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A new study addresses COVID-19 vaccine hesitancy among young cancer survivors. blackCAT/Getty Images
  • A new study raises concerns about vaccine hesitancy among young survivors of cancer in the United States.
  • Cancer survivors often have weakened immune systems due to the cancer itself or certain treatments, so they may be at a higher risk of a severe form of COVID-19.
  • National organizations strongly recommend that cancer survivors receive their COVID-19 vaccine and seek the advice of their healthcare teams if unsure about vaccination.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

Some adolescent and young adult cancer survivors are hesitant to get vaccinated against COVID-19, according to a new study published in JNCI Cancer Spectrum.

The study assessed 342 adults from the western U.S., who were diagnosed with cancer between the ages of 15 and 39 years.

While the majority of those surveyed intended to get the vaccine, more than a third (37.1%) expressed some COVID-19 vaccine hesitancy.

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As of June 2021, there were more than 33 million cases and nearly 600,000 deaths from COVID-19 in the U.S.

Vaccines offer one of the best tactics to control the spread of the novel coronavirus and end the pandemic. However, an estimated 2030% of the U.S. population exhibit some vaccine hesitancy, meaning they are cautious about receiving or would refuse a COVID-19 vaccine.

Such hesitancy could be a particular problem for the cancer community. Certain types of cancer, particularly blood cancers like leukemia and lymphoma, and certain types of cancer treatment can have a major impact on the immune system.

“Generally speaking, people with cancer are often at risk for many types of infections. This is often because of the cancer itself and certain types of treatment,” said Austin Waters from the Huntsman Cancer Institute at the University of Utah, who led the study.

“Like other infections, people with cancer are at higher risk of contracting [SARS-CoV-2] than the general public. They are also at higher risk of severe complications to COVID-19 complications if they [contract] the virus,” Waters told Medical News Today.

However, the picture is less clear for those who had cancer in the past — some of whom might be dealing with long-term effects from the disease or treatment, while others might not.

“There’s less information to go on at this time when it comes to people who’ve completed treatment,” Dr. Rick Alteri, medical editor of the American Cancer Society, told Medical News Today. “This is clearly an area where more research is needed.”

Currently, the Centers for Disease Control and Prevention (CDC) note that having a history of cancer may increase the risk of a serious form of COVID-19. Cancer survivors on active treatment are a priority vaccination group in the U.S.

The study’s authors aimed to identify sociodemographic factors that are associated with COVID-19 vaccine hesitancy among young cancer survivors.

Interestingly, young female cancer survivors were less keen on COVID-19 vaccination, with 42% of female survey respondents indicating vaccine hesitancy, compared with 30.1% of male respondents. The authors suggest that this gender discrepancy could be driven by misinformation asserting that COVID-19 vaccination causes infertility.

“Even before COVID-19, fertility has been and continues to be a concern for many adolescents and young adults during and after their cancer therapies,” Waters explained. “Fertility preservation for patients who have a uterus is often highly expensive, not covered by insurers, and can delay treatment. Thus, fertility is often at the front of [their] minds, potentially leaving them particularly vulnerable to misinformation about the COVID-19 vaccine and infertility.”

Cancer survivors with a high school education or less also showed greater vaccine hesitancy, compared with college graduates. Possibly, lower educational attainment is associated with lower health literacy, which may leave certain cancer survivors more susceptible to misunderstanding public health messaging surrounding vaccination.

Waters noted the important role that oncology professionals play in encouraging young cancer survivors to get vaccinated against COVID-19:

“To ensure equitable protection of vulnerable populations, special attention should be paid to vaccine hesitancy among at-risk groups, such as young adult cancer survivors, and groups that may have higher vaccine hesitancy, such as female survivors or those with a high school education or less.”

While the survey did not ask respondents why or why not they intended to obtain a COVID-19 vaccine, some key factors are particularly relevant to cancer survivors.

“Cancer survivors are likely to have many of the same concerns as other people regarding the vaccines — that is, are they safe, and are they effective? But survivors might have some additional concerns as well,” said Dr. Alteri.

One frequent concern is whether their cancer or treatment might impact how well the vaccine works for them.

“Cancer treatments that have a major impact on the immune system, such as stem cell transplants and CAR T-cell therapy, are the most likely ones to dampen the immune response to the vaccines. So much so, in fact, that people getting these treatments are often advised to wait at least 3 months after treatment before getting vaccinated,” noted Dr. Alteri.

“Other treatments such as chemotherapy, targeted drug therapy, radiation therapy, and different kinds of immunotherapy might also affect the immune system to different degrees.”

Additional considerations include the timing of vaccination for those still undergoing treatment or those who require follow-up imaging tests.

“While these are certainly good questions for survivors to ask their [healthcare professionals], we stress that the vaccine is recommended for the vast majority of cancer survivors regardless of if they are actively receiving cancer treatment or not,” noted Waters.

Dr. Alteri emphasized that each cancer survivor’s situation is unique, and individual factors like the type of cancer, type and timing of treatment, and overall health could influence their attitude toward vaccination:

“While getting the vaccine is ultimately a personal decision, it’s important for cancer survivors to be as informed as possible when considering their options, which is why it’s very important that they speak with their [healthcare professional] about their situation.”

As the authors note in their paper, other factors commonly associated with vaccine hesitancy, such as political affiliation, were not assessed and may have played a part in the results. Furthermore, the population surveyed was overwhelmingly non-Hispanic white, so the researchers could not assess the impact of race.

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