Analysis

COVID-19 vaccination for people with cancer: what you need to know

We answer your questions about COVID-19 vaccinations for people with cancer
Covid vaccination being given

We answer your questions about COVID-19 vaccination for people with cancer

  • As the UK vaccination programme continues, people who are extremely clinically vulnerable – including people with cancer – are expected to receive their first vaccination by 15 February
  • We examine the vaccine approval process, safety concerns, whether the vaccine is safe to have while receiving cancer treatment, possible side effects and the vaccination priority list set out by the government
  • Advice from cancer organisations and what you should tell your patients to allay any fears about having the vaccine

Vaccines protecting against COVID-19 offer hope that the pandemic will finally be brought under control.

But in cancer care,

We answer your questions about COVID-19 vaccination for people with cancer

  • As the UK vaccination programme continues, people who are extremely clinically vulnerable – including people with cancer – are expected to receive their first vaccination by 15 February
  • We examine the vaccine approval process, safety concerns, whether the vaccine is safe to have while receiving cancer treatment, possible side effects and the vaccination priority list set out by the government
  • Advice from cancer organisations and what you should tell your patients to allay any fears about having the vaccine
Picture: Alamy

Vaccines protecting against COVID-19 offer hope that the pandemic will finally be brought under control.

But in cancer care, questions may arise about how patients can access the vaccine safely without compromising any treatment they are having.

Here we set out what nurses need to know so they can address patients’ concerns.

What vaccines have been approved so far?

At the time of writing, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved three COVID-19 vaccines, saying that they all meet required standards.

-70°C

Temperature the Pfizer/BioNTech vaccine must be stored at

The first to be approved was the Pfizer/BioNTech vaccine in early December, followed by the Oxford University/AstraZeneca vaccine on 30 December and the Moderna vaccine on 8 January.

The vaccines work in slightly different ways but produce the same effect, provoking the immune system to provide an immune response to the virus. In trials involving tens of thousands of participants, the vaccines were found to be up to 95% effective.

A major difference between the products is that the Pfizer/BioNTech vaccine must be stored at extremely low temperatures, -70°C, to prevent it from degrading. The Oxford/AstraZeneca vaccine can be stored in a fridge and the Moderna vaccine at temperatures similar to a normal freezer – about -20°C.

How were the vaccines approved so quickly?

The MHRA is the UK regulator for medicines, medical devices and blood products. Its approval process for the Pfizer/BioNTech vaccine began in October 2020 when a team of MHRA scientists and clinicians initiated rigorous analysis of all the available data from trials of the vaccine.

A ‘rolling review’ was used for this regulatory process. Rolling reviews allow for rapid assessment of products that show promise during public health emergencies. Packages of data are analysed as they become available from ongoing studies.

June Raine, chief executive of the Medicines and Healthcare products Regulatory Agency
June Raine

But there was no question of safety being compromised, says MHRA chief executive June Raine.

‘Our expert scientists and clinicians worked tirelessly around the clock, carefully, robustly and rigorously poring over hundreds of pages and tables, methodically reviewing the data.’

She adds: ‘The public’s safety has always been at the forefront of our minds – safety is our watchword.’

So are the approved vaccines safe to give to people living with cancer?

‘We are confident that the vaccines are safe for people living with cancer,’ says Macmillan Cancer Support’s senior cancer information nurse Allan Harper-Reid.

‘This is because they have been approved by the MHRA, which means they have met strict standards for safety, quality and effectiveness.’

He refers cancer nurses and patients to the information on coronavirus vaccines available on the Macmillan Cancer Support website.

It points out that because chemotherapy can lower a patient’s immunity, problems may arise if a ‘live’ vaccine is given. A ‘live’ vaccine is produced using a weakened form of the virus, but this is not the case with coronavirus vaccines, which means the vaccines can be given ‘before, during or after cancer treatment’, says Mr Harper-Reid.

He adds, however, that in patients undergoing chemotherapy and other cancer treatments, inoculation against coronavirus may be slightly less effective than in other population groups.

‘But it is still expected that the vaccine will provide some useful protection against the virus.’

Blood Cancer UK clinical trials nurse adviser Helen McNaught says: ‘Our advice to blood cancer patients is twofold. First, on the basis of the information we’ve been given by NHS England, the Joint Committee on Vaccination and Immunisation (JCVI) and from across the haematology consultant field, blood cancer patients absolutely must receive the vaccine.

‘And second, it’s important for them to speak to their treating teams about any individual risk.’

Public Health England states that only a ‘very small number of people’ cannot have the coronavirus vaccine and it includes those with severe allergies. There is no evidence so far that pregnant women should not be vaccinated, but more data is needed before they can be routinely offered the vaccine.

Can patients have the vaccine while undergoing cancer treatment?

The Cancer Research UK website includes information for patients about having the coronavirus vaccine while receiving systemic anti-cancer therapy (SACT).

It states: ‘Specialists say that everyone having SACT should be considered for the vaccine. Your cancer treatment can also go ahead if you’ve had the vaccine and there’s no need for it to be delayed because of it.’

Picture shows woman with mask looking out of a hospital window
Picture: iStock

And in frequently asked questions (FAQ) for clinicians, the UK Chemotherapy Board (UKCB) says that although none of the coronavirus vaccines have been trialled in people receiving SACT, the ‘overall consensus’ is that having the vaccine outweighs the risks for those patients.

In addition, people who are receiving or have received radiotherapy as part of their treatment can be vaccinated against coronavirus, Mr Harper-Reid says.

And the vaccines can also be given to those having hormonal therapies – for example, as treatment for prostate or breast cancer.

Mr Harper-Reid adds: ‘Experts on cancer immunotherapy have recommended that people on immunotherapy should receive the COVID vaccines.

‘And they can also be given to people who are receiving or who have received targeted therapies, including antibody treatments, as part of their therapy.’

He recommends that patients with cancer undergoing stem-cell transplant should talk to their healthcare team about the best time for them to be vaccinated.

Blood Cancer UK says current thinking among specialists is that people who have had a transplant, whether allogenic or autogenic, should be able to receive the coronavirus vaccine three to six months after the transplant took place.

‘They think at this stage people may be able to produce some response to the vaccine, giving them some protection,’ the charity’s website states.

What about side effects?

Most side effects associated with the vaccines are mild and short term, according to Public Health England. They include tenderness in the arm in which the vaccine is given, headache, fatigue and mild flu-like symptoms.

If patients do develop mild side effects after their first dose, they should still be encouraged to have the second because it will offer longer-lasting protection.

Ms McNaught says that at this stage in the vaccination programme, the concern for patients with blood cancer is less about side effects and more about whether the coronavirus vaccines have the same efficacy in those patients as in the rest of the population.

‘Unfortunately, the data is not there because the vaccine has not been particularly trialled in this group of people.’

When will people with cancer be vaccinated?

The 1.2 million people in the UK who are extremely clinically vulnerable are among those who should have received their first dose of the vaccine by 15 February along with other priority groups.

Peer vaccinators at The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead
Peer vaccinators at The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead

But the JCVI says that immunocompromised individuals ‘may not respond as well to the vaccine’. Therefore after vaccination, they should continue to follow advice on reducing the risk of infection along with the rest of the population.

Further evidence regarding each vaccine will accrue during the vaccination programme, including whether any specific product is preferred for people with a suppressed immune system.

Ms McNaught of Blood Cancer UK says there are ongoing discussions about whether family members of a patient with cancer should be vaccinated at the same time.

4 January 2021

Date vaccination programme for all UK health and social care staff was fully rolled out

‘Even if you have the vaccine, it’s not a 100% prevention against you contracting COVID-19.

‘The hope is you would have a lesser response but there’s a huge clinical argument for family members of blood cancer patients to be vaccinated as well.’

All patients aged 16 to 64 with underlying health conditions, including some cancers, are expected to be vaccinated by April.

But deciding how to prioritise who gets the vaccine is a complex task, says Mr Harper-Reid.

‘The JCVI will have taken many relevant factors into consideration. We want to make sure the rationale is clear for people with cancer.

‘The priority for the first wave of the roll-out of the vaccine was to vaccinate all those at the highest risk of dying if they contract coronavirus.’

How can cancer nurses allay any fears patients have about vaccination?

All the available evidence confirms the safety of the coronavirus vaccines.

Blood Cancer UK clinical trials nurse adviser Helen McNaught says the advice to patients should be to take up the offer of the vaccine, with any particular concerns discussed with the clinical team.

Other charities offering support to people living with cancer, including Prostate Cancer UK and Breast Cancer Now, have also advised that the vaccines are safe. But both organisations encourage patients to speak to their clinicians if they have concerns about being vaccinated while undergoing chemotherapy.

In the longer term, if the vaccines are shown to work well in people with cancer and whose immune system is compromised, current risks and anxieties related to attending hospital appointments may be reduced.

How can people with cancer access the vaccine?

The NHS is discouraging people from contacting their GP to ask when they will be vaccinated. Instead, they should wait for a notification by letter, phone call or text message.

9

priority groups for the first phase of the UK COVID-19 vaccine programme

Source: Joint Committee on Vaccination and Immunisation

Vaccinations are being offered at large, repurposed venues, such as sports stadiums, as well as hospital hubs and via local services such as surgeries and pharmacies. All venues will be COVID-secure. The UK COVID vaccines delivery plan promises ‘safe, convenient and equitable access’ following the JCVI cohort prioritisation plan.

The UKCB FAQ document addresses the issue of when the vaccine should be given during a SACT cycle.

It says there is some evidence from research into the flu vaccine that administration on the same day as chemotherapy reduces the vaccine’s effectiveness. At this stage, it is not clear whether the same is true of the COVID-19 vaccine.

The UKCB document says: ‘As a suggestion, patients could receive the vaccine when they attend for a pre-chemotherapy outpatient appointment (if this is different to the day of SACT administration).’

When will nurses working in cancer care get the vaccine?

Front-line health workers are one of the top priority groups for vaccination so should all receive a first dose by the middle of February.

In a chapter on COVID-19, the NHS Green Book, which collates information on immunisation against infectious diseases, says ‘front-line’ staff are those ‘who have frequent face-to-face clinical contact with patients and are directly involved in patient care’. Hospice nurses are included in that definition.

The RCN recommends that while vaccination of health and care staff should not be mandatory, all nurses and midwives should have the vaccine to protect themselves and their patients as well as the wider community.

The Nursing and Midwifery Council (NMC) says professionals have a responsibility to maintain their own health and should take reasonable precautions to avoid potential health risks to others.

‘We would expect the majority of professionals on our register to be vaccinated,’ the NMC states.

View our COVID-19 resource centre

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