A COVID-19 booster shot could be a gamechanger for cancer patients who are looking to develop or maintain antibodies against the virus, but multiple oncologists tell SurvivorNet that wearing a mask is still the best way for cancer patients to avoid contracting or spreading the virus as the dangerous Delta variant spreads.
Three of the five oncologists that spoke to SurvivorNet were strongly in favor of the booster shot, including Dr. Paul G. Richardson, clinical program leader and director of clinical research at the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute. He notes that getting vaccinated is just one of many steps cancer patients should be taking at this time.Read More
“We are moving from pandemia to endemia and as such long-term adjustments and continued caution are inevitable in terms of treatments for underlying and supportive care. Fortunately, however, we are moving towards a more manageable paradigm of therapy/care, although the danger of SARS CoV2 remains clear and present,” he says.
Moderna was the first to announce that they would be releasing a booster shot back in February, which they plan to roll out in November. Tests got underway in May amid little fanfare.
Pfizer, on the other hand, roared onto the scene by declaring they had a booster shot, would apply for emergency approval, and wanted it available to the public in August. That drew immediate backlash from the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA). Both agencies cited the need for vaccines around the world being far greater than the need for Americans to receive a booster shot. Pfizer also referenced the surging Delta variant as a reason to get the booster.
As of Monday, the CDC reports that only 48.5% of Americans have been fully vaccinated, and deaths are starting to rise again.
That danger seems to be growing with each day as well with the Delta variant rising around the country, and studies show that it is the most vulnerable who are in fact contracting this variant of the virus. Some early research indicates that some blood cancer patients don’t get the same benefit from the COVID-19 vaccine. This includes people with cancer that affects the blood, bone marrow or lymph nodes, particularly those with chronic lymphocytic leukemia.
That is why the third shot would be such a help to those with cancer, explains one oncologist.
“Some medical centers have looked at giving a booster vaccine dose, a third dose, and they found that some of these [cancer] patients now have a high enough immune response to potentially prevent infection,” explains Dr. John N. Greene, chief of infectious diseases at the Moffitt Cancer Center.
“But we don’t know how long-lasting even those are, but at least the numbers are high enough that it could prevent an infection. So if you would give a booster vaccine or you could get a higher immune response quantitatively, then those patients could actually do fine even if exposed to the Delta variant. And that’s been true with other variants as well. They believe that the higher the titers you can maintain, the greater the chance you can prevent infection.”
At the same time, Dr. Greene says he is not in favor of mandatory vaccination.
“Some people say that once it is officially FDA-approved and not under investigation, mandatory vaccinations may happen. So every institution has to make that decision. And then whatever state you live in may not even allow you to do that if you wanted to, so for example in Florida, you can’t mandate the vaccine and so that would obviously limit things depending on what state and where you’re at,” says Dr. Greene.
“Me personally, I’m I don’t agree with mandating vaccine, but I’m all for heavily vaccinating everybody as much as possible including my entire family, from my 99-year-old mother to my college student, who was infected, to get vaccinated, including myself. And every vaccine has been used on my family from Moderna to Pfizer to J&J. And I don’t necessarily have a preference of one over the other long as you get vaccinated.”
Dr. Balzas Halmos, medical oncologist and director of the Thoracic Oncology Program at Montefiore Medical Center, says that he cannot endorse the booster until he sees more research.
“There is emerging encouraging information now from several groups that the currently available FDA-approved vaccines are very effective amongst most patients with a cancer diagnosis just as well as for the general population. However, a small fraction … have received therapies that impair the ability to mount an immune response.. and have a lesser chance of developing a strong immune response,” Dr. Halmos tells SurvivorNet.
“For the typical patient with a cancer diagnosis, there currently does not appear to be a reason for a booster shot unless recommended otherwise for the general population at a later time. There should be emerging research to address the question, whether for the patients where an immune response was not generated, a booster shot could achieve this or not- limited data suggest that in some patients possibly, but this should be formally studied before a general recommendation can be made.”
Booster Shot or Masks
According to the most recent CDC report, the Delta variant now accounts for 51.7 percent of COVID cases in the U.S. as of July 3. This seismic spread comes after the variant has already wreaked havoc around the globe, forcing countries back into lockdown and prompting the World Health Organization to reinstate its mask mandate regardless of vaccination status.
But here in the U.S., the CDC says vaccinated Americans do not need to wear a mask except in rare instances mostly related to travel or if visiting COVID-19 hotspots.
“The problem with a lot of the variants, especially the Delta variant and others, is that if you have a low immune response or low antibody titer, which many of these (cancer) patients would have, it may not be protective against getting an infection,” says Dr. Greene.
“So for these immunosuppressed cancer patients, there is no guarantee that their vaccine is effective because [antibody testing] is not recommended outside of a research setting to actually measure their immune response or their antibody levels. And therefore, since it remains a mystery, they should continue to wear a mask and not go into large crowds where people could infect them and others visiting them.”
He then adds: “I think that’s pretty sound logic because these immunosuppressed patients and people are at higher risk of serious illness if they were to catch COVID-19.”
Dr. Amrita Krishnan, director of the Judy and Bernard Briskin Center for Multiple Myeloma Research at City of Hope, tells SurvivorNet that she continues to urge her patients to wear a mask and social distance.
Dr. Jana Dickter, also from City of Hope, adds: “I would also suggest that patients advocate for themselves by having close relatives, family members, and household contacts get vaccinated.”
Dr. Ben Neel, director, NYU Langone’s Perlmutter Cancer Center, tells SurvivorNet he is recommending cancer patients continue to wear masks indoors, but outdoors is optional.
“Unless otherwise instructed by their doctor,” he says.
Meanwhile, the CDC’s current recommendation regarding immunocompromised patients is: “If you have a condition or are taking medications that weaken your immune system, you may NOT be fully protected even if you are fully vaccinated. Talk to your healthcare provider. Even after vaccination, you may need to continue taking all precautions.”
Former CDC Director Dr. Tom Frieden offered his thoughts in a piece for Elemental.
“Based on experience from other vaccines and preliminary data on the effects of immunosuppression and response to Covid vaccines, some people who are immunosuppressed may not be as well protected from infection. These people may want to wear masks to limit the risk of infection, particularly when in high-risk settings such as indoor locations with many people present,” Dr. Frieden said.
“The spectrum of immunosuppression is vast, and if you have immunosuppressive conditions or are on immunosuppressive medications, consult with your doctor about whether you may need to take additional precautions to prevent Covid even after being vaccinated.”
Dr. Otis Brawley, the former chief medical and scientific officer at the American Cancer Society, previously told Survivor Net that he too was uncertain about telling vaccinated Americans that they could forgo masks.
“I have mixed emotions about this. While it signals things are improving, I worry about variants of COVID that the vaccine does not protect against,” Dr. Brawley said.
“I also worry about non-cancer patients vaccinated, but the vaccine did not stimulate their immune system, and I worry about cancer patients who have an impaired immune system such that the vaccine is less effective.”
He continued: “People tend to forget that the mask protects people around the wearer from the wearer more than it protects the wearer from exposure.”
The National Cancer Institute is currently sponsoring a trial for a vaccine that is specifically designed to protect individuals with cancer from contracting COVID-19. That trial is still in the recruiting stages.