Transcription:

Bill Klaproth: There are many questions surrounding cancer patients and the COVID-19 vaccine. How effective is it? Are there any side effects and what are the concerns? Well, let's find out with Dr. Dixon King, Chair of Pathology and co-medical director at the Kaufman Cancer Center.

This is The hero Podcast from UM Upper Chesapeake Health. I'm Bill Klaproth. First off, Dr. Dixon, thank you so much for your time. We appreciate it. So are there any concerns surrounding the vaccine? And if not, why is it so important for cancer patients to receive the COVID-19 vaccine?

Dr. Dixon King: Well, first of all, let me say that every patient's situation is different. It's really important for you to consult with your oncologist before making any decisions about the vaccine. But having said that, it's really vitally important for virtually every cancer patient or cancer survivor to get the vaccine, unless of course they're allergic to the COVID-19 vaccine itself or some of its components.

The primary reason for this is that because almost every cancer patient has a somewhat compromised immune system. So the risk of getting COVID and having serious complications from getting COVID are much more than that for the general population, some people say three to five times as much. So this can either be because of your cancer treatments have caused you to be immunocompromised or the immunosuppression can be simply be caused by your cancer progressing. And if you do get COVID, this may cause your important chemotherapy or radiation therapy treatments to be delayed until you get over it.

Maryland's vaccine program is currently in the 1C stage, which means that patients undergoing active therapy and that includes both inpatient and outpatient therapy are eligible to receive it. At the moment, I know obviously there's a shortage of vaccine available. I know that's very frustrating for everyone, but it's still important to persevere and get the vaccine just as soon as you can. And I will also mention that even if you've had COVID and recovered, it's still recommended that you get the vaccine.

Bill Klaproth: Really good thoughts. So people that have cancer, as you have pointed out, generally have compromised immune system. So it is important to get the vaccine. Then, on the flip side, Dr. King, are there any patients undergoing active cancer treatment who should not get the vaccine?

Dr. Dixon King: At the present time, I believe there's agreement that only two groups should not get vaccinated as soon as possible. And one would be patients that have just had a stem cell transplant or who are receiving what is known as CAR T-cell therapy. These patients should wait at least three months after they've completed the treatment.

And the other group, I would say would be those patients just starting intensive initial therapy for leukemia. It is recommended that they delay the vaccine until their blood cell counts recover somewhat. And again, these patients should talk to their own oncologist about the timing of exactly when it's best to get the vaccine.

Bill Klaproth: So that's really good to know, patients that have just had a stem cell transplant or who are receiving CAR T-cell therapy or someone who is receiving intensive initial therapy for leukemia. For those people, the vaccine is much more concerning. So then let me ask you this, what about patients undergoing chemotherapy now or who have had cancer surgery planned? What about those scenarios?

Dr. Dixon King: Well, I would say for patients that are undergoing chemotherapy, the overall best approach is just to get the vaccine whenever it's available and whenever you can get it. If possible, however, it is recommended that you get the vaccine somewhere in the middle of your chemotherapy cycle. For example, if you're getting chemotherapy every three weeks, you should try to get it somewhere in the middle of that three-week period, so roughly 10 days after or 10 days before your next treatment. That way, if you happen to get some of the aches and pains and generally not feeling well after the vaccine, as many people do, especially after the second dose, you don't want to have that on top of the side effects of your chemotherapy treatment.

And also for some of the same reasons, you should probably not get vaccinated immediately before or immediately after major cancer surgery, but should try to wait and get vaccinated two to three weeks after surgery.

Bill Klaproth: And then how effective is the COVID-19 vaccine in cancer patients? And what about the side effects and will cancer patients need to get a booster shot later?

Dr. Dixon King: We really don't have good data yet on how effective the vaccine will be in cancer patients. But, as Dr. Fauci recently said, if you're immunocompromised, history tells us that you will not have as big a protective response as someone who is not immunocompromised. But some response is better than none at all. So even if you have a 70% or even a 50% response, while that may not be as good as a 95% response that is seen in the general population, it's still a lot better than no response at all. And even if the vaccine does not prevent you from actually getting COVID, it will probably do a lot to ensure that you do not have a serious case and may keep you from getting the serious complications that can be associated with COVID or ending up in the hospital.

As for the side effects, we've found that in most people with the first dose, they may have just a little pain at the injection site, very similar to what you have with a flu vaccine. Very few have systemic effects with that. One important thing to note, especially for cancer patients, is that when you get the shot in your arm, some people have had a small swelling of the lymph nodes under their arms after the vaccine. And enlarged lymph nodes are especially concerning for cancer patients, as they may interpret this as their cancer coming back or progressing. These enlarged lymph nodes should go down in a week or so and, if not, you should contact your oncologist.

On the other hand, probably the majority of individuals, and this tends to be more in people that are less than 55 years of age, they'll have some aches and pains for a day or so after the second dose, almost like a mini case of the flu. And this usually goes away in 24 to 48 hours. And it's just an indication that your body is producing the protective antibodies against COVID, but still it's very important that you get that second shot to make sure that you're just as protected as you absolutely can be.

You mentioned a booster shot and the jury is still very much out on that question. It may be that a booster shot will be required for patients that didn't get a complete immune response from the first two doses. And as a matter of fact, you know, with new strains coming out of South Africa and the UK and Brazil, we may all be getting booster shots or yearly vaccines in the future as the virus has a tendency to mutate or it could be that our immunity is actually going to wane. So we just really don't have a good idea about those questions yet.

Bill Klaproth: Yeah. And we'll certainly know more in the future. So some really good points there, Dr. King, about the importance of getting the vaccine. As you mentioned, it'll help you from getting a more serious case of COVID-19 and that in and of itself is really important. And then for people who have gotten the shot and their arm is sore or they're fatigued or they're experiencing mild symptoms, that's actually not a bad thing because it means that it's working.

Dr. Dixon King: It might not feel good while it's happening and you feel like your bones and your muscles ache, but it just means that it's doing its job.

Bill Klaproth: Good. That's what we need to know. So that's a great point. So then what about the caregivers of cancer patients? Should they get the vaccine?

Dr. Dixon King: This is an easy one. Absolutely, they should. First of all, there's often been concern about people around people with cancer getting certain vaccines, especially if they're live virus vaccines. Well, this is not a live virus vaccine. There's absolutely no way to get COVID from the COVID vaccine. It's impossible. The vaccine does not contain any live or any dead virus. It only contains synthesized components of a portion of the virus that then trains your immune system to fight the virus when it sees it again. So there's absolutely no way any caregiver or loved one can give the virus to you after they've been vaccinated.

And on the contrary, it's very important for caregivers and loved ones of cancer patients to be vaccinated as soon as possible to guard against transmitting COVID to the cancer patient. As we've said, you know, even after receiving the vaccine, cancer patients may not have a full immune response. So those coming into contact should do everything they absolutely can to avoid getting COVID and passing it on to them. And obviously, the best way that we have to do that now is with the vaccine.

Bill Klaproth: Yep. Another great point. The less COVID around a cancer patient, the better. That's for sure. So then after receiving the second COVID-19 vaccine dose, what precautions does someone with cancer need to continue taking?

Dr. Dixon King: Again, that's an easy one because, for now, the cancer patients, their caregivers, their loved ones, and everyone around them should continue to take those same precautions we've all been doing, namely the mask wearing, the physical distancing, the hand-washing. And although the risk of getting COVID may go down with the vaccine, the risk does not go away completely, especially with immunocompromised individuals.

And we're still not sure if vaccinated individuals can pass along COVID to others. Although I just heard this week that recent data suggests that it doesn't seem like that that's a very common thing to happen, so there might be a little more protection there than we actually think.

I know it's hard to hear that once you've got the vaccine and we've been doing this all for a year or so. I know it's tough, but we all need to still hang in there a little bit longer and continue with mask, the physical distancing and the hand-washing.

Bill Klaproth: We all have to stay vigilant. We all want this to be over with, but we still have to take those necessary precautions. And if we all continue to do that, the sooner we all will be out of this. And thank you so much for your time, Dr. King. Just a few more questions. What about someone who has cancer who is on medications? Do they have to worry about some type of interaction with the vaccine and the medication they're taking now?

Dr. Dixon King: There has really been no reports to that effect as of yet. Again, the vaccines are kind of a new type of vaccine, but actually these mRNA vaccines are originally developed to deliver chemotherapy type doses of medications to oncology patients, so they have been tested kind of in that scenario. But in terms of interactions with their chemotherapy, we really haven't seen that yet. We'll obviously keep looking to see if that happens, but as of now, that really hasn't been an issue.

Bill Klaproth: Okay, good. And any data on chemotherapy or other cancer treatments rendering the vaccine less effective?

Dr. Dixon King: With just about any chemotherapy, there's a certain degree of immunosuppression. And when you are immunosuppressed, your body just can't react in the way same way that a normal person would when they get a vaccine. In people that are healthy, the Moderna and the Pfizer vaccine typically gives about 90% to 95% protection rate against the virus.

We don't know exactly what the protection rate will be in cancer patients that are immunocompromised, but it will probably be less than that. It might be 75%. It might be 50%. But, as I mentioned and Dr. Fauci said, some protection is better than no protection, so that's why we still stress that people should get the vaccine.

Bill Klaproth: And if that can keep you from getting a severe case of COVID-19, that's worth it, right?

Dr. Dixon King: Absolutely. Again. if you have the vaccine and you happen to get COVID, the odds are that you will have a somewhat milder case of it. And obviously, with the cancer diagnosis, the last thing you want is to be in the hospital, because you're very sick from COVID and all the complications that can happen, you know, from that. So you definitely want to get the vaccine. If it doesn't prevent you from getting the virus, then you'll probably have a much milder case than you would've had.

Bill Klaproth: Right. And then last question, Dr. King, and thank you for your time. Where can someone go to get more information about COVID-19 vaccines in patients with cancer?

Dr. Dixon King: I would stress to everyone that if they have more questions about the COVID vaccine and whether they be getting the vaccine and the timing of the vaccine, they should talk to their oncologist or other a healthcare provider, because everybody's situation is specific and everybody's a little bit different, so make sure you do that.

Now, if you do decide to find information on your own online, I would say, please stick to the websites that we can trust, specifically the CDC and the American Cancer Society sites. They have excellent frequently asked question pages regarding specifically COVID vaccine in cancer patients. So again, that's the CDC site and the American Cancer Society site.

Bill Klaproth: Yes, please. Great point. Trusted news sources only. There's so much disinformation and misinformation out there. Please stick to trusted news sources when you're doing your research and educating yourself on the vaccines and the coronavirus. Well, this has really been informative, Dr. King. Thank you so much for your time. We appreciate it.

Dr. Dixon King: It's been a pleasure. Thank you very much for having me.

Bill Klaproth: That's Dr. Dixon King. And for more information about the Kaufman Cancer Center and its services, please visit UMUCH.org/cancer. That's a UMUCH.org/cancer. This is The Hero Podcast from UM Upper Chesapeake Health. Thanks for listening.