COVID Vaccine and Cancer Patients

January 25, 2021

Information

January 24, 2020

Yale Cancer Center

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email: canceranswers@yale.edu

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00:00Support for Yale Cancer Answers
00:02comes from AstraZeneca, working
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00:17Welcome to Yale Cancer Answers with
00:19your host doctor Anees Chagpar.
00:22Yale Cancer Answers features the
00:24latest information on cancer care
00:26by welcoming oncologists and
00:27specialists who are on the
00:29forefront of the battle to fight
00:31cancer. This week, it's a
00:32conversation about the Covid
00:34vaccine and cancer patients with
00:35Doctor Kerin Adelson. Doctor
00:37Adelson is the chief quality
00:39officer and Deputy Chief medical
00:40officer at Smilow Cancer Hospital
00:42and an associate professor at the
00:45Yale School of Medicine where
00:46Doctor Chagpar is a professor of
00:49surgical oncology.
00:51Kerin, let's start by talking
00:54a little bit about this vaccine.
00:56You know there's been a lot in the
00:59news about the vaccine, and many people,
01:03whether their cancer patients or even
01:05the general population have a bit of
01:08trepidation about the vaccine. Can
01:11you tell us about its safety?
01:13Yes, this vaccine is very, very safe.
01:19Both vaccines that are currently approved
01:21were studied in a randomized
01:25controlled trial with thousands
01:27of patients and demonstrated to
01:29be both very safe and highly
01:32effective, and so in terms
01:35of cancer patients,
01:37I know that they may have a
01:39lot of concerns themselves
01:41that may be separate and apart
01:44from the general population.
01:47So the first thing is should they
01:51get the vaccine?
01:53They may be on treatment, they may
01:55have just finished treatment.
01:58Are you recommending the
01:59vaccine to your patients?
02:01I most certainly am.
02:03So patients with cancer
02:06who have other medical problems,
02:09patients who are on treatment that
02:12could make them more vulnerable to
02:16the effects of COVID-19 are in a
02:20position where they need the vaccine
02:22more than the general population.
02:26Is that because cancer patients are
02:28more at risk of contracting covid?
02:32They are not necessarily
02:34more at risk of catching covid,
02:37but they are more at risk of
02:39having a severe course of illness.
02:42And it's not all patients with cancer,
02:45but especially patients who have active
02:48cancer or cancer in the lungs or cancer
02:51where the cancer itself suppresses
02:53the immune system like some of the
02:56blood cancers may be more vulnerable
02:59to the serious complications that can
03:01happen with the COVID-19 infection.
03:04And for those people, it is really,
03:06really important that they take
03:09advantage of this opportunity to
03:11protect themselves with the vaccine.
03:16Cancer patients are often older now,
03:19of course not across the board,
03:21but we know that older patients
03:24are also more vulnerable to the
03:27effects of COVID-19.
03:28A couple of questions to follow
03:30up on that, you know patients
03:33who are currently on treatment,
03:36they are worried about
03:39the fact that their immune system
03:42often is repressed with chemotherapy,
03:45such that sometimes their oncologists
03:48may even give them things like GCSF
03:51to kind of boost
03:55their immunity
03:57and so they may be
04:01wondering whether they will mount
04:04an effective response against
04:07Covid with the vaccine,
04:09has that been studied?
04:11That is a great question,
04:13so there have not been trials of the
04:17vaccine in patients with cancer yet.
04:21And so all of those concerns
04:23are legitimate concerns.
04:24And what I would really stress is that
04:27each patient should talk to their
04:30treating oncologist or hematologist,
04:32or even primary care doctor, about when
04:35in the course of treatment is the
04:38best time for them to get the vaccine.
04:41Generally across the country we are erring
04:44on the side of it's better to get the
04:48vaccine and hopefully get some protection.
04:51But we understand that there may be
04:53patients with a suppressed immune system
04:56who don't mount as much of a response to
04:59the vaccine as would be ideal.
05:02We're not going to know that, though,
05:05until patients get the vaccine and we
05:08actually are able to collect their serum
05:11and study whether or not they are able
05:14to make the antibodies that they
05:16will need to be protected from COVID-19.
05:19But it's really important to point out,
05:21that even if they don't make a large response
05:25to protect them from COVID-19 to the vaccine,
05:30they're not at risk for extra
05:32complications of getting the vaccine.
05:35This is not a live vaccine,
05:38it's not a dangerous vaccine,
05:40so the recommendations still are
05:42that people become vaccinated.
05:48There may be some populations of patients
05:52who are the most severely immunosuppressed,
05:54have gone through a recent bone marrow
05:58transplant for example or Car T cell therapy
06:01who may it may be recommended by their
06:04treating doctor that they wait a few
06:08months before getting the vaccine,
06:10but that is the vast minority
06:12of patients on cancer treatment.
06:15And for patients who are on
06:17pretty standard
06:19chemotherapy and immunotherapy,
06:20we absolutely are recommending
06:22that they get vaccinated.
06:22that they get vaccinated.
06:25So a couple of follow up questions to that.
06:28One of the concerns that many people
06:30have not only cancer patients,
06:32but even the general population
06:34is whether they can catch
06:35covid from the vaccine.
06:37And I know that you
06:39mentioned that in passing,
06:40but maybe you'd like to
06:42just reiterate the point
06:43that this vaccine will not give you covid.
06:46It is not a live virus that can
06:49spread throughout the body.
06:50It does not have all the mechanics and
06:53parts it needs to grow and reproduce.
06:56So when you hear about people developing
06:58symptoms from the COVID-19 vaccine,
07:01those symptoms are really
07:02related to the vaccinee,
07:05so I think I just made up that word,
07:08but the vaccinees own immune system
07:11revving up to begin to
07:14mount protection
07:16against the COVID-19 virus.
07:18But it is not from the vaccine
07:21itself doing harm or damage.
07:24And so
07:25I've already had one dose of
07:28the vaccine and I definitely
07:31developed some achiness afterwards,
07:32the way one might if they
07:35were fighting a virus,
07:37but it's mild and it
07:39lasted a few days and
07:42now I'm getting ready for
07:44my second dose.
07:46The other question has to do with when
07:50cancer patients should get the vaccine.
07:52So we talked a little bit about mounting
07:55an immune response to the vaccine.
07:58So would you recommend that people
08:01get it if they haven't yet started chemo
08:03that they get it before they start chemo?
08:07We advise
08:11if there is time for
08:14them to get at least one dose of the
08:17vaccine before they start treatment,
08:20we certainly would recommend that.
08:24Currently, the state limitations are not
08:26open to everybody who has cancer yet,
08:29but I think in the next month we
08:33will begin to see the sort of parameters
08:36of who the vaccine is available for
08:40broadening mostly I would say the really
08:43most important thing is for
08:45every patient who's dealing with a cancer
08:48diagnosis to talk to their treating
08:51doctor about what timing is ideal.
08:53But certainly if there's an
08:55opportunity before they start treatment
08:57to get vaccinated,
08:59we would recommend that and then for
09:01patients who are on cyclical treatment
09:04or repeated doses of chemotherapy,
09:06we would recommend that you talk to
09:09your doctor and figure out with your
09:12doctor which timing is best given your
09:15specific regimen.
09:17And once you get the vaccine, are there
09:19precautions that you need to take?
09:22It's very important for everyone
09:24to realize that the vaccine does
09:26not confer immediate projective
09:28action against COVID-19 infection
09:30even after the first dose,
09:33it could take 10 days or more to
09:36mount an immune response and I think
09:40the estimates are that after one
09:43vaccine you have about 50% protection,
09:46so we absolutely recommend that
09:49people continue to socially isolate,
09:51continue to wear masks and
09:54continue to exercise all of the
09:57precautions that we've learned
09:59are so protective
10:01against getting a COVID-19 infection.
10:03What about families of cancer patients?
10:06Should they get vaccinated too?
10:08Does that have any implications
10:11for the cancer patient themselves?
10:13So that's a great question.
10:16We know that COVID-19
10:18does spread rapidly within families,
10:21but in terms of family members,
10:24being able to get the vaccine,
10:27they currently fall into the group
10:30that their
10:32demographic falls into already,
10:33so family members will be able to
10:36get the vaccine based on their own
10:38age and or their profession or their
10:41degree of medical problems following
10:44the algorithms that have
10:46come from all the different states.
10:48Is it possible that at some point the
10:52vaccine would be opened up to family
10:55members of patients who are at higher risk?
10:58It's possible,
10:59but that has not been committed to yet
11:02given the limited number of
11:04vaccines that have been available
11:07so far, and that brings me to other
11:10groups of cancer patients and
11:13we talked a little bit about cancer
11:16patients on active treatment too,
11:18might be at particularly high
11:21risk for sequelae of covid.
11:23What about cancer survivors?
11:25Let's say you had breast
11:27cancer five years ago.
11:29You might be taking endocrine therapy,
11:32but otherwise are pretty well.
11:34Would you get priority
11:37in terms of getting the vaccine?
11:39Is it important for you to
11:42get the vaccine earlier,
11:43or should you wait until it's
11:46open to the general population?
11:48That's another really good
11:50question that has some subtlety
11:52in how patients
11:54will be selected for the vaccine.
11:57So for the most part,
11:59somebody who has been cured of cancer
12:02who is not on any active treatment
12:05that would affect their immune system,
12:07who does not have metastatic cancer is
12:10not really at higher risk for COVID-19
12:14or the complications related to it.
12:17That aside, I think that the state will
12:20be rolling out the vaccination at some
12:23point to patients who have comorbidity,
12:26or another diagnosis that
12:29could lead to complications of
12:32COVID-19 and so really all patients
12:35should be talking to their doctors
12:38about which group they fall into.
12:41I think that all of
12:44these are such important questions
12:46and we're going to take a short
12:49break for a medical minute to learn
12:51more about Covid and the vaccine,
12:54especially for cancer patients.
12:55Please stay tuned to learn more
12:57with my guest Doctor Kerin Adelson.
13:00Support for Yale Cancer Answers comes from
13:04AstraZeneca, working to change how cancer
13:07is treated with personalized medicine.
13:10Learn more at astrazeneca-us.com.
13:14This is a medical minute about genetic
13:17testing which can be useful for
13:19people with certain types of cancer
13:22that seem to run in their families.
13:24Patients that are considered at risk
13:27receive genetic counseling and testing so
13:29informed medical decisions can be based
13:32on their own personal risk assessment.
13:34Resources for genetic counseling and
13:36testing are available at federally
13:38designated comprehensive cancer centers.
13:40Interdisciplinary teams include geneticists,
13:42genetic counselors, physicians,
13:43and nurses
13:44who work together to provide risk
13:47assessment and steps to prevent
13:49the development of cancer.
13:50More information is available
13:52at yalecancercenter.org.
13:53You're listening to Connecticut Public Radio.
13:57Welcome
13:57back to Yale cancer Answers.
13:59This is Doctor Anees Chagpar and
14:02I'm joined tonight by my guest doctor
14:04Kerin Adelson and we’re talking about Covid
14:07and cancer patients and right before
14:09the break we were talking about
14:11the covid vaccine and the fact that
14:13for many of our cancer patients,
14:16particularly those who are
14:17on active treatment,
14:18that the vaccine is still recommended
14:20and that you should talk to your
14:23doctor about getting this when it
14:25is available for cancer patients.
14:27Kerin, just to kind of tag
14:30on to the discussion that we
14:32were having before the break,
14:35you had mentioned that after
14:36you get the dose of vaccine,
14:39your body mounts an immune response
14:41that can leave you with some sequelae.
14:44Maybe some achiness, maybe a low grade fever.
14:47Maybe chills and for a lot of people
14:51they may have heard that you kind
14:53of feel a little bit like crap,
14:56and when you're on chemo,
14:58you might feel like crap too. NOTE Confidence: 0.87298423
15:03So how should cancer patients
15:06think about how they're going
15:09to feel after the vaccine?
15:11And are there any precautions or
15:13concerns that you might advise
15:16in terms of overcoming those
15:18sequelae?
15:22That's a great question and the way to really think about this is
15:25that if you develop side effects or if you
15:29develop symptoms after getting the vaccine,
15:31that's a sign that your immune system
15:34is kicking in and doing its job.
15:37We don't know yet whether people who
15:39get more side effects actually get
15:41more protection from the vaccine.
15:44That doesn't seem to be the case, but I
15:47certainly would not be overly concerned.
15:49And patients who are getting side effects,
15:52say achiness or a low grade fever,
15:56people have a lot of actual
15:58soreness at the injection site,
16:00more even than with other vaccines
16:02like the flu vaccine, for example,
16:05but we would just recommend
16:07taking some Tylenol,
16:08taking it easy,
16:09trusting your body and really
16:12appreciating the fact that the side
16:15effects you may feel may be a sign
16:18that in the next six weeks or so you
16:21will have protection against this virus and
16:24so if you have taken the
16:26vaccine and you're due for
16:28your next dose of chemotherapy,
16:31but you're feeling like crap,
16:33what should you do?
16:34Should you talk to your doctor about
16:37maybe pushing your next dose of chemo out?
16:41Should you go and take the chemo anyways?
16:44How should patients kind of
16:47navigate that landscape?
16:48Yeah, I think
16:49that is a question that I can't
16:52answer for the general population
16:54because people's treatment and the
16:57timing of their treatment vary so much,
17:00and in the urgency of getting
17:02a treatment on time,
17:04varies with different
17:06treatments in different regimens as well.
17:08So I would say the most important
17:11thing is to talk to their treating
17:14oncologist or hematologist.
17:16Well I want to transition a
17:18little bit to talking about
17:21actual covid and cancer patients.
17:23Many cancer patients have questions
17:25that pertain to what it's like or what
17:29they should do when exposed to covid.
17:31So let's take it from the
17:34most benign to the most severe cases.
17:37So right now, we know that we're
17:40in the middle of the pandemic,
17:42and every day we watch the
17:44news and we see more and more
17:47people getting affected by covid.
17:50We know that there are
17:52variants in the population
17:55that have more infectivity
17:57than the standard strain,
17:59so just in terms of general precautions,
18:02what precautions should cancer
18:04patients take in order to mitigate
18:07their risk of developing covid?
18:11Yes, maintaining social
18:12isolation is the
18:15most important thing right now.
18:18It's not putting yourself in
18:20a place where you are at risk
18:24for contracting the virus.
18:26So really, minimizing exposures
18:28to groups of people,
18:30especially in the indoor setting.
18:35Certainly not getting together
18:38with people who were exposed to the virus
18:42and whenever you do need to be in close
18:46proximity to somebody, wearing a mask
18:48other than your immediate family members.
18:51I think as the covid prevalence
18:54has really spread through the community,
18:58the chance of having an asymptomatic
19:00infection has gone way up,
19:02so there will be circumstances and we've
19:06certainly seen this in our patients where
19:09a family member does have covid and
19:12the rest of the family needs to protect
19:16themselves against contracting the
19:18virus and in that situation,
19:21obviously, if that person can go stay
19:24somewhere else where they won't expose
19:26their family member or especially their
19:29family member with cancer, that's ideal.
19:32If that's not feasible,
19:33we really recommend that the infected
19:36person be isolated in a room wearing masks,
19:39and that contact be minimized.
19:42Hand sanitizer be used as regularly as
19:45possible and that people really,
19:48really work to do whatever
19:50they can not to get the virus,
19:53so picking up on that when you
19:56talk about cancer patients,
19:58social isolating do you
20:00say they shouldn't
20:02go to the grocery store,
20:04they shouldn't
20:05socialize or is it really just
20:08maintaining that 6 foot distancing?
20:10Or do cancer patients really
20:12need to take more precautions
20:14than the general population?
20:17That's a great question,
20:18and I think there's been a lot of
20:22controversy with what precautions the
20:24general population should take as well.
20:26I would really stress that social
20:29isolation not putting yourself in
20:31a position where you're exposed to
20:33many people who could be carrying the
20:36virus remains absolutely essential.
20:38Mask wearing is better,
20:39but it's by no means a guarantee,
20:42so this is not the
20:45time to go to rock concerts.
20:48But we all have to eat occasionally.
20:51We have to go to the supermarket
20:54and if you do that,
20:56I just suggest wearing a mask
20:59and using hand sanitizer,
21:00and certainly taking advantage of
21:02things like on line grocery delivery
21:05programs whenever possible.
21:08Bringing us to the next situation which
21:11you mentioned in terms of families and
21:14before the break you had also mentioned
21:17that we're seeing an increase in covid
21:20cases spread between family members.
21:22So even when you're in your household,
21:26say you have cancer,
21:27you're in active treatment,
21:29you have a partner who might be working.
21:33You have kids who might
21:36be going to school part time or
21:39going out outside should
21:42you be wearing a mask inside
21:45your house even amongst your
21:47immediate family members or not?
21:50Or is that something that you should
21:52do only if somebody contracts covid?
21:57So it's very hard for people to
21:59wear masks in their own house,
22:02but I would say that if they are in
22:05close proximity to a family member who
22:08is at risk, grandchildren
22:11who are probably not following the
22:14rules the same way older people might.
22:17If you have a family member
22:19who's an essential worker,
22:21and going to work where they
22:24could potentially contract it,
22:25maintaining distance and wearing masks
22:27certainly is ideal,
22:29not easy to implement in one's own house,
22:32but certainly as much as they can.
22:35We would recommend
22:36that. And if somebody tests positive
22:39then you really want to isolate
22:41that person who tested positive.
22:55What about mealtimes with
22:56people who might have covid?
22:59Many people have talked about
23:01the fact that when we're eating,
23:03we're clearly not wearing a mask.
23:05There tends to be a lot of droplets.
23:08If you're in a household where somebody does
23:11have covid and you're a cancer patient,
23:13what should you do at mealtimes?
23:15Should you separate those or
23:17how should that work?
23:19Yeah, if you have a
23:21family member with Covid,
23:22they need to be alone in a
23:24room getting their meals.
23:26This is not the time for us to
23:29come together in celebration so
23:32we do not recommend group meals especially
23:35when somebody has
23:37been identified as having covid,
23:39I'm going to digress a little,
23:42but one thing that
23:44has been so hard for people
23:46in this year of the pandemic,
23:49and especially for patients with cancer
23:51who are often facing questions of
23:54mortality and can be really worried
23:56about living to the most in the
23:59time that they have left.
24:04This virus has really posed a challenge.
24:07A lot of my patients
24:09articulating that
24:10Covid has taken what they feel
24:13is a critical year from them,
24:15and being able to be with their loved ones
24:18and be with their family and experience
24:21life and experience the world
24:22and the only way
24:24to really see that limitation,
24:26or that last
24:29time coming to an end, is
24:31if we can all get vaccinated,
24:33and really get control of this
24:35virus on a national level.
24:37So if you're debating whether
24:39or not to get the vaccine,
24:41the vaccine
24:43is what will allow you to begin
24:45to get your life back.
24:47So important.
24:48I know that many patients
24:50might be thinking you know,
24:52especially when we go back to the
24:54situation of having family members
24:56with covid and having to isolate
24:58And you might be, as you say,
25:01contemplating your own mortality
25:03and how much time you have left,
25:05maybe thinking you know what,
25:07I don't want to not have
25:10dinner with my family.
25:11My family is really important to me and
25:14I don't know how many days I have left.
25:18These are such tough
25:21choices for people to make.
25:24This has been such a tough year
25:28really for everyone. But this
25:31brings us to the last topic,
25:35which is what about when cancer patients
25:38actually start to get symptoms that
25:41might make them concerned about covid?
25:44So the first question is
25:46sometimes the symptoms of Covid,
25:49as you say, can be completely asymptomatic,
25:51but sometimes they can have low grade fever.
25:54They might have a cough,
25:56they might have some chest pain,
25:58they might have some shortness of
26:00breath or changes in how they perceive,
26:02taste and smell, but you can get a
26:05lot of those symptoms with chemo too.
26:07So how are patients to
26:09differentiate the two,
26:11and when should they call their doctor?
26:13Yeah, so they should call
26:15their doctor as soon as they have
26:17any of those symptoms.
26:19And you're absolutely right.
26:20It can be very hard to figure out
26:23whether patients are just experiencing
26:25the side effects of treatment,
26:27or whether they actually
26:29might have a covid infection,
26:31and because it was so important
26:33for us to be able to protect our
26:36population of patients with cancer
26:38from those who might actually be
26:40carrying the virus or contagious.
26:42We had to develop a whole new
26:45area actually just
26:47to screen our cancer patients
26:49for Covid so that they wouldn't expose other
26:52patients when they might have symptoms,
26:55and so we are able
26:57if you call your doctor because
27:00you're having symptoms,
27:01we are able to get a rapid test and
27:04screen our patients for symptoms to
27:07figure out whether it's just side
27:09effects from treatment or whether they
27:12actually carry the virus.
27:14And so in our last minute or two,
27:17what if a cancer patient actually gets covid?
27:20What happens then?
27:21Can you kind of lay out the
27:24landscape of what happens?
27:25I mean, are they immediately hospitalized?
27:28Do they have to self isolate?
27:30What does that mean in terms of treatment?
27:33I mean that must be just a double whammy.
27:38When one of our patients gets
27:41covid we have to evaluate them clinically,
27:44and if they are very clinically
27:46stable like many people are,
27:48we will send them home
27:50with instructions to self isolate
27:52and we probably will hold their
27:55chemotherapy treatment at least during
27:57the phase of the acute infection,
28:00we have a program where our nurses
28:03will call to check up on our
28:06patients who have covid daily and
28:09make sure that they're doing OK.
28:12And assuming their symptoms don't get worse,
28:15they will finish out their 10 days
28:17to two weeks and then can come back
28:20and resume treatment. For patients
28:22who develop more severe symptoms,
28:24they could in the end
28:26need to be hospitalized,
28:27especially if they're
28:28having breathing problems.
28:30And if any of those more serious
28:32symptoms are developing, we would
28:34make sure that you
28:36talk to your doctor and
28:38if needed, bring you into the hospital.
28:41Doctor Kerin Adelson is the chief
28:43quality officer and Deputy Chief
28:45medical Officer at Smilow
28:47and an associate
28:49professor at the Yale School of Medicine.
28:51If you have questions,
28:53the address is canceranswers@yale.edu
28:54and past editions of the program
28:56are available in audio and written
28:58form at yalecancercenter.org.
29:00We hope you'll join us next week to
29:03learn more about the fight against
29:05cancer here on Connecticut Public Radio.