COVID-19 Vaccines in Patients With Cancer: NCCN Guidance

While some patients are the exception, most should get vaccinated as soon as they are eligible to do so.

Now that there are 3 COVID-19 vaccines granted Emergency Use Authorization (EUA) by the FDA, patients and clinicians alike may be wondering if it is safe for a person with cancer to be vaccinated – and if so, when?

The National Comprehensive Cancer Network (NCCN) this week published guidance on COVID-19 vaccination, treatment delays, and more for patients with cancer.

“The most important thing is that people get whichever vaccine is offered to them as soon as they can,” said Steve Pergam, MD, MPH, associate professor, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center and Infection Prevention Director at

Seattle Cancer Care Alliance, co-leader of the NCCN COVID-19 Vaccination Advisory Committee, in a statement.

The NCCN advocated for patients with active cancer and those who are being treated for cancer to be prioritized for vaccination. Nurses should discuss the importance of getting the vaccine with patients who are eligible but undecided on whether or not they will get the shot.

Caregivers of those with cancer should also receive the vaccine when it is available to them.

When it comes to delaying COVID-19 vaccination, the NCCN suggests that survivors follow the same guidelines as the general public, such as waiting due to recent COVID-19 exposure. There are also cancer-specific factors, the agency said, explaining that patients should wait 3 months after hematopoietic cell transplantation or engineered cell therapy (like CAR T-cell therapy) to ensure that the vaccine can be as efficacious as possible.

Patients with hematologic malignancies who are receiving intensive cytotoxic chemotherapy should delay the vaccine until absolute neutrophil count (ANC) recovers, according to the NCCN.

When it comes to which vaccine patients get, the NCCN supports the use of any of the 3 vaccines that have an EUA.

“At this time, the available data does not indicate major differences in effectiveness relative to the most important clinical outcomes, and all three have been determined to be safe for adults. The exception is for people age 16 or 17 who should only receive a vaccine that has been approved for their age group,” Pegram said.

In the event of a vaccine shortage, the NCCN states that patients with cancer should be prioritized, with a special consideration to those on active treatment, and those with additional risk factors for COVID-19 complications, like advanced age, comorbidities, and social/demographic factors.

“If there are limits to supply, prioritization may need to be considered for cancer patients. Prioritization is challenging to develop when considering the diverse population of patients with their varied comorbidities, demographic and social factors known to increase risk of COVID-19 acquisition, morbidity, and/or mortality. Decisions must be made in accordance with state and local vaccine guidance on allocation,” the guidelines read.