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The contraindication for those who are immunosuppressed has been eliminated. What is not yet known about the effects of anticovid substances in these cases.
Jujuy al día® – The shadow of the pandemic reaches all societies. Among its multiple sequelae, there is also how it has affected patients of other diseases, such as cancer, who have seen their diagnosis and treatment have delays and delays due to the urgent need to treat people infected by coronavirus.
According to a study published in November in the specialized journal British Medical Journal (BMJ), people whose cancer treatment is delayed, even just one month, have a risk of dying between 6% and 13% higher. The researchers calculated that the risk continues to increase the longer it takes to start your treatment. Thus, a delay of eight weeks in breast cancer surgery would increase the risk of death by 17%, and a delay of 12 weeks, by 26%.
The pandemic caused significant delays in testing, diagnosis, treatment and follow-up strategies for cancer patients around the world. In addition, scientific work has shown that these patients have a higher risk of having a severe Covid-19, especially among those with hematological and pulmonary neoplasms, solid tumors or metastatic disease, although more studies are still necessary in this regard. So, should cancer patients be vaccinated against SARS-CoV-2?
Coronavirus Vaccine
In Argentina it has recently been determined to eliminate the restriction to vaccinate people with immunosuppression. However, this does not mean that it places a cancer patient in a privileged position to receive the vaccine earlier, and it will always be essential that doctors analyze it on a case-by-case basis.
The European Society for Medical Oncology (ESMO), for its part, recently published a document recommending that all member states of the European Union anticipate their vaccination among people with cancer due to the high impact that the coronavirus has on them.
“We ask that patients undergoing cancer treatment be a priority in vaccination,” explains Solange Peters, president of ESMO. We also want more trials looking at its possible side effects in this vulnerable group and more education so that people understand the importance of immunization, that the benefits always outweigh the risks. And for those who doubt the duration of immunity, just to say that some protection is always better than none. “
According to the European Cancer Society, it is that if the objective is to protect the patient in immunosuppressive treatment, a complementary measure to their vaccination will be the immunization of their environment. In short: caregivers should be equally a priority in vaccination.
In Argentina
“What has just happened in Argentina is that vaccination against Covid-19 in immunosuppressed people is removed as a contraindication, as something very general,” explains infectologist Florencia Cahn, president of the Argentine Society of Vaccination and Epidemiology, SAVE -. But we must be very clear in stating that it is necessary to evaluate in each case, because it may happen that a person with an active cancer and undergoing chemotherapy treatment has a quite weakened immune system, which could not have a good response to the vaccine”. And he adds: “You have to even evaluate what type of chemotherapy that person is receiving to see what the ideal time is for them to be vaccinated.”
Something fundamental to take into account is that, within the staggered vaccination regulations that now exist in our country, an immunosuppressed person could be vaccinated “as long as they are health personnel or over seventy years,” the specialist clarifies. In other words, those who have some type of oncological disease, and are in a position to receive the vaccine, will do so as long as they are part of the risk and priority groups defined so far.
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According to the memorandum on “Update on special situations in the target population to be vaccinated”, issued on February 10, “Argentina, like other countries in the world, is implementing a staggered and staged vaccination strategy, in which Different groups of the target population will be incorporated simultaneously and / or successively, subject to the supply of vaccines and prioritizing the defined risk conditions ”.
First, the vaccination strategy considers the population at risk for exposure and strategic role. This includes: health personnel; armed forces, security and prison service personnel; teaching and non-teaching staff (initial, primary and secondary); other strategic populations defined by jurisdictions and dose availability.
The memorandum then describes the “population at risk for serious illness”: adults 60 years and older; elderly people residing in long-stay homes; adults aged 18 to 59 belonging to risk groups (obesity grade 2 or more, insulin-dependent or non-insulin-dependent diabetes, chronic diseases such as kidney, respiratory or cardiovascular).
The novelty then is that the National Immunization Commission (CoNaIn), in consensus with various scientific societies and experts outside the National Ministry of Health, and in line with the analyzes and recommendations published in recent weeks in other countries, have recommended the Ministry of Health to exclude the concept of “contraindication for vaccination against COVID-19” to pregnant women, women who are breastfeeding, immunocompromised people or people with autoimmune diseases that are part of the groups that belong to the target population to be vaccinated (always and when the vaccine platform used is not live attenuated viruses).
“That is to say that what was previously a contraindication, being immunosuppressed, is now no longer so. And then the people in that situation who have cancer and under treatment would be candidates to be vaccinated as long as they are part of the groups described above, ”says Cahn.
In summary: the fact that the contraindication has been eliminated does not imply that cancer patients or pregnant women will be first on the list simply because they have either of these two conditions.
Cancer radiation therapy
Surveillance and adverse effects
In any case, and beyond the good news and the recommendations of European experts, there is much that is still unknown and therefore prudence is king.
For most of the experts in oncology the vaccine is safe. “The message that must be given is that the vaccine is safe, as it is for the rest of the population, so we must immunize as many patients as possible and as quickly as possible,” says Thomas Powles, a researcher at the Institute. Barts Cancer Center in London (UK). “Although they have not been tested in cancer patients, the benefit can be very great if some type of immunity is generated quickly.”
However, the experts admit that the information on the effects of the anticovid vaccines in cancer patients is still very limited, and they limit themselves to saying that with the data currently available there are no explicit recommendations to exclude any group of adult patients.
The efficacy and duration of immunity in cancer patients are still unknown. “Data on the humoral or cellular response to vaccination are scarce in cancer patients, so we still do not know if the degree of immunity they acquire – that is, protection against infection – is the same as in healthy people. ”, Says Pilar Garrido in charge of the Oncology division for women at ESMO.
Of course, given its immune compromise and fragility, the experts demand a follow-up in the registries and specific clinical trials, as well as an evaluation of possible adverse events.
To date, there are also not enough data to evaluate the interactions between the various cancer treatments with the covid-19 vaccination. However, since the vaccine appears to provide a higher level of neutralizing antibodies than natural infection, immunization is recommended in patients receiving chemotherapy.
Despite the vaccines, it is still essential to continue with preventive measures: always use a mask, physical distancing measures, avoid meetings in closed places that do not have ventilation or whose ventilation is poor (there must be a draft), hand hygiene. That this is of use and custom with or without vaccines, will be essential, specialists believe, at least until 2022.
* SINC Agency and Andrea Gentil.
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