Hesitancy and malignancy: Vaccine hesitancy among individuals with cancer.

Abstract

148 Background: The World Health Organization cited vaccine hesitancy as one of 2019’s top ten threats to global health, a threat that has been further exacerbated by COVID-19 pandemic. Existing COVID-19 vaccine hesitancy research focuses on the general population, but less is known about the specific concerns of medically vulnerable populations, including individuals with cancer. Methods: This cross-sectional analysis used data that assessed likelihood of COVID-19 vaccination (likely vs unlikely/unsure) among past or current patients with cancer from a nationwide survey administered in December 2020 by the Patient Advocate Foundation (PAF), a non-profit organization that provides case management and financial aid to patients diagnosed with a chronic illness. Inclusion criteria included previous or current cancer treatment, aged ≥ 19, and a valid e-mail address. Age, sex, race/ethnicity, and urban/rural residence were abstracted from the PAF database. Respondents self-reported education level, employment status, trust in media regarding COVID-19 pandemic, and media viewership on COVID-19 vaccine development. The Group-Based Medical Mistrust Scale assessed respondents’ level of mistrust in medical providers based on ethnicity. Likelihood of COVID-19 vaccine acceptance was evaluated using risk ratios (RR) and 95% confidence intervals (CI) from modified Poisson regression models with robust error variance. All variables were included in our model. Results: Of 429 respondents, 48% were unlikely/unsure about accepting the COVID-19 vaccine, primarily due to concerns about vaccine safety (32%) and worry about health conditions (12%). When compared to those likely to accept COVID-19 vaccine, respondents who were unlikely/unsure were more often Black, Indigenous, or People of Color (40% vs. 23%), aged 36-55 (40% vs. 29%), and female (80% vs. 65%). In adjusted analysis, Black respondents were 55% less likely to accept a COVID-19 vaccine, when compared to White respondents (RR 0.55; 95% CI 0.4-0.8). When compared to those who did not follow the media regarding COVID-19 vaccine development, those who followed the media very closely were 4.5 times more likely to accept a COVID-19 vaccine (RR 4.5; 95% CI 1.6-13.2). Respondents who reported below average trust in the media were 60% less likely to accept a COVID-19 vaccine (RR 0.6; 95% CI 0.5-0.8), compared to those who reported above average trust in the media. Conclusions: Despite being at high risk of COVID-19 morbidity and mortality, a substantial proportion of under-resourced individuals with cancer were unlikely/unsure about vaccination, exposing a significant disconnect between risk of severe disease and vaccine acceptance. Our analysis also reveals a need to assess for and debunk misinformation to increase vaccine enthusiasm among medically vulnerable populations.

Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population

“…In our study on cancer patients, 95% of the respondents were either Black or Hispanic, with 65% vaccinated and actively receiving treatment for their cancer during the crucial time of the initial rollout of COVID-19 vaccines in New York City. Overall, a large majority of our patients—79%—perceived that COVID-19 was risky and dangerous, and 65% considered the vaccines to be safe, similar to prior results in cancer patient studies [ 25 , 28 , 29 , 30 , 33 , 35 , 41 , 42 , 43 , 44 ]. Other self-reported reasons for being vaccinated stated by our participants included protecting themselves, family, and friends, the collective good of ending the pandemic, and trust in the vaccine and science; again, these were very similar to previous studies in cancer patients and ethnic minorities [ 23 , 25 , 28 , 29 , 31 , 35 , 50 ].…”

“…This concern is further amplified if a patient with COVID-19 is not only unvaccinated but also has comorbidities such as cancer, predisposing them to higher risk of morbidity and mortality. COVID-19 vaccine hesitancy has been studied previously in cancer patients worldwide [ 25 , 26 , 27 , 28 , 29 , 30 , 32 , 39 , 40 , 41 , 42 , 43 , 44 ] and in the United States [ 31 , 33 , 35 , 36 , 45 ], including multiple studies of ethnic minorities in the US [ 21 , 22 , 23 , 24 , 46 , 47 , 48 , 49 , 50 , 51 ], but no known research exists specifically examining ethnic minority cancer patients and their views on the COVID-19 vaccine. This study helps address this gap in the knowledge by uniquely examining two different time-points of vaccination status 6-months post-initial survey, employing a vaccine knowledge score composite and exploring a brief educational intervention to raise patients’ awareness, to gain valuable insight into this distinctly disadvantaged population in the US.…”

“…Currently, only a few available studies have assessed vaccine hesitancy in cancer patients residing in the US, and in particular in Hispanic or Black cancer patients. In a cross-sectional study using online surveys of US cancer patients in December 2020, respondents who were unlikely/unsure of accepting the COVID-19 vaccine were more often Black compared to Non-Black and 55% less likely to accept a COVID-19 vaccine [ 33 ]. Major reasons behind hesitancy were questions of safety, inadequate information, mistrust of the government, seeing no reason for the vaccine, and fear of side effects [ 33 , 34 , 35 ].…”

“…In a cross-sectional study using online surveys of US cancer patients in December 2020, respondents who were unlikely/unsure of accepting the COVID-19 vaccine were more often Black compared to Non-Black and 55% less likely to accept a COVID-19 vaccine [ 33 ]. Major reasons behind hesitancy were questions of safety, inadequate information, mistrust of the government, seeing no reason for the vaccine, and fear of side effects [ 33 , 34 , 35 ]. The strongest predictors of vaccine uptake were plans to encourage vaccination of family, friends, community, and physician recommendation.…”

Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study

“… 3 , 4 , 5 A cancer diagnosis or cancer treatment has generally been an exclusion criterion for vaccine trials, leading to a paucity of clear evidence of their benefit and some vaccine hesitancy among patients with cancer. 6 , 7 …”