COVID-19 vaccine uptake among patients undergoing treatment for lung cancer: A cross-sectional study in India.

Vaccination has been the cornerstone of the fight against COVID-19. Although vulnerable patient groups like cancer patients have much to gain from vaccination, they were excluded from most vaccine trials. Nonetheless, subsequent real-world data has shown that vaccines produce a serological response and are effective in preventing breakthrough infections due to COVID-19 in cancer patients, including those on chemotherapy.[1] In a large population-based case-control study, the vaccine effectiveness was 65.5% in cancer patients in comparison to 69.8% in control patients.[2] Preliminary studies found that the uptake of COVID-19 vaccines among cancer patients has ranged from 55% to 72%.[3,4] This study, conducted between May and July 2022 at a tertiary hospital in India, aimed to estimate the COVID-19 vaccine uptake among patients with lung cancer and the perceptional and attitudinal factors associated with the same. Patients were considered “fully vaccinated” if 2 or more weeks had elapsed since the receipt of the second dose of the vaccine on the date of the interview. They were considered “unvaccinated” if they had not received any dose of a COVID-19 vaccine. All others were considered “partially vaccinated”. A total of 100 subjects (83% male) with lung cancer with a mean (SD) age of 58.3 (10.9) years were recruited. Among them, 65 (65%) had received prior chemotherapy. A total of 74 subjects had received the COVID-19 vaccine, including 56 (75.7%) patients who were fully vaccinated and 18 (24.3%) who were partially vaccinated. Among those vaccinated, 57 (77%) had received Covishield, 15 (20.3%) had received Covaxin, and 2 (2.7%) had received the Sputnik V vaccine. The demographic profiles of the subset of fully vaccinated patients were comparable to that of the unvaccinated patients. The comparison of attitudes and perceptions related to COVID-19 and vaccination are compared between the vaccinated and unvaccinated subjects in Table 1. In comparison to unvaccinated patients, those who were fully vaccinated were more likely to “mostly adhere” to masking and handwashing in public places. The fully vaccinated patients were also significantly more likely to perceive the COVID-19 vaccine to be safe, effective, and easily accessible as compared to unvaccinated patients.Table 1: Comparison of key attitudes and perceptions between COVID-19 vaccinated (partial or full) and unvaccinated lung cancer patientsOur study showed a COVID-19 vaccine uptake rate of 74% among patients with lung cancer. By the time this study was performed in May 2022, 74% of India’s population received at least one dose.[5] This percentage included India’s sizeable under-12 years-old population in its denominator who were ineligible for the vaccine. Hence, it can be deduced that a significantly higher percentage than 74% of all Indian adults had received a vaccine dose by May 2022. This suggests that the vaccine uptake rate was lower among lung cancer patients than in the general population. Among the unvaccinated patients, we explored the reasons for not taking the vaccine [Figure 1]. The lack of knowledge regarding their eligibility for receiving the COVID-19 vaccine was the leading cause (73.1%) of remaining unvaccinated. Previously, Figueiredo et al.[4] also found insufficient knowledge about the vaccine in 64% of vaccine-hesitant cancer patients. In our study, only about half of the patients had received advice from their doctor to take the vaccine. Other reasons for vaccine hesitancy include fear of adverse effects, perceived ineffectiveness, low perceived susceptibility to COVID-19, and lack of confidence in the vaccine development process.[6]Figure 1: Reasons for not taking COVID-19 vaccineIn conclusion, after one year of the vaccination campaign against COVID-19 in India, a significant proportion of patients with lung cancer are not fully vaccinated. Many unvaccinated patients are unaware of their eligibility to be vaccinated. Clear advice from the healthcare provider to receive the COVID-19 vaccine may improve its acceptability among vaccine-hesitant patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.