NCCN Releases Guidelines on COVID-19 Vaccinations in Patients With Cancer

New guidelines from the National Comprehensive Cancer Network (NCCN) provide information on proper coronavirus disease 2019 (COVID-19) vaccination practices for providers treating patients with cancer.¹

Recently, 2 vaccines were granted Emergency Use Authorization by the FDA for the prevention of COVID-19. They vaccine include the BNT162b2, codeveloped by Pfizer and BioNTec, as well as mRNA-1273 vaccine developed by Moderna. Both vaccines were found to be more than 90% effective in preventing COVID-19.^2,3

The guidelines, written by the NCCN COVID-19 Vaccine Committee, suggest vaccinating all patients receiving active cancer treatment.⁴ The committee is amade up of hematology and oncology experts knowledgeable about infectious diseases, medical ethics, vaccine development and delivery, and health information technology.¹ They make further suggestions for cancer care providers on how to make decisions that will protect their patients during the pandemic, such as how to recommend the appropriate scheduling for patients based around their immunosuppressive therapy.

“Right now, there is urgent need and limited data,” Steve Pergam, MD, MPH, associate professor of the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center; infection prevention director at Seattle Cancer Care Alliance; and coleader of the NCCN COVID-19 Vaccine Committee, said in a statement. “Our number one goal is helping to get the vaccine to as many people as we can. That means following existing national and regional directions for prioritizing people who are more likely to face death or severe illness from COVID-19.”

“The evidence we have shows that people receiving active cancer treatment are at greater risk for worse outcomes from COVID-19, particularly if they are older and have additional comorbidities, like immunosuppression,” Pergam continued.

Other issues covered in the guidelines include balancing vaccination efforts between cancer centers and community settings; how to communicate with patients and their caregivers, especially people who do not speak English; accounting for societal inequities; prioritizing communities who are at-risk; preparing for potential interactions with patients medication or adverse events; and which patients to prioritize if there are limited supplies and staff capacity.

“My philosophy is don’t waste a dose and keep it simple. Too many caveats can lead to confusion,” Lindsey Baden, MD, associate professor of medicine and infectious disease at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, and committee coleader, said in a press release. “Of course, if strong new evidence comes out to support prioritizing certain groups over others, we can always adjust. This is intended to be a living document that is constantly evolving—it will be updated rapidly whenever new data comes out, as well as any potential new vaccines that may get approved in the future.”

Additionally, these guidelines recognize that the effectiveness of the vaccines among patients with cancer are not known yet, even though the vaccines have shown to be safe in the general population. The data from the vaccine trials showed the vaccines reduce the incidence of COVID-19 and complications, but it is uncertain if the vaccines prevent infection or subsequent transmission. The committee suggests that caregivers and others in the household should also get the vaccine once they are considered eligible in their area, as well as continuing to wear masks and social distance.

“One of our primary goals is reducing morbidity and mortality,” Sirisha Narayana, MD, associate professor of medicine and chair of the UCSF Ethics Committee at UCSF Health, said in a statement. “We also have to take social determinants of health into account and make special efforts for people in high-risk communities.”

The committee plan to meet regularly to improve their recommendations as new information becomes available.

“The medical community is rising to one of the biggest challenges we have ever faced,” Robert W. Carlson, MD, Chief Executive Officer of the NCCN, said in a press release. “The COVID-19 vaccines exemplify the heights of scientific achievement. Now we have to distribute them quickly, equitably, safely and, efficiently, using clearly defined and transparent principles.”

_References:

_{1. NCCN shares new guidance principles for vaccinating people with cancer against COVID-19. News release. NCCN. Published January 22, 2021. Accessed January 28, 2021. https://bit.ly/3iU496R}

_{2. FDA takes key action in fight against COVID-19 by issuing emergency use authorization for first COVID-19 vaccine. News Release. FDA. December 11, 2020. Accessed January 28, 2021. https://bit.ly/37kzg7r}

_{3. FDA takes additional action in fight against covid-19 by issuing emergency use authorization for second covid-19 vaccine. News release. FDA. December 18, 2020. Accessed January 28, 2021. https://bit.ly/3am2IvD}

_{4. NCCN: Cancer and COVID-19 Vaccination. NCCN. Published January 22, 2021. Accessed January 28, 2021. https://bit.ly/3clJCXC}