Patients With Cancer and Survivors Wary About COVID-19 Vaccinations

Gwen Nichols, MD

In the United States, 1 in 3 patients with cancer and cancer survivors are unlikely to get or are unsure about getting a vaccine for COVID-19, according to a survey from The Leukemia & Lymphoma Society (LLS).¹

Information about COVID-19 vaccination hesitancy was the result of a survey of 6516 individuals who either had cancer or were cancer survivors.2 The survey was conducted by LLS in collaboration with Boston University Questrom School of Business, and The Behaviouralist, a London-based research consultancy. These results add to the issues of patients with cancer and cancer survivors currently struggling to receive vaccines.

"These findings are worrisome, to say the least," said Gwen Nichols, MD, chief medical officer, LLS, in a statement. "We know cancer patients–and blood cancer patients, in particular–are susceptible to the worst effects of this virus. All of us in the medical community need to help cancer patients understand the importance of getting vaccinated."

The concern experts have with the cancer population not being vaccinated is that prior research has shown that those with hematologic malignancies, if hospitalized for COVID-19, have a high probability of death. One study showed that patients with hematologic malignancies had a mortality rate of 53% versus 34% for solid tumors. However, both patients with solid tumors and those with hematologic malignancies had significantly higher mortality rates when hospitalized for COVID-19 when compared with the general population (2.7%).³

The survey is the largest known survey inquiring about attitudes towards COVID-19 vaccines in patients with cancer and cancer survivors. Participants were patients with cancer and cancer survivors from the LLS database who were surveyed online in December 2020.^1,2

Of the participants, 59.8% were female, 86.5% identified as White, 70% had an Associate’s degree or higher, and the average age was 64 years.

Fifty percent of participants indicated that there were very likely to get a COVID-19 vaccine and 20% were likely.

Participants were also probed about their reasons for being hesitant about getting vaccinated for COVID-19 and the majority of individuals expressed concern about the adverse effects of the vaccines (54%) and fear that the vaccines did not go through proper testing (54%).

According to LLS, there is no research to suggest that any COVID-19 vaccine is unsafe for patients with hematologic malignancies. There is some evidence, though, pertaining to immune responses being less different for those with hematologic malignancies compared with others. This is somewhat due to the fact that patients with cancer were predominantly excluded from COVID-19 clinical trials.¹

Reportedly, the exclusion has continued for the cancer community, even though there are now 3 vaccines for COVID-19 that have been granted Emergency Use Authorization by the FDA. Rena Conti, dean’s research scholar and associate professor at Boston University Questrom School of Business, stated in the press release: “Blood cancer patients are being given preferential access to limited vaccine supplies in many communities, but that doesn’t mean they are willing and able to get vaccinated. We need both adequate supply and strong demand to keep this vulnerable population safe.”

The key to encouraging more patients with cancer and cancer survivors to get vaccinated may be better education about the vaccines, according to LLS. The organization launched the LLS National Patient Registry in an effort to help provide some of the information that patients may need. LLS is also recommending that patients speak with their oncologists about vaccines to develop a better understanding.

“Right now, we’re missing key data–and patients know it,” Nichols said. “That may be one of the reasons they’re skeptical. By improving our understanding of how blood cancer patients and survivors respond to these vaccines, we can develop better strategies to protect them from COVID-19.”

LLS has plans to repeat the survey again to see how the responses of patients with hematologic malignancies and survivors have changed after more information was provided to them.

_References:

_{1. New survey reveals COVID-19 vaccine hesitancy among those with cancer diagnosis. News release. Leukemia & Lymphoma Society. March 8, 2021. Accessed March 8, 2021. https://bit.ly/3t26RuE}

_{2. Conti R, Akesson J, Weiss M, et al. COVID-19 vaccine hesitancy among blood cancer patients. Leukemia & Lymphoma Society. Accessed March 8, 2021. https://bit.ly/2OXTFbq}

_{3. Bange EM, Han HA, Wileyto P, et al. CD8 T cells compensate for impaired humoral immunity in COVID-19 patients with hematologic cancer. Res Sq. 2021;rs.3.rs-162289. doi:10.21203/rs.3.rs-162289/v1}