The National Comprehensive Cancer Network recommends that people undergoing most cancer treatments be prioritized for the COVID-19 vaccine. This guidance is supported by a recent review led by Antoni Ribas, MD, PhD, director of the UCLA Jonsson Comprehensive Cancer Center’s tumor immunology program and president of the American Association for Cancer Research (AACR).
People receiving chemotherapy and some other cancer treatments are particularly vulnerable to developing serious illness from COVID-19, Dr. Ribas says, and delaying cancer treatments to accommodate quarantine and isolation for the infection could have dire effects on their health prognoses.
“Certain conditions that lead to increased frequency of cancer also increase complications of COVID-19,” he says. “For example, history of smoking, obesity and several chronic inflammatory conditions are linked to both diseases.”
Age is another risk factor for cancer and for COVID-19 severity.
“The Venn diagrams of risks for cancer and risks for complications from COVID-19 overlap in a certain number of patients,” says Dr. Ribas, a professor of surgery, medicine and molecular and medical pharmacology at the David Geffen School of Medicine at UCLA “So if you prioritize vaccination for patients with cancer, you’re already prioritizing vaccination for people who have a series of co-morbid conditions that increase the risk of COVID-19.”
Some cancer therapies, such as chemotherapy and antibody treatments, make it harder for the body to naturally fight infection by reducing white blood cells, which are needed to produce the antibodies that protect cells from viruses such as COVID-19. These patients need the defensive boost the vaccine provides. UCLA Health considers current cancer treatment in its risk-stratification process for vaccine distribution.
The COVID-19 vaccines authorized for use in the United States work by telling the body to make spike protein, so named for the spikes on the coronavirus, which stimulates antibody production to defend and protect the body should actual exposure to the virus occur.
There is no live virus in the COVID-19 vaccines, which makes them safe for most people with cancer, Dr. Ribas says, adding that people undergoing cancer treatment have long been advised to get the flu vaccine. Cancer survivors are safe to get the vaccine according to public health schedules, he says.
The patients with cancer most vulnerable to severe illness from COVID-19 are those with blood cancers, such as leukemia and lymphoma, and people with lung cancer. Treatment for leukemia and lymphoma often includes chemotherapy and antibody treatments that suppress natural immune function.
“Patients who have blood cancers are getting therapies that further decrease their immune system,” Dr. Ribas says. “I would argue that it would be better to have an artificial infection, which is the vaccine, as opposed to allowing them to get the natural infection because the virus that causes COVID-19 has certain features that decrease the immune response, where the vaccine increases immune response.”
Patients with lung cancer are susceptible to serious COVID-19 issues because the virus attacks the lungs. “The main risk factor for lung cancer is chronic cigarette smoking, which damages the lungs,” Dr. Ribas says, “and patients with COVID-19 who have a precondition of lung damage are more likely to have respiratory complications.”
Because people actively battling cancer often receive frequent clinical care, they’re also regularly exposed to other people, and thus more at risk of contracting or spreading COVID-19.
“These are therapies that are life-saving for the cancer, so any delay or derailment of treatment would have a negative impact on these patients, and that’s what a diagnosis of COVID would result in,” Dr. Ribas says. “Any increased immunity in these patients who are at high risk would be good for society.”
Blood cancers and lung cancers, Dr. Ribas says, disproportionately affect Latino and Black populations, communities already at higher risk of dying from COVID-19.
“For reasons that are unclear, Latinos have a higher frequency of certain leukemias and lymphomas,” he says. “Blacks have a higher frequency of myelomas, which is a disease of the cells that make antibodies, and that's a particularly troublesome thing because then they can’t make antibodies to COVID-19.”
Black and Latino populations also have been targeted as key consumers by the tobacco industry, he says, and have more tobacco-related cancers as a result.
“To undo these chronic inequities in society and in health care — and especially because some of these people may be of lower socioeconomic class, so if they get COVID they may not have all the same benefits of early intervention and expensive treatments — I think they have to be particularly considered,” Dr. Ribas says, “and given the option of priority vaccination.”
