Some Young Cancer Survivors Hesitant About COVID-19 Vaccine

By Lisa Rapaport

July 02, 2021

(Reuters Health) - More than one in three adolescent and young adult cancer survivors report that they are hesitant to get vaccinated against COVID-19, a new survey suggests.

The survey, conducted at two health systems in Utah and surrounding states, included 342 cancer survivors aged 18 and older who were diagnosed with cancer between the ages of 15 and 39 years. The survey asked whether participants "agreed" or "strongly agreed" that they should receive the COVID-19 vaccine when it's available and recommended (agreeing to vaccinate), or if they "neither agreed nor disagreed," "disagreed," or "strongly disagreed" (vaccine hesitancy).

Overall, 37.1% of respondents were vaccine hesitant, researchers report in JNCI: Cancer Spectrum.

"Many survivors are supportive of COVID-19 vaccination and willing to be vaccinated, even though some of these individuals still have concerns about how effective the vaccine is for preventing COVID-19, risk of side effects, and concerns over whether their immune system is strong enough to be vaccinated," said lead author Austin Waters, research program manager in cancer control and population sciences at Huntsman Cancer Institute at the University of Utah in Salt Lake City.

"While these are certainly good questions for survivors to ask their providers, we stress that the vaccine is recommended for the vast majority of cancer survivors regardless of whether they are actively receiving cancer treatment or not," Waters said by email.

Female cancer survivors in the study were significantly more likely than males to express vaccine hesitancy (odds ratio 1.81), with 42% of females indicating vaccine hesitancy compared with 30.1% of males.

When survivors had no more than a high school education, they were significantly more likely to report vaccine hesitancy than college graduates (OR 3.15), the study also found.

A greater proportion of Hispanic participants (53.9%) than white participants (31.6%) reported vaccine hesitancy, but this difference wasn't statistically significant

One limitation of the study is that results may not be generalizable to other health care systems or other regions in the U.S., the researchers note. Another is lack of data on political affiliation to determine if it had an influence on vaccine hesitancy.

"There would be no vaccine hesitancy if we had their confidence that the COVID-19 vaccines are generally safe and far outweigh the risks of being exposed to the whole virus," said Dr. Antoni Ribas, a professor of medicine, surgery and molecular and medical pharmacology at the David Geffen School of Medicine at the University of California, Los Angeles.

"But in this group of persons, having undergone multiple medical procedures and treatments, many without them clearly knowing why they had to do this when their peers did not go through it, many resulting in great discomfort, is likely to make them skeptical of new medical advice," Dr. Ribas, who wasn't involved in the study, said by email.

This puts the onus on clinicians to spend extra time educating young cancer survivors about the risks of COVID-19 and the safety and effectiveness of the vaccine, particularly if patients have concerns related to long-term immunosuppression, Dr. Ribas said.

There have been mixed messages regarding COVID-19 vaccination in persons who are immunocompromised, Dr. Ribas said. Research to date suggests that the Moderna and Pfizer-BioNTech vaccines should be as safe in persons with some type of immunosuppression as they are in immunocompetent persons, Dr. Ribas added.

"Any additional immunity to the virus would be welcome even if the vaccine does not elicit the same protective response as in immunocompetent persons," Dr. Ribas said. "There is also emerging data that giving a third booster vaccine may allow people with immunosuppression to gain protective immunity to COVID-19."

SOURCE: JNCI: Cancer Spectrum, online June 29, 2021.