COVID-19 and cancer

Expert Guidelines

CDC COVID-19 initial vaccination guidelines

• All people ages 5-17 should be vaccinated with the Pfizer vaccine and people 18 and older should be vaccinated with a Moderna, Pfizer or Johnson & Johnson vaccines unless contraindicated (e.g., known allergic reaction to a vaccine component). 
• People should be vaccinated even if they have already had a COVID-19 infection.
• COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
• People ages 5 or older with a weakened immune system, should get a COVID-19 vaccination (if they have no other contraindications). People with a weakened immune system may have a reduced immune response.
• People with an autoimmune condition, may receive an mRNA COVID-19 vaccine. 

CDC COVID-19 booster recommendations  

• The following people who received Pfizer or Moderna vaccines for their initial shot series should receive a booster at least 6 months after receiving their 2nd dose:
  • All people age 50 and older.
  • People who are 18 and older who live in a long-term care facility. 
• The following people who received Pfizer or Moderna vaccines for their initial shot series may receive a booster at least 6 months after receiving their 2nd dose:  
  •   People who are 18 and older. 
• People who received Johnson & Johnson for their initial shot series should receive a booster at least 2 months after receiving their initial dose. 
• Moderately to severely immunocompromised people ages 12 years and older who completed their Pfizer vaccine primary series and ages 18 years or older who complete their Moderna COVID-19 vaccine primary series should plan to get an additional primary dose followed by a booster dose.

NCCN booster recommendations for people diagnosed with cancer

NCCN released recommendations for the following people diagnosed with cancer to receive COVID-19 boosters at least four weeks after their second dose of Pfizer or Moderna.  

• Patients who have received cancer treatment within 1-year of their initial vaccination or are actively being treated, including those undergoing chemotherapy, targeted therapy, hormonal therapy, surgery, radiation or treatment with therapy that is currently used only in an experimental setting (e.g., a clinical trial).
• Patients with newly diagnosed cancer or recurrent cancer who will receive cancer treatment in the future.
• Patients with cancer of the blood regardless of whether they are currently receiving treatment.
• Patients who have received a stem cell transplant or engineered cellular therapy (e.g., CART cells).
• Patients who have had COVID-19 after their initial vaccine series should also get a booster (delayed more than 28 days after completion of the first series and documented clearance of the virus).

The NCCN guideline update did not address people who received the one-shot Johnson & Johnson COVID-19 vaccine.

Questions To Ask Your Health Care Provider

• Are there options for consultations or appointments by telephone or video?
• What are the risks and benefits of delaying in-person appointments, screening or treatment?
• Are there treatments that limit the number of in-person visits I will need?
• Can any of my treatments be safely delayed; and if so, for how long?
• What signs or symptoms should I monitor?
• If I require an in-person visit, are there times of the day that are less crowded or locations other than hospitals that are not treating COVID-19 patients where I can be seen?
• Given my treatment or health, am I immunocompromised? If so, what recommendations do you have for me? What precautions should I take?

Open Clinical Trials

The following are studies on COVID and cancer:

• NCT04872738: Patient Experiences With the COVID-19 Vaccination After Breast Cancer Treatment (LymphVAX). This study aims to elicit patient experiences, choices, and side effects associated with the COVID-19 vaccine after breast cancer surgery. 
• NCT04659135 ASCO Survey on COVID-19 in Oncology (ASCO) Registry
  This trial is looking at how the virus impacts cancer care and outcomes for cancer patients during the COVID-19 pandemic and beyond.
• NCT04354701 COVID-19 and Cancer Consortium Registry (CCC19).
  This trial collects data about cancer patients who are diagnosed with COVID-19 to understand what factors may be linked to short- and long-term outcomes, severity and mortality. Researchers also want to determine changes to cancer treatment that may have occurred due to COVID-19 and how COVID-19 may affect cancer outcomes.
• NCT04387656 NCI COVID-19 in Cancer Patients, NCCAPS Study
  This study looks at how COVID-19 affects outcomes for patients in cancer treatment and how cancer affects COVID-19.