Dear Editor,
We read with interest the study reported by Di Noia et al. [1] in the August issue of European Journal of Cancer about adherence to SARS-COV-2 vaccine, entitled ‘The first report on coronavirus disease 2019 (COVID-19) vaccine refusal by patients with solid cancer in Italy: early data from a single-institute survey’.
All patients with cancer were offered the BNT162b2 vaccine by phone contact or during scheduled visits, with 102 (11.2%) of the 914 eligible patients refusing vaccination. The most frequently given reasons were concerns about possible adverse events (48.1%), suspicions over negative interactions with ongoing anticancer treatments (26.7%), or previous allergic reactions (10.7%). These data differ substantially from the experience of our Oncology and Hematology Department, where only three (0.68%) of 443 eligible patients with cancer with advanced active disease and on systemic antitumour treatment, or who had received treatment within the last six months, refused vaccination.
We would like to offer some explanation for the varying rates of adherence among patients with cancer in the same country, albeit in different areas of northern and south-central Italy in Piacenza and Rome, respectively.
Italy was the first country after China to be affected by the pandemic, and our city, Piacenza, is close to the epicentre of the outbreak in Italy, being just 10 min away by car. Many oncology patients from that area were actively receiving treatment at our hospital. Some became infected by COVID-19, and many of them died. We previously reported the first 25 patients with cancer with COVID-19 pneumonia in the Western world, finding a mortality rate of 36.00% [2]. Subsequently, we reported cases involving 51 cancer patients with COVID-19 and found a mortality rate of 23.53% [3].
Vaccines BNT162b2 and mRNA-1273 were approved [4] and recommended by both the United States Food and Drug Administration and the European Medicines Agency to prevent COVID-19 disease. However, there is a paucity of data on the efficacy and safety of mRNA COVID-19 vaccines in patients with cancer in terms of their antibody-mediated response and tolerability.
We engaged the local community of patients with cancer and used TV and radio campaigns, as well as the social media presence of various volunteers to promote the importance of COVID-19 vaccines for oncology patients. In addition, a vaccine task force composed of nurses, oncologists and psychologists was established in our department. All 443 patients with cancer, who were eligible for COVID-19 vaccination, were contacted by phone and given information about the benefits and risks from the reference oncologist and nurse, after which 394 patients immediately accepted the invitation. Of those contacted, 49 (11.06%) patients were initially dubious about the vaccine, but a second conversation with caregivers and the oncologist helped them take the decision to vaccinate. Ultimately, only three (0.68%) of the 443 patients refused vaccination, with two citing ideological reasons and one refusing for fear of interference with their cancer and its treatment.
In conclusion, we agree with Curigliano et al. [5] that, given the greater severity of and higher risk of death from COVID-19 in patients with cancer, we as healthcare workers need to make every possible effort to improve vaccination adherence by this group. The high adherence to COVD-19 vaccination by oncology patients in our district has been recognised by local health authorities as a model to promote vaccination in other populations [6].
Funding
None.
Conflict of interest statement
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Luigi Cavanna: Consulting or Advisory Role for AstraZeneca; Travel, Accommodations, Expenses from Pfizer, Ipsen and Celgene. Other authors: No Relationships to Disclose.
References
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