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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 568-570

Authors' reply to Villarreal-Garza et al., Kelekar et al., Jacob et al., Pimple et al., Ghafur, and Potter

1 Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2 Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission30-Aug-2021
Date of Acceptance04-Sep-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Kumar Prabhash
Professor, Department of Medical Oncology, Tata Memorial Hospital, Mumbai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_211_21

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How to cite this article:
Abraham G, Noronha V, Prabhash K. Authors' reply to Villarreal-Garza et al., Kelekar et al., Jacob et al., Pimple et al., Ghafur, and Potter. Cancer Res Stat Treat 2021;4:568-70

How to cite this URL:
Abraham G, Noronha V, Prabhash K. Authors' reply to Villarreal-Garza et al., Kelekar et al., Jacob et al., Pimple et al., Ghafur, and Potter. Cancer Res Stat Treat [serial online] 2021 [cited 2022 May 28];4:568-70. Available from: https://www.crstonline.com/text.asp?2021/4/3/568/327793

We thank Villarreal-Garza et al., Kelekar et al., Jacob et al., Pimple et al, Ghafur, and Potter for their critical evaluation and suggestions on our study on COVID-19 vaccine hesitancy in Indian patients with cancer.[1],[2],[3],[4],[5],[6],[7]

One of the major take-home messages from this and previous studies[7],[8] was that oncologists should actively provide guidance to their patients with regard to the safety, efficacy, and timing of the COVID-19 vaccination. We agree with Villarreal-Garza et al.[1] that while we advise patients regarding all the precautions to be taken to avoid COVID-19,[9],[10] it is equally important to provide the same advice to the caretakers and all the members of the patient's household, and to recommend that they receive vaccination as well.

We agree with Kelekar et al.[2] that based on the findings of our study, there is an emerging need to train health-care workers (HCWs) and patients regarding the necessity and the optimal timing of not only the COVID-19 vaccination but also all other vaccinations that are indicated for susceptible patients, an area that is frequently neglected by cancer care physicians in daily practice.[11],[12] We concede that our study methodology may have led to the possibility of an observer bias (the Hawthorne effect) as our team acted both as the researchers who administered and filled out the questionnaires, as well as the treating oncologists. However, we felt that this strategy helped us to gather significant additional data regarding the vaccine attitudes of the patients and their families which may not have been possible with a self-administered questionnaire. Our patients may have had difficulty in the accurate interpretation of the questions due to illiteracy and a high prevalence of stress and anxiety concerning cancer treatment in the hospital environment.[13] During the process of data collection, most of the patients were receptive and were willing to comply with the treating physician's advice regarding taking the vaccine and we found that a brief period of counseling was of great benefit toward changing their attitudes and calming their fears regarding the vaccine. There could be a very small proportion of patients who agreed for vaccination in an attempt to comply with the social norms without an actual change in attitude.

Accessibility to the COVID-19 vaccine was a big crisis during the period of our study and almost all patients below the age of 45 years were unvaccinated, hence we had to exclude those patients to get a good understanding of the perceptions of patients in whom vaccination was easily available.[14] The limitation of this approach as pointed out by Jacob et al.[3] was that we were unable to understand the adolescent and young adult perception of vaccination. The lack of availability of the vaccine is a well-known problem, but the goal of our study was to draw attention to vaccine hesitancy attitudes among patients with cancer and the reasons for the same. Most of the official guidelines like those from the European Society for Medical Oncology, the National Comprehensive Cancer Network, and the American Society of Clinical Oncology recommend that patients with cancer should receive COVID-19 vaccination irrespective of their clinical status, type of malignancy, and comorbidities and hence we did not perform a multifactorial analysis. Since it was not a self-administered questionnaire, we could not gather information regarding the patients' trust in the government authorities or the belief about the need for vaccination, socioeconomic, and cultural issues. We have a hospital-based immunization center at the Tata Memorial Hospital, Mumbai, India, for all patients with cancer for COVID-19 vaccination. We completely agree with Pimple and Mishra.[4] that physical frailty and poor performance status of the patients are additional underexplored areas which could have contributed to vaccine hesitancy due to the fear of long queues and the high risk of exposure that patients might encounter at vaccination centers and this underlines the need for dedicated hospital-based immunization centers at all oncology centers.

We agree with Villarreal-Garza et al.[1] that there needs to be an urgent audit done on the proportion of HCWs who counsel their patients regarding COVID-19 vaccines and also the prevalence of vaccine hesitancy among HCWs.[15]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Villarreal-Garza C, Vaca-Cartagena BF, Becerril-Gaitan A, Ferrigno AS. Strategies aimed at overcoming COVID19 vaccine hesitancy among oncologic patients. Cancer Res Stat Treat 2021;4:561-2.  Back to cited text no. 1
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Kelekar AK, Lucia VC, Afonso NM. Combating vaccine hesitancy: A call to implement healthcare worker training in patient counseling skills. Cancer Res Stat Treat 2021;4:562-3.  Back to cited text no. 2
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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.  Back to cited text no. 4
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Ghafur A. We need to tackle vaccine hesitancy in our patients with cancer. Cancer Res Stat Treat 2021;4:564-5.  Back to cited text no. 5
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Potter D. The oncologist as COVID-19 vaccine teacher and logistician: A pathway to better outcomes. Cancer Res Stat Treat 2021;4:567-8.  Back to cited text no. 6
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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. 7
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Villarreal-Garza C, Vaca-Cartagena BF, Becerril-Gaitan A, Ferrigno AS, Mesa-Chavez F, Platas A, et al. Attitudes and factors associated with COVID-19 vaccine hesitancy among patients with breast cancer. JAMA Oncol 2021;7:1242-4.  Back to cited text no. 8
Srivastava P, Tilak TV, Patel A, Das CK, Biswas B, Mahindru S, et al. Advisory for cancer patients during the COVID pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:145-8.  Back to cited text no. 9
Kulkarni T, Sharma P, Pande P, Agrawal R, Rane S, Mahajan A. COVID-19: A review of protective measures. Cancer Res Stat Treat 2020;3:244-53.  Back to cited text no. 10
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Shekhar R, Sheikh AB, Upadhyay S, Singh M, Kottewar S, Mir H, et al. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines (Basel) 2021;9:119.  Back to cited text no. 11
Sarkar L, Golu VB, Menon N, Patil VM, Noronha V, Prabhash K. Vaccination practices, efficacy, and safety in adults with cancer: A narrative review. Cancer Res Stat Treat 2021;4:505-15.  Back to cited text no. 12
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Alagizy HA, Soltan MR, Soliman SS, Hegazy NN, Gohar SF. Anxiety, depression and perceived stress among breast cancer patients: Single institute experience. Middle East Curr Psychiatry 2020;27:29.  Back to cited text no. 13
Choi EM. COVID-19 vaccines for low- and middle-income countries. Trans R Soc Trop Med Hyg 2021;115:447-56.  Back to cited text no. 14
Mustapha T, Khubchandani J, Biswas N. COVID-19 vaccination hesitancy in students and trainees of healthcare professions: A global assessment and call for action. Brain Behav Immun Health 2021;16:100289.  Back to cited text no. 15


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