States Didn’t Follow CDC Recs to Prioritize COVID Vaccine for Cancer Patients

CHICAGO — Nearly two-thirds of states did not follow CDC guidelines to prioritize patients with cancer for the COVID-19 vaccine, a researcher reported, thereby “risking unnecessary morbidity and mortality, as this population is particularly vulnerable to COVID-19.”

While 43 states included cancer patients as a priority subpopulation for COVID-19 vaccination during the initial rollout, only 8 precisely defined a qualifying cancer diagnosis and just 17 states (34%) gave patients with cancer the same immunization priority as those ages 65-74, according to Rahul Prasad, MD, MBA, a radiation oncologist at the Ohio State University Comprehensive Cancer Center in Columbus.

The problem was most likely that the CDC’s definition of high-risk medical conditions was too broad, he noted.

“Although the CDC recommended that all states consider people with significant medical conditions to have equal vaccination priority with people over the age of 65, we found that nearly two-thirds of states did not give equal vaccination priority to patients with cancer,” Prasad said in a presentation at the Radiological Society of North America annual meeting.

“I don’t think anyone intended to push people to the back of the line,” Rahul stated. “The [prioritization] efforts were well intentioned.”

While the presentation may seem out of place at a radiology meeting, imaging is a major part of the cancer care continuum, and the imaging community this year played an integral role in identifying certain side effects from COVID-19 vaccines, such as post-vaccine myocarditis or lymphadenopathy, and axillary adenopathy on breast imaging.

In March, the American College of Radiology released a a list of resources to help radiologists care for recently vaccinated patients during screening or diagnostic imaging studies.

For their study, Prasad and colleagues conducted a search of every states’ COVID vaccination webpage through a keyword-based internet search in order to identify data on vaccination for cancer patients. They pointed out that “Finding detailed vaccination information required significant computer literacy, as it routinely required navigation through multiple webpage subdomains.”

Elliott Fishman, MD, professor of radiology, oncology, and surgery at Johns Hopkins University in Baltimore, commented that when vaccine rollouts take place, “you should always make sure that you take care of the highest risk patients first. I think we would all be comfortable saying that. Obviously, cancer patients are high-risk patients, although not every cancer patient is at the same risk.”

However, patients on active cancer therapy, and those who have just completed therapy, should get vaccine priority, stated Fishman, who was not involved in the study. Regardless of the cancer patients’ age, “it would make all the sense in the world that those patients should be prioritized first,” he added.

Fishman noted that because this was a retrospective study, “you could say that this is water under the bridge…I think what we have to do is to figure out what to do with the next wave, or the next disease, and put in place knowledge of what went wrong [with vaccine rollout] to make sure that next time, things go right.”

Prasad explained that initial limitations in vaccine supplies forced the CDC Advisory Committee on Immunization Practices to make difficult patient-prioritization decisions. People ages 16-64 with high-risk conditions were grouped into the final part of the first phase, along with people ages 65 to 74. However, this group encompassed 129 million people nationally, leading many states to sub-prioritize, he stated.

“You could have someone diagnosed with breast cancer at age 40, who is now 55 [and] in remission, and wondering if they’re eligible,” Prasad said. “On the other side of the spectrum, someone newly diagnosed with low-risk prostate cancer may not be particularly immunocompromised if they haven’t started treatment yet.”

Prasad’s group stressed that policy interventions in future waves requiring boosters, or in other pandemics, should ensure timely vaccination of vulnerable populations to better mitigate disparities.