A Q&A with Guilherme Cantuaria, M.D., Ph.D., chairman, Northside Hospital Cancer Program, and Paul Gill, M.D., Atlanta Cancer Care
The National Comprehensive Cancer Network (NCCN) COVID-19 Vaccination Advisory Committee released preliminary recommendations in January for patients with cancer. Please provide a general overview of their recommendations.
Due to the increased risk of complications from COVID-19, patients with active solid tumor cancer should be prioritized for vaccination and should be immunized when the vaccine is available to them. Immunization is also recommended for all patients receiving active therapy.
For patients with hematologic malignancies receiving active therapy, there are no vaccine data available at this time. Generating data for this population is a research priority, especially in the setting of active cancer therapy. There are no known safety concerns associated with the potential use of COVID-19 vaccines in patients undergoing cancer care, but vaccine efficacy in the setting of cancer care with a weakened immune system is unknown.
Are there any special considerations for patients with hematologic malignancies versus patients with solid malignancies?
In patients with solid malignancies, the NCCN has more or less universally recommended vaccination regardless of tumor type or treatment status. This means that even if you are actively receiving treatment for your cancer, the NCCN still recommends getting the vaccine when it becomes available.
In patients with hematologic malignancies, this is also the case as recommended by the NCCN with the exception being patients who are actively receiving induction chemotherapy for acute leukemia, patients undergoing bone marrow transplant (BMT) and patients undergoing a novel cellular therapy, such as CAR-T. For these special instances, there are nuances in terms of vaccine timing.
Are there any special considerations for patients currently in treatment, immediately post-treatment or receiving a specific type of treatment?
For solid tumors, patients receiving cytotoxic chemotherapy, targeted therapy, checkpoint inhibitors and immunotherapy should get the vaccine as soon as it is available to them. For patients undergoing major surgery, we recommend getting the vaccine at least one week before the scheduled surgery and no sooner than two weeks after surgery.
The NCCN recommendation does list a few exceptions to their recommendations, specifically in patients with acute leukemia or who are undergoing BMT or cellular therapy (see Table). Outside of these unique populations, all other patients with hematologic malignancies should be vaccinated whenever the vaccine becomes available to them regardless of treatment status.
Discuss the recent information and recommendations surrounding the timing of the COVID-19 vaccine and screening mammograms or lymph node swelling.
The Society of Breast Imaging (SBI) states that women who have recently been vaccinated could have swelling and a lump in the lymph nodes of their armpit, which can be mistaken as a sign of breast cancer. Although not common, this is considered a normal immune system reaction to the vaccine. If possible, and it does not delay care, patients should consider scheduling screening exams before the first dose or 4-6 weeks following the second dose.
Should patients with cancer and survivors continue to wear masks and maintain social distancing guidelines after being fully vaccinated?
According to the Centers for Disease Control and Prevention (CDC), after being fully vaccinated, everyone should continue to wear a mask over their nose and mouth, stay at least six feet away from others, avoid crowds, avoid poorly ventilated spaces and wash their hands often. We do not yet know whether getting a COVID-19 vaccine will prevent the spreading of the virus, and we do not know how effective the vaccines are against the multiple variants that have emerged.
What is the best way for a patient with cancer or survivor to register to receive a COVID-19 vaccine?
Patients who meet the CDC criteria should contact their Northside Hospital physician and make an appointment to get their vaccine at one of Northside's vaccination locations. For patients that do not meet the CDC criteria, we suggest going through sites outside of the Northside system that are available to the general public.
Where can I find out more information about the vaccines and possible side effects?
Please visit the Georgia Department of Public Health for more information about the vaccine, current eligibility and the rollout to the community.
Learn more about Northside's COVID-19 response and latest vaccine updates.
