key: cord-0894791-cd2uogmw
authors: Stoeklé, Henri-Corto; Sekkate, Sakina; Angellier, Elisabeth; Hervé, Christian; Beuzeboc, Philippe
title: Refusal of anti-COVID-19 vaccination in cancer patients: is there a difference between the sexes?
date: 2021-07-21
journal: Eur J Cancer
DOI: 10.1016/j.ejca.2021.06.048
sha: aa5ef70ce3d88aefe407207cfdf8ddb628cca680
doc_id: 894791
cord_uid: cd2uogmw

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The same Pfizer-BioNTech vaccine was proposed in both our study and that of Di Noia et al. Refusal rates differed between our study and the Italian study. Only 5.6% (29/522) of the 522 patients in our study (218 men and 304 women) refused an offer of immediate vaccination, versus 11.2% in the study by Di Noia et al. However, it should be noted that a French survey performed before the launch of the vaccination campaign had reported a refusal rate of 16.6% (4). In the cohort of Di Noia et al., the refusal rate even rose to 19.7% after the suspension of the AstraZeneca vaccine was announced, demonstrating the variability of attitudes towards refusal over time as a function of the information delivered by the media or social networks.

The principal finding of our study was an unexpected significant difference between men and women: 9.6% refusal (21/218) for women, versus only 2.6% (8/304) for men (pvalue = 0.001). This difference did not seem to be due to a selection bias in our cohort. Before the start of the vaccination campaign, a similar tendency for women to be more reticent about 

Outside of Europe, another study, by Villarreal-Garza et al. was recently published in JAMA Oncology. It reported an even higher rate of refusal (34%) in a cohort of 540 women suffering from breast cancer (6) . This study also analyzed the reasons given by these women to justify their refusal. Misinformation, problems of confidence in the health system and cultural reasons predominated. Age was also identified as a possible factor. The median age of the women in our series (65) was much higher than that in the study by Villarreal-Garza et al. (49). In their series, age, with a threshold of 60 years, was found to influence the rate of refusal.

Whatever the reasons, sex clearly appeared to be a discriminating factor in our study.

How can we, as of now, improve the information provided to patients, so as to improve the acceptability of vaccination? A pragmatic, global, bioethical reflection concerning these results is now required, particularly as the pandemic does not seem to be abating.

None.

Cancer associates with risk and severe events of COVID-19: A systematic review and meta-analysis

COVID-19 vaccines for patients with cancer: benefits likely outweigh risks

The first report on Covid-19 vaccine refusal by cancer patients in Italy: early data from a singleinstitute survey

Acceptance of SARS-CoV-2 vaccination among French patients with cancer: a cross-sectional survey

Social inequalities in hostility toward vaccination against Covid-19

Attitudes and factors associated with COVID-19 vaccine hesitancy among patients with breast cancer