Blood Cancer Patients, Survivors Hesitate Over COVID-19 Vaccine

Pam Harrison

March 10, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Nearly one in three patients with blood cancer and survivors say they are unlikely to get a COVID-19 vaccine or unsure about getting it if one were available. The findings come from a nationwide survey by The Leukemia & Lymphoma Society, which collected 6517 responses.

"These findings are worrisome, to say the least," Gwen Nichols, MD, chief medical officer of the Society, commented in a statement.

"We know cancer patients — and blood cancer patients in particular — are susceptible to the worst effects of the virus [and] all of us in the medical community need to help cancer patients understand the importance of getting vaccinated," she added.

The survey — the largest survey ever done in which cancer patients and survivors were asked about their attitudes towards COVID-19 vaccines — was published online March 8 by The Leukemia & Lymphoma Society.

Survey Sample

The survey asked patients with blood cancer and survivors about their attitudes to COVID-19 and COVID-19 vaccines.

"The main outcome [was] vaccine attitudes," note the authors, headed by Rena Conti, PhD, dean's research scholar, Boston University, Massachusetts.

Specifically, respondents were asked: "How likely are you to choose to get the vaccine?" Participants could indicate they were very unlikely, unlikely, neither likely nor unlikely, likely, or very likely to get vaccinated.

"We found that 17% of respondents indicate[d] that they [were] unlikely or very unlikely to take a vaccine," Conti and colleagues observe.

Among the 17% — deemed to be "vaccine hesitant" — slightly over half (54%) stated they had concerns about the side effects associated with COVID-19 vaccination and believed neither of the two newly approved vaccines had been or would ever be tested properly.

The survey authors note that there is no reason to believe COVID-19 vaccines are any less safe in patients with blood cancers, but concerns have been expressed that patients with some forms of blood cancer or those undergoing certain treatments may not achieve the same immune response to the vaccine as noncancer controls.

Importantly, the survey was conducted December 1-21, 2020, and responses differed depending on whether respondents answered the survey before or after the Pfizer-BioNTech and Moderna vaccines had been given emergency use authorization by the US Food and Drug Administration starting December 10, 2020. 

There was a slight increase in positive responses after the vaccines were granted regulatory approval. (One third of those who responded to the survey after the approval were 3.7% more likely to indicate they would get vaccinated). "This suggests that hesitancy may be influenced by emerging information dissemination, government action, and vaccine availability, transforming the hypothetical opportunity of vaccination to a real one," the survey authors speculate.

Survey respondents who were vaccine hesitant were also over 14% more likely to indicate that they didn't think they would require hospitalization should they contract COVID-19. But clinical data have suggested that approximately half of patients with a hematological malignancy who required hospitalization for COVID-19 die from the infection, the authors note.

"Vaccine hesitant respondents [were] also significantly less likely to engage in protective health behaviors," the survey authors point out. For example, they were almost 4% less likely to have worn a face mask and 1.6% less likely to have taken other protective measures to guard against COVID-19 infection.

Need for Clear Messaging

To counter vaccine hesitancy, the authors suggest there is a need for clear, consistent messaging targeting patients with cancer that emphasize the risks of COVID-19 and underscore vaccine benefits.

Conti pointed out that patients with blood cancer are, in fact, being given preferential access to vaccines in many communities, although this clearly doesn't mean patients are willing to get vaccinated, as she also noted.

"We need both adequate supply and strong demand to keep this vulnerable population safe," Conti emphasized.

The Leukemia & Lymphoma Society plans to repeat the survey in the near future to assess patients' and survivors' access to vaccines as well as their willingness to get vaccinated.

The authors have reported no relevant financial relationships.

The Leukemia & Lymphoma Society. Published online March 8, 2021. Survey

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