COVID-19: CONSIDERATIONS FOR GYNECOLOGIC CANCER PATIENTS
As someone who is coping with a gynecologic cancer, you may have questions about how the novel coronavirus (COVID-19) pandemic might impact your treatment or follow-up appointments. You might also be interested in getting vaccinated with one of the available COVID-19 vaccines. Specific treatment recommendations need to be made in conjunction with your gynecologic oncologist based on the goals of your treatment, clinical status and risks versus benefits. Official policies may vary based on geographic region, but here are a few things to keep in mind.
- Your doctor’s office might need to pre-screen you via telephone/patient portal for COVID-19 symptoms the day before a clinic appointment, and repeat the screening during patient check-in. This may include having your temperature taken.
- You may be limited to having one person accompany you to an outpatient appointment; it is possible that you won’t be allowed to bring someone with you.
- Maintain physical distancing in waiting areas; your doctor’s practice may have to schedule fewer patients at a time so there will be less people in the waiting area.
- You may have to minimize clinic/hospital/laboratory visits in favor of telemedicine visits and home-based or local collection of labs.
- You may have to reschedule asymptomatic surveillance visits and conduct routine postoperative visits and discussion of pathology results with telemedicine.
- If you are in active treatment, your doctor may consider chemotherapy regimens that will avoid frequent clinic visits.
- Second opinions may be accomplished with the use of telemedicine, as resources allow.
- Enrollment and treatment in clinical trials may be delayed or halted based on the availability of clinical and research support at your institution.
- If you are already in a clinical trial, verify with your research team the status of your trial.
- If you are a candidate for surgery, the procedure may be scheduled as usual or delayed as appropriate, depending on various factors to be determined by your gynecologic oncologist in conjunction with institutional and/or government agency recommendations.
As a gynecologic cancer patient, should I get vaccinated for COVID-19?
- The short answer is yes! We encourage all gynecologic cancer patients who are on active therapy or have completed therapy to get vaccinated, especially since COVID-19 can be particularly dangerous for patients with cancer. The only patients who should not get the vaccine are those who have had an immediate allergic reaction to components of the vaccine or who are younger than 16. See below for more information.
- These recommendations are based on the current data we have available and may change as more data is published. (February 2021).
- For any specific questions, please reach out to your provider.
For some patients whose treatment goals of have changed and include hospice and no active therapy, you may choose not to get the vaccine. Talk to your doctor.
Should people undergoing active treatment (chemotherapy, immunotherapy, hormonal therapy, radiation, or enrolled in a clinical trial) for cancer be vaccinated against COVID-19?
- Yes! Patients undergoing cancer treatment should be vaccinated unless they have an allergy to the components of the vaccine. You should talk to your oncologist about the timing of the vaccine to increase how well the vaccine works and to help keep you safe.
- Experts say that immunocompromised patients may not get as much protection against COVID-19 from the vaccine than someone who is not immunocompromised. However, the vaccine is still likely helpful in reducing the severity of COVID-19. Additional information about the vaccines can be found on the Center for Disease Control (CDC) website.
- If you are participating in a clinical trial and interested in vaccination, please discuss this with your research team prior to receiving the vaccine. The National Comprehensive Center Network (NCCN) supports the vaccination of participants on clinical trials.
Should people scheduled for surgery be vaccinated against COVID-19?
- Yes. The NCCN recommends not being vaccinated within a few days of surgery. In the event of a bigger surgery that could involve removing the spleen (like an ovarian cancer surgery), it is better not to be vaccinated within 2 weeks before or after surgery. This will help to determine if any symptoms are side effects are from the surgery or the vaccine.
- Notify your surgeon immediately if you are offered a spot for getting your COVID vaccine but have an upcoming surgery.
Are there people who should not be vaccinated?
- At this time, the only patients who should not get the vaccine are those who have had an immediate allergic reaction to components of the vaccine. An immediate allergic reaction is a reaction that occurred within 4 hours of exposure, including hives, swelling or problems breathing.
- The most likely component to cause an allergic reaction in the vaccine is polyethylene, or PEG. Polysorbate is not in the vaccine but is very similar to PEG. The CDC recommends that people who have had an immediate allergic reaction to PEG or polysorbate should not receive the vaccine.
- People who have an immediate allergic reaction to the first COVID-19 vaccine should not get the second vaccine. These reactions have so far been extremely rare.
- People who have had an immediate reaction to carboplatin or paclitaxel can safely receive the vaccine. If you had an immediate reaction to a different chemotherapy, it is most likely still safe to receive the vaccine, however please check with your provider first.
- Children younger than 16 currently cannot receive the vaccine. This may change with new trials that are ongoing.
- These recommendations are described in detail on the CDC’s vaccine clinical considerations page.
How effective is the COVID-19 vaccine?
- The Pfizer/BioNTech vaccine was reported to be 95% effective after two doses, and 52% effective after the first dose alone. The Moderna vaccine was reported to be 94.1% effective after two doses (CDC report). The vaccine is fully effective 1-2 weeks after the second dose. This is true for all groups of participants who were evaluated, regardless of age, weight, or race. We do not know if the vaccine will be as effective in women who are immunocompromised (for instance, people receiving chemotherapy, radiation, or immunotherapy) as it wasn’t in the study. Even if the vaccine is less effective in women who are immunocompromised from cancer treatment than it was in the trials, it should still provide more protection than not getting the vaccine.
Can I get COVID from the vaccine?
- No. The COVID vaccine does not contain the COVID virus, so you can’t get COVID from the vaccine.
What is known about COVID-19 vaccine side effects?
- Flu-like symptoms (headache, fever, muscle aches) may happen, especially after the second vaccination.
- This is a normal sign that the body is building protection and should go away in a few days. However, if you do not have these symptoms, your body can still be mounting a strong immune response, so don’t worry.
- To reduce any injection site pain and manage symptoms, see these helpful tips from the CDC.
Should getting the vaccine change how I behave?
- Until experts learn more about the protection that COVID-19 vaccines provide under real-life conditions, people who are vaccinated should continue to follow all current guidance to protect themselves against COVID-19 after they are vaccinated especially because we don’t know exactly how effective the vaccine is. That means:
• Wearing a mask
• Staying at least six feet away from others
• Avoiding crowds
• Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
• Following CDC travel guidance
• Following quarantine guidance after exposure to COVID-19
• Following any applicable workplace guidance
The isolation associated with social distancing due to COVID can be especially hard for patients with cancer. If you are struggling with this, please talk to your provider.
Should I get the COVID-19 vaccine if my treatment goals have shifted toward symptom control or hospice care?
- The NCCN recommends that all cancer patients receive the COVID-19 vaccine. Patients with a life expectancy less than one month may not get full benefit from the vaccine and should seek help from their doctor with the vaccination decision. Shared decision making between patients and providers should take into account life expectancy, vaccine tolerability/side effects, and access to the vaccine. NCCN also recommends the prioritization of caregiver vaccination.
Should I still follow social distancing recommendations if I am on hospice or close to the end of life?
- This is an individual decision. Being with people we love is critical, particularly at the end of life. People who are on hospice or otherwise near the end of life may decide to loosen some social distancing measures to see and hug people whom they love. We encourage patients to discuss this with their doctors to help make the safest decision possible (for the patient and for their loved ones). Please continue to wash hands frequently and wear masks as much as possible, and encourage those around you to take the same steps.
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