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With the development of the Covid-19 vaccines, there is hope that these vaccines will be the magic bullets to beat the pandemic. In an accelerated manner, the vaccinations were approved for mass immunization within the year of inception. This is unprecedented and it shows great advances in science and the willpower of mankind.

However, there may still be doubts and uncertainty at this stage for many people. We speak with Dr Asok Kurup and Dr Richard Quek to find out more about the Covid-19 vaccination and its effect on cancer patients.

Dr Asok Kurup is an Infectious Diseases Physician and Chairman of the Chapter of Infectious Diseases Physicians, Academy of Medicine, Singapore

Dr Richard Quek is a Senior Consultant, Medical Oncology from Parkway Cancer Centre

1. Can you share more about the Covid-19 vaccination?

   Dr Asok: Great advances in science have led to the development of the COVID-19 mRNA vaccines which give instructions to our cells to make a harmless piece of protein found on the surface of the COVID-19 virus. Our immune cells recognize that the protein does not belong to the body and builds up an immune response with antibodies. Once vaccinated, protection is gained against falling sick from COVID-19 disease.

   To find out more about how a vaccine works, go to https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work

2. How is the vaccination administered?

   Dr Asok: Intramuscularly on the upper arm muscle and 2 doses separated by 21 days

3. I am currently on cancer treatment, should I go for the Covid-19 vaccination at this point?

   Dr Quek: The clinical trials that led to the approval of the current vaccines had specifically excluded patients who are receiving treatment with immunosuppressive therapy, or diagnosed with an immunocompromising condition.

   Cancer is a condition that suppresses one’s immune system. Cancer patients may also be receiving chemotherapy which may further suppress one’s immune system. Thus it is unclear if patients on active treatment especially those on chemotherapy should receive vaccination. Additionally, patients with a dampened immune system may not be able to mount an antibody immune response even after the vaccination.

   For well patients who are on maintenance hormonal therapy e.g. in breast cancer and prostate cancer, whose disease is in remission and patients’ immune systems are intact, it is not unreasonable to consider vaccination since one’s immune system is likely to be able to mount an antibody immune response to the vaccine.

   Discuss with your treating oncologist if you should take the vaccine when offered.

4. Will the vaccination affect my cancer treatment? (if yes to above question)

   Dr Quek: Unfortunately not a lot is known about vaccination and cancer treatment at this point in time since cancer patients and those on active immunosuppressive therapy e.g. chemotherapy, were specifically excluded from the COVID-9 clinical trials.

   It is unknown if vaccination will affect cancer treatment, in particular chemotherapy. Complications, if any, arising from vaccination may potentially result in delays to any on-going cancer treatment. It is reasonable to assume that any antibody response may be dampened following vaccination in patients with a suppressed immune system [i.e. cancer patients and in those receiving chemotherapy].

   While clinical data is not yet available to fully answer this question, for well patients who are on maintenance hormonal therapy e.g. in breast cancer and prostate cancer, with disease in remission and immune systems intact, theoretically, vaccination should not affect these forms of treatment.

5. I am on immunotherapy treatment, will the vaccination cause me to have more severe side effects?

   Dr Quek: Right now, it is unclear what impact of immunotherapy has on COVID-19 vaccination and vice-versa. Will the presence of immunotherapy treatment in a patient lead to a heightened immune response following vaccination? And if so, what is the resulting implication/ complication to the patient and cancer? Unfortunately, these questions remain unanswered at the time of this writing.

   Dr Asok: Yes, I agree with Dr Quek, that there is currently no evidence on this.

6. What are some of the potential side effects of the vaccination?

   Dr Asok: Some of the reported side effects include: Soreness, and pain at the injection site, fatigue, headache, and muscle pain may be common but serious side effects are very rare.

7. I am currently in remission, is my immunity considered compromised? Should I be vaccinated?

   Dr Asok: On a case by case basis and with guidance from your oncologist, you may be able to receive the vaccine.

   Information is accurate as at 30 Dec 2020.