How COVID-19 vaccines affect patients with cancer
Mays Cancer Center Annual Report
During the COVID-19 pandemic, the Mays Cancer Center prioritized offering the COVID-19 vaccine to its patients and launched an observational study to better understand how the immune system responds to the novel coronavirus vaccine in patients with cancer.
Dimpy Shah, MD, PhD, leader of the cancer and infectious diseases epidemiology research program at the Mays Cancer Center, is leading the study “Host Immune Response to Novel RNA COVID Vaccination in Patients with Cancer” with Kate Lathrop, MD, a breast oncologist at the Mays Cancer Center.
“This study will help us understand who has developed protection against COVID-19 and who might need an additional booster shot,” said Shah. “From my past studies looking at different viruses, we have observed that, despite vaccination, some patients with cancer do not develop sufficient antibodies to fight infection. This is because cancer suppresses the immune system.”
“This will be a very important study for helping us achieve the best possible outcomes in our patients with cancer and COVID-19. The study could also potentially help us predict how similar vaccines will affect our patients in the future,” said Lathrop.
Black patients with cancer fare worse
Shah was also senior author of a study published in JAMA Network Open indicating that Black patients with cancer experienced significantly worse outcomes after COVID-19 diagnosis than non-Hispanic white cancer patients.
“We saw worse COVID-19 illness at presentation, higher rates of hospitalization, higher rates of intensive care unit admission, higher rates of mechanical ventilation and worse death rates in Black patients compared to non-Hispanic white patients, even after making the two groups comparable in terms of type, status and treatment of cancer by statistical analysis methods,” Shah said.
Investigators of the COVID-19 and Cancer Consortium, which includes more than 125 cancer centers and other organizations, studied the electronic health records of 3,506 patients for the analysis, including data of 1,068 Black patients and 2,438 non-Hispanic white patients.
Researchers also noted differences in COVID-19 treatments provided to the two groups. White patients had higher administration of remdesivir, an antiviral drug approved by the U.S. Food and Drug Administration to treat COVID-19 in adults and children 12 and older.
Hydroxychloroquine, a malaria drug, was prescribed more in Black patients. The FDA withdrew emergency use authorization of it after data indicated it is not effective in treating coronavirus infection. The study is another step toward changing attitudes to hopefully improve health and treatment outcomes, the study leaders agreed.
Addressing disproportionate disease burden
“Understanding and addressing racial inequities within the causal framework of structural racism is essential to reduce the disproportionate burden of diseases, such as COVID-19 and cancer, in Black patients and other minorities,” the authors concluded.
According to Shah and her co-authors, a framework of structural racism in the U.S. can explain the increased COVID-19 burden in Black patients.
“Race in medicine is largely a social construct because the majority of differences in health outcomes between Black patients and white patients are due to systematic racialization,” Shah said. “Some of the societal root causes of health disparities, including lack of access to health care, social determinants of health, preexisting comorbidities and access to clinical research, are common to both cancer and COVID-19, and together these two diseases create a perfect storm.”
Besides adding to the science of COVID-19 and cancer, this study is important because it is a call to action that structural racism still very much exists, said Shah.