[ad_1]
Editor’s Note: Find the Latest COVID-19 News and Guidance on Medscape Coronavirus Resource Center.
Every day, about 1.5 million doses of the COVID-19 vaccine are administered in the United States, but oncologists and patient advocates say that cancer patients are being missed.
While government agencies recommend that cancer patients be given priority, only 16 states currently prioritize them in vaccine deployment (see Table).
The other 34 states so far have not screened cancer patients for earlier vaccination.
This runs counter to recommendations from heavy hitters like the CDC’s Advisory Committee on Immunization Practices (ACIP), the National Comprehensive Cancer Network (NCCN), and the American Association for Cancer Research (AACR).
Everyone agrees: patients on active cancer treatment should be prioritized for the available vaccine due to their increased risk of death or complications from SARS-CoV-2 infection.
“Until now, all municipalities, states, cities, and even individual hospitals have been left to their own devices to try to figure out the best way to do this and that often conflicts with other recommendations or guidelines,” said E John Wherry, PhD, chair of the Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia.
Wherry was on a panel at an AACR conference last week that discussed the failure of vaccine delivery to cancer patients.
During the meeting, lung cancer advocate Jill Feldman commented on the situation in Chicago, one of the jurisdictions that has not prioritized cancer patients: “People don’t know what to do. ‘Do I have to sign up somewhere? Will the doctor’s office contact me? “
Feldman said that a lot of people have called their cancer centers, “but cancer centers don’t really give us updates directly. And they don’t because they don’t have the information. [either]. “
Even in the 16 states that have brought cancer patients to the front of the line, the process for singling these people out is often unclear or non-existent.
“Everyone who signs up is basically on the same playing field … because there is no verification process. That is very unfortunate,” said patient advocate Grace Cordovano, PhD, describing the vaccine registration process at New Jersey.
“It’s an easy solution,” Cordovano said. “Adding some more fields [in the form] it could really make a difference. “
Death rates from COVID-19 are two times higher in people with cancer than in people without cancer, according to a review published in December by the AACR. Working Group on COVID-19 and Cancer In the diary Cancer discovery. Hematologic malignancies confer an especially high risk.
“Any delay in access to the vaccine will result in loss of life that could be prevented with earlier access to the vaccine,” said AACR President Antoni Ribas, MD. Medscape Medical News At the time.
There are also strong epidemiological reasons for prioritizing high-risk cancer patients for the COVID-19 vaccine, said immunologist Wherry. Medscape Medical News. “What we do with infectious diseases is think about where their transmission and risks are highest,” he said, citing cancer treatment centers as examples.
People with hematologic malignancies also tend to be long-term viral shedders, he said, putting caregivers and healthcare personnel at greater risk. “There is a great, great impact [in vaccinating cancer patients] and the numbers are not small, ”Wherry explained.
The CDC’s Jan. 1 recommendation is that cancer patients should be assigned to priority group 1c, along with other “16- to 64-year-olds with other high-risk medical conditions.”
However, more recent NCCN guidance hastened the urgency, advising that “cancer patients should be assigned to the [CDC] priority group 1b / c. “
Of the 16 states that currently prioritize cancer patients, three states have exceeded official councils, placing cancer patients in priority group 1a. They opened their first batches of vaccine to all people “deemed extremely vulnerable to COVID-19 by hospital providers” (Florida), or to “persons aged 16 to 64 with a chronic disease” (Mississippi) and “persons from 16 to 64 years “. with high-risk conditions “(Pennsylvania, some jurisdictions).
Yet despite these heroic intentions, no jurisdiction appears to have specifically addressed the thorny issue of cancer subgroups that are more urgent than others, and this worries oncologists.
“Not all cancer patients are the same,” said Marina Garassino, MD, a medical oncologist at the National Tumor Institute in Milan, Italy. He shared registry data with AACR panelists indicating that COVID-19 mortality in thoracic and hematologic malignancies increases to 30% -40% compared to 13% for cancer overall.
At the AACR meeting, the moderator of the discussion Ribas summarized his opinion on the subject: “It is clear to me that cancer patients should be prioritized. So we have to start defining this population and it should be the patient with a diagnosis of active cancer under treatment, in particular patients with lung cancers or hematological malignancies “.
Given that cancer patients as a whole have trouble getting vaccinated on time, let alone someone with lung cancer or leukemia, panelists at the AACR meeting struggled to find solutions.
Cordovano said it was “obvious” to start with cancer centers. “The patients there are already registered, they have an account in the electronic medical record system, they have insurance information, the care team knows them,” he said in an interview with Medscape Medical News.
Vaccination referrals sent directly from oncology centers would eliminate the need for the patient to provide verification or any additional documentation, he noted.
However, in New Jersey, cancer centers “have been completely excluded from the process,” he said.
Florida and New Hampshire have somewhat adopted the mechanism suggested by Cordovano. These states require healthcare providers to verify that a patient is “especially vulnerable” (Florida) or “medically vulnerable” (New Hampshire) in order for the patient to receive priority access to the vaccine (see Table). In New Hampshire, patients must have at least one other medical condition in addition to cancer to be on the list.
Jia Luo, MD, a medical oncology fellow at Memorial Sloan Kettering Cancer Center in New York City, told the meeting that MSKCC has established a proactive task force that sends “daily emails” to clinic staff highlighting the patients eligible for the vaccine. “My feeling is that active cancer treatment is given priority,” Luo said. “All of our doctors are currently discussing [it] at every appointment and … all of our nurses and staff have been talking to our patients on the phone. “
Cordovano, while advocating a lot for cancer patients today, remained optimistic about tomorrow: “This is not a long-term thing. This is only until things catch up. We knew we were going to have this problem.” His hope is that within 6 months, the COVID-19 vaccine will become a standard of care in cancer.
Wherry agreed: “It’s going to take time to catch up on how behind we are on certain things … What we are seeing is a healthy debate rather than something we should be concerned about, as long as that debate leads to action. fast. “
“We have to follow the science,” Cordovano concluded. “We can do better than this.”
| Table. States Currently Prioritize Cancer Patients for COVID-19 Vaccination | |||
|---|---|---|---|
| States that prioritize cancer patients | Earliest eligibility | Definition | Restrictions / Warnings |
| Florida | Currently eligible | “People deemed extremely vulnerable to COVID-19 by hospital providers” | Only available through hospitals / healthcare providers |
| Maryland* | Phase 1c (current) | “Cancer patients currently in active treatment” | Must be receiving active treatment in hospital (including outpatient) |
| Mississippi | Currently eligible | “16 to 64 years with a chronic disease” ** | |
| Missouri | Phase 1b (current) | “Any adult with cancer” | |
| Montana | Phase 1b (current) | “People from 16 to 69 years old with high risk diseases” ** | |
| Nebraska | Phase 1b (current) | A “high risk medical condition” ** | Only “current” cancer; over 18 years |
| New Hampshire | Phase 1b (current) | Under 65 and “medically vulnerable” with two or more conditions ** | Healthcare Providers Must Register and Verify “Medically Vulnerable” Patients |
| New Jersey | Phase 1b (current) | CDC Listed “High Risk Persons” Ages 16-64 with a Medical Condition ** | |
| New Mexico | Phase 1b (current) | “16 years or older with underlying medical conditions that put them at higher risk” ** | |
| North Dakota* | Phase 1b | “People ages 65 to 74 with two or more high-risk medical conditions” ** | |
| Oregon | When Phases 1a and 1b are completed | “People of all ages with underlying conditions that put them at moderately higher risk” | |
| Pennsylvania* | Phase 1a (current) | “People aged 16 to 64 with high-risk conditions” | |
| South Dakota | Phase 1d (current) | “Current cancer patients” | |
| Texas | Phase 1b (current) | “People over 16 years of age with at least one chronic disease” ** | |
| Virginia | Phase 1b (current) | “People 16 to 64 years old with an underlying disease” ** | |
| Wyoming* | Phase 1b (current) | “People 16 to 64 years old with an underlying disease” ** |
* May vary by local jurisdiction ** Cancer is listed as an eligible condition
Sources: List of states prioritizing high-risk adults as of February 8, 2021 The New York Times . All other data Medscape Medical News.
Cordovano, Feldman and Wherry have disclosed no relevant financial relationships. Luo declared a financial relationship with Targeted Oncology. Ribas declared financial relationships with Amgen, 4C Biomed, Advaxis, Agilent, AstraZeneca, Arcus, Kite-Gilead and Bristol-Myers Squibb.
Virtual meeting of the American Association for Cancer Research (AACR): COVID-19 and cancer. February 3-5, 2021
To learn more about Medscape Oncology, join us at Twitter Y Facebook
[ad_2]
