COVID-19 vaccination in people with cancer
Patients with cancer and survivors of cancer may be at higher risk of health complications from COVID-19. This is not surprising given that this group of individuals is often immunocompromised. There is emerging evidence that patients with hematological malignancies, including leukemia, lymphoma, and multiple myeloma, have a greater risk of infection and complications than patients with other cancer diagnoses. There is also evidence that patients with progressing cancer when they are diagnosed with COVID-19 may be at higher risk of death or serious health complications compared with those with disease in remission. Getting vaccinated is one of several steps you can take to protect yourself and others from COVID-19. The vaccines have been found to significantly lower the risk of being infected with COVID-19. They have also been shown to be very effective at lowering the risk of severe disease, being hospitalized, or dying from COVID-19 if you are infected.
Frequently Asked Questions
I have cancer. Is the vaccine safe for me?
Yes. Live vaccines are contraindicated in patients who are immunocompromised whilst receiving chemotherapy. The AstraZeneca and Pfizer vaccines are not live vaccines. A small number of people have developed an allergic reaction to ingredients of the vaccines, so it is important to talk to your doctor if you have ever had a reaction to a previous vaccine or medication.
I have completed chemotherapy and/or am only taking endocrine therapy (tablets). Am I immunocompromised?
No. People who have completed anti-cancer therapy and are without active cancer have an immunity level similar to that of the general population.
Will the vaccine hurt or make me sick?
Common side effects of the COVID-19 vaccine include pain in the arm where the vaccine was given, tiredness, headache, muscle and joint pain, chills, and fever. Side effects tend to occur within 2 to 3 days of the vaccine and may be more noticeable with the second dose. They often go away within a week, usually in a few days. Side effects are more common in those younger than 55 years of age. These side effects are generally a sign that your immune system is doing exactly what it is supposed to do—working and building up protection to disease.
Some people have reported temporary swelling of the lymph nodes in the axilla (armpit) or supraclavicular area (above the collar bone) on the side on which they received the vaccine. Because this possible side effect may be mistaken for a sign of breast cancer, it is best to delay a mammogram for up to a month after receiving the COVID-19 vaccine.
Will I get blood clots from the vaccine?
People with cancer and/or people taking certain endocrine therapies (including Tamoxifen) are at increased risk of venous thromboembolic events (VTE). Concerns were initially raised in European nations with regards to venous thromboembolic disorders following vaccination with the AstraZeneca vaccine. However, on review by the European Medicines Agency, the concern is specifically regarding thrombosis with thrombocytopenia syndrome (TTS), rather than thromboembolic events in general.
The incidence of TTS is rare: 0.001%, with the Australian government recommending the Pfizer vaccine be preferred over the AstraZeneca vaccine in people aged under 60. Please check the Victorian Goverment Covid19 website for current advice.
When should I receive the vaccine?
People with cancer would ideally receive their vaccination at least two weeks prior to their commencement of chemotherapy. If the patient is already receiving chemotherapy, we recommend vaccination in between chemotherapy cycles and away from the nadir (low white blood cell count) period.
Is there anything I can do to improve my general health and my immune system?
You should follow the recommendations of your care team and general recommendations for a healthy lifestyle. Do not use tobacco products, eat a well-balanced diet rich in fruits and vegetables, exercise regularly, get enough sleep and follow public health guidelines on social distancing and hand washing.
This webpage is a summary by Southen Breast Oncology informed by the following references.
Australian Government Dept of Health
Futher vaccine related reading is available on the Victorian Comprehensive Cancer Center site.