Cancer and recommendations for Covid-19 vaccination
November 16, 2022 - read ≈ 5 min
Mayo Medical School
Darya Kizub, MD
MD Anderson Cancer Center
Mark Poznansky MD
Massahussets General Hospital, Harvard Medical School
I have cancer or recently had cancer. Should I get the COVID-19 vaccination?
Several national and international health organizations recommend that current and recent cancer patients should be fully vaccinated against COVID-19.[1-8] The benefits of vaccination far outweigh the risks of severe COVID-19 infection. Patients should work with their medical team to coordinate the timing of vaccination and cancer treatments so that the vaccine is as effective as possible. Special guidelines for patients receiving specific therapies include:
- Patients planning to start or restart chemotherapy, radiation, or other immunosuppressive treatments (including splenectomy)* should receive the vaccine at least 2 weeks before treatment if possible. For patients currently receiving immunosuppressive therapy, vaccination should not be delayed.
- Patients receiving CAR-T therapy or hematopoietic stem cell transplant should wait at least 3 months after treatment to get the vaccine.
- Patients receiving B-cell depleting therapy such as rituximab or ocrelizumab should be vaccinated at least 4 weeks before therapy or should wait at least 6 months after treatment to get the vaccine.
- Patients with hematologic cancer such as leukemia, lymphoma, or myeloma who are undergoing intensive chemotherapy should wait to be vaccinated until neutrophil recovery (neutrophil count above 500 cells/µL for 3 days).
Additionally, patients with a history of breast cancer should be vaccinated on the side opposite the cancer. For example, someone with a history of cancer in the left breast should receive a vaccine in the right arm. If possible, screening mammograms should be completed either before receiving the vaccine or several weeks after vaccination.  The COVID vaccine can sometimes cause temporary inflammation and swelling of lymph nodes, which can be worrisome for patients if it happens on the same side as their breast cancer.
Revaccination, defined as repeating primary series vaccinations, can be considered in some circumstances. Revaccination is recommended for patients at least 3 months after receiving CAR-T therapy or hematopoietic stem cell transplant, or at least 6 months after receiving B-cell depleting therapy.[4,5] Antibody testing to assess immune response to vaccination is not currently recommended.
* Immunosuppressive therapies include high-dose corticosteroids, alkylating agents, antimetabolites, certain chemotherapeutic agents, and other therapies. Ask your doctor if you are not sure whether a treatment you are receiving is immunosuppressive.
Why should I be vaccinated?
Patients with cancer or who are receiving treatment for cancer are at an increased risk for severe complications from COVID-19 infection.[1, 4]
Your immune system may not be able to combat the COVID-19 virus as well as it could if you were healthy. The vaccine helps your body fight the COVID-19 virus so that you can avoid infection or have less severe symptoms if you do become infected. Without the vaccine, you are a greater risk for severe symptoms that may lead to hospitalization or even death.
Vaccination helps keep you safe.
What else can I do to stay safe?
Work with your healthcare provider to coordinate the best timing for vaccination, health screenings, and cancer treatments. In addition, you should keep up safe habits like washing your hands frequently with soap and water, wearing a mask, and maintaining social distancing when possible.
Your household members and close contacts can also help keep you safe by being fully vaccinated and practicing hand washing, masking, and social distancing. These measures are especially important if you are receiving chemotherapy or other immunosuppressive treatments.
Which vaccine should I receive?
If you started a vaccine series already, you should complete the primary series of vaccinations with the same brand of vaccine if possible. If the same brand is not available for subsequent doses, you can use a different brand at least 28 days after your last COVID-19 vaccine dose.
Immunocompromised patients who receive the Moderna or Pfizer-BioNTech primary series should receive an extra primary series dose. For booster doses and/or revaccination, or if you have not yet received any vaccinations, Moderna or Pfizer-BioNTech vaccines are preferred if available.
Is the vaccine safe and effective for people with cancer?
In general, the COVID-19 vaccine is safe for people with current or recent cancer or who are receiving cancer therapy because there is no active virus in the vaccine. If you have ever had an allergic reaction to a vaccination, you should tell your healthcare provider so that the right vaccine can be chosen for you.
Several studies have looked at vaccine safety and efficacy in patients with current or recent cancer or who are receiving cancer therapy. While the body’s response to the vaccine may be less in cancer patients whose immune system is suppressed, studies suggest that the vaccine is between 70 and 98% effective in cancer patients, with variation based on the specific type of cancer and treatment. Lower response was observed in patients who received CAR-T or hematopoietic stem cell therapy within the last 3 months, as well as patients who received B-cell depleting therapy (e.g. rituximab) within the last 6 months.
This means that for most cancer patients, vaccination offers significant, effective protection against COVID-19 infection. Many more studies are in progress to better understand vaccine safety and efficacy in cancer patients.
- COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed November 5, 2022.
- Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Centers for Disease Control and Prevention. Updated October 19, 2022. Accessed November 5, 2022. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#print
- COVID-19 Vaccines in People with Cancer. American Cancer Society. Accessed November 5, 2022. https://www.cancer.org/treatment/coronavirus-covid-19-and-cancer/covid-19-vaccines-in-people-with-cancer.html
- COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised. Centers for Disease Control and Prevention. Updated November 3, 2022. Accessed November 5, 2022. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html
- Garassino MC, Vyas M, de Vries EGE, Kanesvaran R, Giuliani R, Peters S. The ESMO Call to Action on COVID-19 vaccinations and patients with cancer: Vaccinate. Monitor. Educate. Ann Oncol. May 2021;32(5):579-581. doi:10.1016/j.annonc.2021.01.068
- NCCN COVID-19 Vaccination Guide for People with Cancer. National Comprehensive Cancer Network; 2022. https://www.nccn.org/docs/default-source/covid-19/covid-vaccine-and-cancer-05.pdf?sfvrsn=45cc3047_2
- Castelo-Branco L, Cervantes A, Curigliano G, et al. ESMO Statements on Vacciation Against COVID-19 in People with Cancer. European Society of Medical Oncology. Updated December 16, 2021. Accessed November 5, 2022. https://www.esmo.org/covid-19-and-cancer/covid-19-vaccination
- Lazăr DE, Munteanu A. COVID-19 immunization in people with cancer-Is it safe and efficient? What do we know? Tumori. Oct 2022;108(5):420-430. doi:10.1177/03008916221090544
- Addeo A, Shah PK, Bordry N, et al. Immunogenicity of SARS-CoV-2 messenger RNA vaccines in patients with cancer. Cancer Cell. 2021;39(8):1091-1098.e2. doi:10.1016/j.ccell.2021.06.009