDC has developed toolkits to assist clinicians in 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.