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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 566-567

Pitfalls of generalizing the causes of COVID-19 vaccine hesitancy among patients with cancer

Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission16-Jul-2021
Date of Decision30-Jul-2021
Date of Acceptance10-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Sharmila Pimple
Professor & Physician Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Homi Bhabha National Institute, Tata Memorial Centre, Mumbai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_163_21

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How to cite this article:
Pimple S, Mishra G. Pitfalls of generalizing the causes of COVID-19 vaccine hesitancy among patients with cancer. Cancer Res Stat Treat 2021;4:566-7

How to cite this URL:
Pimple S, Mishra G. Pitfalls of generalizing the causes of COVID-19 vaccine hesitancy among patients with cancer. Cancer Res Stat Treat [serial online] 2021 [cited 2022 Jan 18];4:566-7. Available from: https://www.crstonline.com/text.asp?2021/4/3/566/327766

We read with interest the article by Noronha et al. titled, “COVID-19 vaccine uptake and vaccine hesitancy in Indian patients with cancer: A questionnaire-based survey.”[1] Vaccine hesitancy is a complex issue influenced by multiple factors. Globally, the top three most commonly cited reasons for vaccine hesitancy are safety concerns, lack of knowledge about its importance, and cultural and socioeconomic issues regarding vaccination.[2]

However, findings from surveys aimed at identifying the determinants of vaccine hesitancy or acceptance and uptake among the general population may not be applicable to high-risk individuals such as patients with cancer. Moreover, broadly labeling non-vaccination as “hesitancy” is perhaps inaccurate, as the reasons for under-vaccination in a specific high-risk population such as patients with cancer could be more related to feasibility, appropriate communication, access, and failure of services or policies.[3]

In case of patients with cancer, the contextual influences with respect to the underlying malignant disease condition and the logistics of the treatment for the same could play a more significant role in influencing the decisions related to vaccination. A commonly reported cause for low vaccine acceptance is the lack of knowledge, and hence, providing information and facts will help improve vaccine uptake in the general population. However, this may not be true for patients with cancer, as vaccine hesitancy in this group could be due to sociopsychological causes that are not knowledge-related.[4]

As reported by the authors themselves, of the 20% of patients with cancer who availed the vaccine, 47% got vaccinated based on their doctors' advice, while 43.7% made the decision on their own. This highlights the need for a credible source of information, such as recommendation of the treating physician, to build trust in the vaccine and overcome fears related to the impact of vaccination on cancer treatment.

Moreover, we believe that with regard to patients receiving active anti-cancer treatment, low vaccine uptake has been wrongly attributed to vaccine hesitancy by the authors, as decisions about vaccine uptake in these patients would be less self-driven and more physician-guided because of the lack of knowledge among the patients about the safety, timing, and appropriateness of the vaccine administration in the presence of the ongoing treatment regimens. In the general population, vaccine hesitancy could be largely driven by perceptions of the people around and inferences drawn from public information, social media, or other sources. However, in patients with cancer, especially in those seeking treatment from specialty care centers, there is an overt dependency of the patients on the treating oncologist for guiding them about COVID-19 vaccination.

Vaccine hesitancy could also be driven by frailty and poor physical health of the patients with cancer, as COVID-19 vaccination requires queuing up for long hours, rather than hesitancy or a lack of information about the risks and benefits of vaccination. Clearly, the context of the specific high-risk group such as patients with cancer matters and communications must be designed to fit the contextual needs and motivations of these special risk groups. There is a need to develop and evaluate solutions tailored to the real challenges associated with vaccine uptake among patients with cancer, as solutions to mitigate vaccine hesitancy in the general population may not be applicable to patients with cancer.

Although healthcare providers are usually the most trusted source of information on vaccines, the evidence for COVID-19 vaccination in patients with cancer is still emerging. Hence, oncologists may not be aware of the most updated guidelines and may find it difficult to guide patients with cancer or initiate vaccination conversations to implement standard evidence-based guidelines with a mandated institutional policy for COVID-19 vaccination in patients with cancer. Interventions such as dedicated hospital-based immunization could go a long way to maximize COVID-19 vaccine uptake among patients with cancer.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Noronha V, Abraham G, Bondili SK, Rajpurohit A, Menon RP, Gattani S, et al. COVID-19 vaccine uptake and vaccine hesitancy in Indian patients with cancer: A questionnaire-based survey. Cancer Res Stat Treat 2021;4:211-8.  Back to cited text no. 1
  [Full text]  
Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015-2017. Vaccine 2018;36:3861-7.  Back to cited text no. 2
Bedford H, Attwell K, Danchin M, Marshall H, Corben P, Leask J. Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology. Vaccine 2018;36:6556-8.  Back to cited text no. 3
Thomson A, Vallée-Tourangeau G, Suggs LS. Strategies to increase vaccine acceptance and uptake: From behavioral insights to context-specific, culturally-appropriate, evidence-based communications and interventions. Vaccine 2018;36:6457-8.  Back to cited text no. 4


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