Table 1.

Recommendations on COVID-19 vaccine rollout for adults with cancer in Mexico.

Topic	Recommendation
Vaccination in adults with cancer	SMEO recommends that all adults with cancer in Mexico be vaccinated in strict accordance with the National Vaccine Rollout Policy, using any of the currently available vaccines authorized by COFEPRIS (21). (Level of evidence 1b, grade of recommendation B).
Prioritization of adults with cancer in vaccination campaigns	Adults living with active cancer and undergoing antineoplastic treatment or who are planning to initiate treatment, especially for hematological neoplasms, should be priority for vaccine rollout, particularly considering limited vaccine availability (17,19,24). (Level of evidence 2b, grade of recommendation B).
Vaccination in patients receiving cytotoxic chemotherapy	Vaccination should not be delayed (Level of evidence 2b, grade of recommendation B). If possible, and if this does not hinder timely access to the vaccine, vaccination should take place two weeks before initiating treatment, or when the absolute neutrophil count is within normal ranges, particularly for adults with hematological malignancies (13,19). Updated bloodwork is not needed before vaccination. (Level of evidence 5, grade of recommendation D).
Vaccination in patients receiving immunotherapy or targeted therapy	Vaccination should not be delayed. Previous studies with other vaccines have concluded that vaccination does not increase the risk for immune-related adverse events (25,26). A study in Israel among adults who received the Pfizer-BioNTech vaccine showed that vaccination was not associated with a higher risk for immune-related adverse events (27). (Level of evidence 2b, grade of recommendation C).
Vaccination in patients after hematopoietic stem cell transplantation	Among patients who undergo hematopoietic stem cell transplantation, vaccination should be delayed 3-6 months post-transplant (28., 29., 30.). If vaccination is feasible before transplant, a 2–4-week term is recommended between both events, if possible (31). (Level of evidence 2b, grade of recommendation C).
Vaccination in patients receiving radiotherapy	Vaccination should not be delayed. Each case should be evaluated by the attending radio-oncologist for specific recommendations (32). (Level of evidence 5, grade of recommendation D).
Vaccination in patients treated surgically	Vaccination should take place at least 7-10 d after the surgical procedure. This should avoid any vaccine-related adverse events (fever, fatigue, etc.) being incorrectly attributed as surgical complications (19). Additionally, this would allow for adjuvant treatment initiation in candidate patients (33). (Level of evidence 5, grade of recommendation D).
Number of vaccine doses	Among adults with cancer who receive two-dose vaccines, administration of the second dose not be delayed under any circumstance, since this could lead to a hindered response and insufficient protection (15). (Level of evidence 2b, grade of recommendation C).
Socioeconomic factors and vaccination	Given the observed associations between poverty, overcrowded living conditions, and worse COVID-19 related outcomes, adults with cancer from rural and marginalized areas should be considered a priority in vaccine rollout strategies (7). (Level of evidence 2c, grade of recommendation B).
Social distancing after vaccination	Social distancing and mask wearing strategies are highly encouraged even after vaccination for adults with cancer, given the lack of robust evidence regarding the immune response in patients with cancer, particularly those undergoing active treatment. (Level of evidence 5, grade of recommendation D).
Vaccination-related research	We encourage research centers to design and implement studies aimed at measuring the immune response and prevalence of adverse events following vaccination against COVID-19 in patients with cancer (17). (Level of evidence 5, grade of recommendation D).
Strategies to decrease vaccine hesitance	Government instances, medical societies, patient advocacy organizations and all medical practitioners should actively participate in conveying information via traditional and social media regarding the safety and efficacy of COVID-19 vaccination, with the objective of generating public confidence and increasing vaccine uptake (17,34). (Level of evidence 5, grade of recommendation D).
Cancer registries and vaccination	We recommend strengthening national cancer registries to facilitate the identification of patients at higher risk for worse outcomes in the event of future pandemics (35). (Level of evidence 5, grade of recommendation D).
Vaccination of healthcare providers	We recommend all healthcare personnel involved in the care and treatment of patients with cancer be vaccinated according to the strategies proposed in the National Vaccine Rollout Policy (21). (Level of evidence 5, grade of recommendation D).