Recommendation on COVID-19 vaccination for cancer patients undergoing systemic radionuclide therapy: a normative analysis

Introduction: Elderly and individuals with chronic diseases have increased risk of morbidity and mortality from COVID-19 infection.Unless with contraindications, COVID-19 vaccines are highly recommended for the elderly and individuals with stable medical diseases. Currently, there is no specific evidence-based guidance for COVID-19 vaccination for cancer patients undergoing/having undergone systemic radionuclide therapy.

Methods: Relevant up-to-date evidence is reviewed. A normative analysis is then performed to promulgate the guidance in line with the ethical principles of beneficence, non-maleficence, autonomy and justice. Specifically, the analysis seeks to answer: 1. What are the current data, if any, about the efficacy and safety profiles of COVID-19 vaccines for cancer patients receiving systemic radionuclide therapy? What vaccination policy would serve their best interests? How should we strategise so as to respect their autonomy and do good to society?

Results: Although the immunogenicity and efficacy COVID-19 vaccine is uncertain and expected to be lower in cancer patients receiving systemic radionuclide therapy, these patients likely have increased risk of morbidity and mortality from COVID-19 infection. No additional safety concerns are evident associated with potential use of COVID-19 vaccines in these patients. Overall, the potential for benefit from vaccination likely outweighs these uncertainties. It also serves to do greater societal good to encourage these patients to receive vaccination. Having said that, they should retain the autonomy to decide whether to have the vaccination.

Conclusions: Cancer patients receiving systemic radionuclide therapy should be encouraged to receive vaccination as soon as possible. They should be encouraged to continue wearing masks, social distancing, and maintaining good hand hygiene even after vaccination. Caregivers and household/close contacts should also be immunised when possible.