ALEXANDRIA, Va. – In a study of more than 1,100 people with COVID-19 undergoing treatment for cancer, researchers found lower COVID-19 vaccination rates among patients with comorbidities, metastatic solid tumors or non-B-cell hematologic malignancies, and those living in areas with lower education attainment and higher levels of unemployment. The study, funded by Conquer Cancer®, the ASCO Foundation, was published today in Cancer [i].
“The results of this study underscore the critical need for targeted efforts to increase COVID-19 vaccine uptake among cancer patients who fall into these lower vaccination rate categories and are at an increased risk for infection and severe outcomes due to their cancer diagnosis and treatment,” said Julie R. Gralow, MD, FACP, FASCO, ASCO Chief Medical Officer. “The findings in this study serve as a call to action to address disparities in vaccine uptake among vulnerable populations to improve outcomes of patients with cancer and COVID-19.”
About the Study
This is the first large-scale study of patterns and factors associated with vaccine uptake among people in cancer treatment who were infected with COVID-19. Using the ASCO Survey on COVID-19 in Oncology Registry (ASCO Registry), researchers analyzed data of 1,155 patients from 56 practices who were undergoing cancer treatment, developed COVID-19 prior to the availability of vaccines, and had vaccination information in the Registry.
In the study population, the median age of COVID-19 infection was 64 years (range 19-95 years), and 41% of patients had at least one additional comorbidity besides cancer (diabetes, pulmonary disease, renal disease, coronary artery disease). Patients with one or more additional comorbidities were approximately 20% less likely to be vaccinated than patients without any of these comorbidities.
When comparing vaccination rates for the general U.S. population (from the Center for Disease Control and Prevention (CDC)), patients in this study were overall more likely to be vaccinated against COVID-19 at the time points of June 1 and August 1, 2021. By mid-April 2021, 50% of the study population had at least one vaccine. This was approximately 100 days after vaccines were available for patients with cancer. Timing of vaccine receipt did not differ significantly between groups based on race and ethnicity; by April 1, 2021, patient vaccination rates were: 42% Hispanic, 39% Asian, 41% Black, 47% white. Of the 1,155 patients in the study, 9% (109) were Hispanic, 2% (24) Asian, 12% (138) Black, 71% (818) white, and 6% (65) other or unknown.
In terms of types of cancer, 40% of patients had nonmetastatic solid tumors, 34% metastatic solid tumors, 20% B-cell malignancies, and 6% non-B-cell hematologic malignancies. Rates of vaccination in patients with metastatic solid tumors were approximately 15% lower than in patients with non-metastatic tumors. Rates of vaccination in patients with non-B-cell hematologic malignancies were approximately 30% lower than patients with non-metastatic tumors. The authors note considerable debate still exists about optimal timing for effective vaccination in patients receiving chemotherapy, and that this may have had an impact on this patient population’s vaccination rates.
According to the study, older patients (over age 50) with cancer received vaccinations at higher rates than those of younger ages in the early months of 2021. The difference in vaccination rates by age diminished in May 2021 and beyond.
The study found patients living in areas with the highest unemployment rates (>1.6% unemployed) had vaccination rates approximately 20% lower than those living in areas with lower unemployment rates. Patients living in areas with the lowest levels of education (>41% ending education at high school) had approximately 30% lower rates of vaccination than those living in areas with lower levels of high school-only education.
“These patients with cancer were in active care and likely regularly in touch with their healthcare teams. This disparity highlights the opportunity for cancer care teams to educate patients – particularly those at higher risk – about the COVID-19 virus and the importance of vaccination,” said Dr. Gralow.
The authors note that additional research is needed to further explore the reasons for the disparities seen in the study and identify more targeted ways to address them.
COVID-19 Data Resources
The ASCO Registry was launched in April 2020 to help the oncology community learn more about patterns, symptoms, and severity of COVID-19 among patients with cancer, as well as treatment delays and outcomes. The Registry collects longitudinal data and now includes more than 6,000 patients from about 70 U.S. practices.
COVID-19 Registry data is available through ASCO’s Data Library for research use by qualified individuals and organizations and can be explored interactively via the Registry Dashboard. Projects that address the needs of patients with cancer, including marginalized populations and communities, will be prioritized. The ASCO Registry is supported by Conquer Cancer®, the ASCO Foundation, through its COVID Impacts Cancer Fund.
Ending the COVID-19 Public Health Emergency
In January, the Biden Administration announced its intent to end the COVID-19 national emergency and public health emergency declarations on May 11, 2023. ASCO provides resources that can help providers ensure they are up to date on major policies related to the unwinding of the public health emergency and flexibilities that are currently set to expire between May 11, 2023, and December 31, 2024.
Disclosures for study authors can be viewed within the manuscript.
[i] Kurbegov, D., Bruinooge, S.S., Lei, X.J., et al: Rate of COVID-19 Vaccination Among Patients with Cancer Who Tested Positive for SARS-CoV-2: Analysis of the ASCO Registry. Cancer 10970142, 2023, Available at: https://acsjournals.onlinelibrary.wiley.com/journal/10970142.
About the American Society of Clinical Oncology
Founded in 1964, the American Society of Clinical Oncology, Inc. (the Society) is committed to the principle that knowledge conquers cancer. Together with the Association for Clinical Oncology, ASCO® represents nearly 45,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of high quality and equitable patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. Conquer Cancer, the ASCO Foundation, supports the Society by funding groundbreaking research and education across cancer’s full continuum. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, Instagram, and YouTube.