key: cord-0960955-1mbc8ct4
authors: Figueiredo, J.C.; Ihenacho, U.; Merin, N.M.; Omid;, H.; Darrah, J.; Gong;, J.; Paquette, R.; Mita, A.C.; Vescio;, R.; Mehmi, I.; Basho, R.; Salvy, S.J.; Shirazipour, C.H.; Caceres, N.; Finster, L.J.; Coleman, B.; Arnow, H.U.; Florindez, L.; Sobhani, K.; Prostko, J.C.; Frias, E.C.; Stewart, J.L.; Merchant, A.; Reckamp, K.L.
title: SARS-CoV-2 vaccine uptake, perspectives and adverse reactions following vaccination in patients with cancer undergoing treatment
date: 2021-10-20
journal: Ann Oncol
DOI: 10.1016/j.annonc.2021.10.004
sha: 8095899350f5c5fbfedef291f2c7b33a3988f6ec
doc_id: 960955
cord_uid: 1mbc8ct4

nan

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines were developed, tested, and approved in record time. As patients with cancer were excluded from vaccine trials, some patients may be hesitant [1] given unanswered questions around safety and adverse reactions, especially those undergoing treatment. One study conducted among 134 patients receiving immune checkpoint inhibitors (ICI) reported a 81% BNT162b2 vaccine uptake rate with similar rates of acute adverse reactions as reported among healthy individuals, except for higher frequency of myalgias among patients with cancer. [2] Further research is needed by tumor type and treatment in order to better inform clinicians and patients during the vaccine decision-making process.

We report data on uptake and perspectives on SARS-CoV-2 vaccination and postvaccination adverse reactions in 208 recently diagnosed patients with cancer (median age=63 years, 52.4% women, 33.2% non-White minorities) at a large health care system in Los Angeles spanning the timeline from limited vaccine availability to broader dissemination (November 2020 to July 2021). Vaccine hesitancy and perspectives were measured using a modified version of the World Health Organization vaccine hesitancy scale (Supplemental Material). [3] A selfadministrated symptoms questionnaire was given to vaccinated recipients after dose 1 (D1) and dose 2 (D2) for mRNA SARS-CoV-2 vaccines. Electronic medical records provided correlative clinical information. Chi-square tests were used to assess differences for categorical variables and a Wilcoxon rank-sum test for continuous variables (Stata v. 15.1). All tests were two-sided and considered statistically significant at p<0.05. Older (p=0.02), highly educated (p=0.03), and retired (p=0.003) individuals were more likely to be vaccinated (Supplemental Material). Adverse reactions were common (D1: 27.6% and D2: 53.5%). There were no significant differences in adverse reactions by age, mRNA vaccine type or prior SARS-CoV-2 infection. We found that ECOG score was not associated with adverse reactions after D1 (p=0.72), but being fully active was associated with a greater number of reported adverse reactions after D2 (p=0.005). Women experienced more pain compared to men (D2: 66.7% v. 37.3%; p=0.002), including pain (p=0.02) and fatigue/malaise (p=0.003, Figure   1 ). Patients with solid tumors also reported more symptoms compared to those with hematologic malignancies (D2: 62.3% v. 35.1%; p=0.006); more specifically, symptoms were less frequent among those receiving BCTs compared to those not on BCTs (D2: 35.5% v. 60.2%; p=0.02).

Fevers were more common among patients receiving ICIs compared to those not on ICIs (D2: 34.1% v. 11.4%, p=0.003). Women on HT frequently reported muscle/bone/joint or nerve J o u r n a l P r e -p r o o f symptoms (D2: 11.5% v. 2.0%; p=0.025). Patients on CT reported muscle/bone/joint/nerve (D1:

15.2% v. 0%; p<0.001) and cough/chest or breathing symptoms (D2: 10.7% v. 1.2%; p=0.02).

Our study shows post-vaccination adverse events varied by tumor type and treatment.

The report of adverse events in this study may be subject to recall bias and the potential influence of the media. Previous studies have suggested that patients receiving combined ICI therapy (anti-PD-1, anti-PD-L1, anti-CTLA-4) should be closely monitored for increased immune-related adverse reactions during vaccine administration. [4, 5] Addressing specific vaccine concerns among patients with cancer early may ensure high compliance, in particular among women. The findings discussed here may be generalizable to 

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

Short-term safety of the BNT162b2 mRNA COVID-19 vaccine in patients with cancer treated with immune checkpoint inhibitors

Measuring vaccine hesitancy: Field testing the WHO SAGE Working Group on Vaccine Hesitancy survey tool in Guatemala

Indications for and contraindications of immune checkpoint inhibitors in cancer patients with coronavirus disease 2019 vaccination

Immune Checkpoint Inhibitors for Cancer Therapy in the COVID-19

We sincerely appreciate all SeroNet-CORALE participants and each member of the study (www.corale-study.org) and biospecimen management group. We are also grateful to all the front-line healthcare workers in our healthcare system who continue to be dedicated to delivering the highest quality care for all patients.