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Frequently Asked Questions about COVID-19 vaccines for people affected by cancer

Cancer Australia has compiled answers to Frequently Asked Questions (FAQs) about COVID-19 vaccines for people affected by cancer based on information and evidence currently available in Australia and internationally.

Updated 9 April 2021

People affected by cancer have many questions about the COVID-19 vaccines, including questions about:

  • Vaccines in general, as well as the COVID-19 vaccines in particular
  • When and where people affected by cancer can receive the COVID-19 vaccines
  • Whether the COVID-19 vaccines are safe and whether they work for people affected by cancer (safety and effectiveness)
  • Risks and side effects of the COVID-19 vaccines for people affected by cancer
  • Whether a person’s cancer care or other health care (such as flu vaccination) will be affected by the COVID-19 vaccines
  • How we will collect information about the use of the COVID-19 vaccines in people with cancer.

Cancer Australia has compiled these Frequently Asked Questions (FAQs) based on input from cancer clinicians and people affected by cancer, including via a roundtable meeting of key cancer control stakeholders, consultation with consumer representatives and organisations, and queries and concerns raised in social media. The answers to these FAQs are based on information and evidence currently available in Australia and internationally. This webpage will be updated as new information emerges.

This information is intended to supplement the broader information provided by the Australian Government for clinicians and the Australian community about COVID-19 vaccines in Australia, available at www.health.gov.au/COVID19-vaccines.

To print these FAQs, click here.


General information about the COVID-19 vaccines

What is a vaccine? How does it work?

Vaccines are a way of producing an immune response in the body without causing illness. Vaccines strengthen a person’s immune system by training it to recognise and fight against specific infections.

Vaccines use weakened (or inactivated) viruses or parts of the virus (such as a protein) to make our bodies think we have already had a particular disease. When a person is vaccinated against a disease, their immune system can quickly recognise and clear out bacteria and viruses that can cause serious illnesses from that disease.

What is a COVID-19 vaccine? How does it work?

The COVID-19 vaccines strengthen a person’s immune system by training it to recognise and fight something that is specific to COVID-19. For most of the COVID-19 vaccines, this specific thing is the coronavirus ‘spike’ protein.

The spike protein is not the virus itself - it is the ‘pointy’ bit of the coronavirus cell which helps the virus enter people’s bodies. The COVID-19 vaccines that are available in Australia train our immune system to recognise this spike protein as foreign and produce long-lasting immune cells and antibodies to fight it.

None of the COVID-19 vaccines approved for use in Australia use the live or whole virus that causes COVID-19.1 The COVID-19 vaccines cannot give you COVID-19.

How are the COVID-19 vaccines tested for safety before they are approved for use in Australia?

Australia has strict requirements for the testing and approval of vaccines. Before a COVID-19 vaccine is approved for use in Australia, it must:

  • pass several different phases of clinical trials to prove the vaccine is safe and effective; and
  • pass the Therapeutic Goods Administration’s (TGA) rigorous assessment and approval processes. This includes assessment of the vaccine’s safety, quality and effectiveness.

For more information, visit How COVID-19 vaccines are tested and approved on the Australian Government Department of Health website.

Which COVID-19 vaccines are available in Australia?

Australia has entered into four separate agreements for the supply of COVID-19 vaccines, if they are proved to be safe and effective.2

  1. Pfizer/BioNTech (also known as Comirnaty). This vaccine has been provisionally approved by the Therapeutic Goods Administration (TGA) for people 16 years and older.3
  2. University of Oxford/AstraZeneca. This vaccine has been provisionally approved by the TGA for people 18 years and older.4
  3. Novavax. This vaccine is currently in large-scale phase 3 clinical trials.
  4. COVAX Facility. This is an agreement which includes multiple other vaccine candidates which are in various clinical trial stages.

What is the difference between the COVID-19 vaccines available in Australia? How does each vaccine work?

As at the end of February 2021, two different COVID-19 vaccines have been approved for use in Australia, but many other vaccines are still being tested in clinical trials.

There are several different types of COVID-19 vaccines. All COVID-19 vaccines aim to cause an immune response specific to the COVID-19 coronavirus without causing illness. Most of the vaccines use the coronavirus ‘spike’ protein to cause an immune response.

You might hear some of the scientific terms for the different types of vaccines, including “mRNA vaccines”, “viral vector vaccines”, and “protein-based vaccines”.

  • Messenger RNA vaccines (or mRNA vaccines) use a genetic code called ribonucleic acid (RNA) to spark the production of the coronavirus’ specific spike protein. The Pfizer/BioNTech vaccine is an mRNA vaccine. The vaccine cannot change your DNA or genes.
  • Viral vector vaccines use a safe, weakened animal virus which contains the genetic code for a protein unique to the coronavirus, usually the spike protein, to prompt an immune response. The University of Oxford/AstraZeneca vaccine is a viral vector vaccine.
  • Protein-based vaccines use a non-infectious component of the coronavirus, usually the spike protein (manufactured in a laboratory), to prompt an immune response. The Novavax vaccine is a protein-based vaccine.1

Which COVID-19 vaccine is suitable for which age group?

On 8 April 2021, the Australian Technical Advisory Group on Immunisation (ATAGI) issued a statement on the AstraZeneca vaccine in response to new vaccine safety concerns.

Because of evidence of a rare but serious side effect involving thrombosis (clotting) with thrombocytopenia (low blood platelet count) after receiving the AstraZeneca vaccine,  the Pfizer/BioNTech vaccine is preferred in adults aged under 50 years.

The AstraZeneca vaccine can be used in adults aged under 50 years where the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits. 

People who have had the first dose of the AstraZeneca vaccine without any serious adverse effects can be given the second dose, including adults under 50 years. 

For more information, visit the following information on the Australian Government Department of Health website:

When can people in Australia get the COVID-19 vaccines?

The Australian Government has a COVID-19 vaccine national roll-out strategy which commenced in February 2021.

This strategy contains five roll-out phases (phases 1a, 1b, 2a, 2b, and 3). Each phase includes a list of population groups who will be eligible to receive the vaccinations.

The population groups who have been prioritised to receive the COVID-19 vaccines first (in phase 1a) include:

  • People who are most likely to be exposed to COVID-19 (including quarantine and border workers and frontline healthcare workers)
  • People who would be at the highest risk of serious illness if they contracted COVID-19 (including aged and disability care staff and residents, elderly adults, and older Aboriginal and Torres Strait Islander people).

Initial supply of COVID-19 vaccine will be limited, which is why the delivery of vaccine will be restricted to priority population groups. However, more people will have access to a vaccine as more doses become available throughout 2021.

For more information, visit the Australian Government’s COVID-19 vaccine eligibility checker.

 

Getting the COVID-19 vaccines - for people with cancer

When will adults affected by cancer be eligible to receive a COVID-19 vaccine?

Many (but not all) people affected by cancer are eligible to receive a COVID-19 vaccine in the second phase (phase 1b) of the Australian Government’s COVID-19 vaccine national roll-out strategy. Phase 1b vaccinations commenced on 22nd March, 2021.5,6

People affected by cancer fit into the priority group “Younger adults* with an underlying medical condition” and may also fall into some other groups in phases 1a or 1b, such as adults over the age of 70 years and aged care residents.

At this time, the people affected by cancer who fit into the priority group “Younger adults with an underlying medical condition” include those who**:

  • have blood (haematological) cancers, including leukaemia, lymphoma or myeloma resulting in immunocompromise*** 
  • have other (non-haematological) cancers:
    • diagnosed within the last 5 years; or
    • on chemotherapy, radiotherapy, immunotherapy or targeted anti-cancer therapy (active treatment or recently completed); or
    • have advanced disease (regardless of treatment)
  • are adult survivors of childhood cancers
  • have had a bone marrow transplant or have received CAR-T therapy***.5,6

Speak to your healthcare professional if you are unsure which roll-out group you fit into.

* The eligibility criteria of an "underlying medical condition" applies to adults aged 69 years and under (people aged 70 years and older are already eligible to receive the vaccine in phase 1b based on age). 16- and 17-year-olds affected by cancer will be eligible to receive the Pfizer/BioNTech vaccine in line with eligibility for the phase 1b priority group.6

** This is the current list provided by the Australian Health Protection Principal Committee (AHPPC).

*** Discuss with your specialist regarding the optimal timing of vaccination.

For more information, visit the following information on the Australian Government Department of Health website:

When will children and young adults affected by cancer be eligible to receive a COVID-19 vaccine?

Australia’s COVID-19 vaccine national roll-out strategy does not have a dedicated category for children and young adults affected by cancer. In the future, children and young adults affected by cancer under the age of 16 may be eligible for a COVID-19 vaccine in the final phase (phase 3) of the vaccine roll-out, if recommended by Australian medical experts.

Currently, the COVID-19 vaccines available in Australia are not approved for use in people aged under 16. The Pfizer/BioNTech vaccine is approved for people aged 16 and older, and the AstraZeneca vaccine is approved for people aged 18 and older.5

When will carers of people affected by cancer receive the COVID-19 vaccine?

Carers (paid and unpaid) of people affected by cancer who are eligible to receive the COVID-19 vaccine in phase 1b, can now also receive the vaccine in phase 1b.

For more information, visit the following information on the Australian Government Department of Health website:

Where can people affected by cancer receive their COVID-19 vaccine?

For people affected by cancer, decisions about where to receive the COVID-19 vaccine may be made on an individual basis by the person affected by cancer, in consultation with their healthcare team.

COVID-19 vaccines in Australia will be provided by healthcare professionals through selected hospitals and general practitioners (GPs), GP-led Respiratory Clinics, Aboriginal Community Controlled Health Services, state vaccination clinics and pharmacies.

For more information about where the COVID-19 vaccines will be available, visit How COVID-19 vaccines will be distributed on the Australian Government Department of Health website. This webpage will be updated as more information becomes available.

Who will give (administer) the COVID-19 vaccines to people with cancer?

The decision about who will give people with cancer their COVID-19 vaccine may be made on an individual basis, together with their healthcare team.

Only qualified healthcare professionals can administer the COVID-19 vaccines. Additionally, every healthcare professional who administers the COVID-19 vaccines must complete compulsory COVID-19 vaccination training which covers the handling and administration of COVID-19 vaccines.7

For more information about the training required in order to administer the COVID-19 vaccines, visit COVID-19 vaccination training program on the Australian Government Department of Health website.

Will people with cancer receive a different COVID-19 vaccine or a different dosage than other people receiving the vaccines?

People with cancer are likely to be offered the same COVID-19 vaccines as the rest of the Australian population.

Based on early clinical trial results, it is likely that all people in Australia (including people affected by cancer) will require two doses of the COVID-19 vaccines.2

  • The two doses of the Pfizer/BioNTech vaccine should be given at least three weeks apart. It is particularly important for people with cancer to get the second dose of the vaccine as close to three weeks after the first dose as possible to ensure they are adequately protected from COVID-19.8
  • The two doses of the AstraZeneca vaccine can be safely administered between 4-12 weeks apart, however, the Australian Technical Advisory Group on Immunisation (ATAGI) recommend 12 weeks between the first and second dose. 

Whether people will need additional ‘booster’ doses, such as an annual booster, for COVID-19 vaccines is not yet known. This is still being determined by ongoing clinical trials.

Why is it important for people with cancer to receive two doses of the COVID-19 vaccine?

It is important for all people to get the recommended dosage of the COVID-19 vaccine they are offered. However, this may be particularly important for people with cancer.

Early results from a study conducted in the United Kingdom (UK) for the Pfizer/BioNTech vaccine found that cancer patients had lower levels of protection from the SARS-CoV-2 virus (the virus that causes COVID-19) following the first dose of the vaccine, compared to people without cancer. However, when cancer patients received their second dose three weeks after the first dose, protection against the SARS-CoV-2 virus improved significantly.8

When people who have lower COVID-19 protection come into contact with the virus, they are more vulnerable to COVID-19 and also risk spreading the virus to their close contacts, such as family and carers.

Currently in Australia, there is low community spread of COVID-19 compared to other parts of the world, including where this study was conducted (the UK). However, even after receiving the vaccine, it is still important for people affected by cancer in Australia, and their close contacts, to continue taking other protective measures against COVID-19, including practising good hygiene and maintaining physical distancing.

 

Safety and effectiveness

Were people with cancer included in clinical trials for the COVID-19 vaccines?

People with cancer were not included in most clinical trials for the COVID-19 vaccines. This is because clinical trials typically need to see whether the vaccines will work in people with healthy immune systems.9

Is it safe for people with cancer or people who have a weaker immune system (are immunocompromised) to get the COVID-19 vaccines?

Many cancer organisations internationally currently recommend COVID-19 vaccination for people with cancer and those with a weaker immune system (this is also known as being immunocompromised).10,11 This is because:

  • People with cancer are more vulnerable to contracting COVID-19 and are at an increased risk of more severe infection.10,12,13,14,15,16,17,18,19,20
  • Similar evidence from use of other vaccines suggests that COVID-19 vaccines may be safe and effective for people with cancer.10,21,22,23

Because people with cancer were not included in clinical trials, there is limited evidence about whether the COVID-19 vaccines are safe for people with cancer, or people who are immunocompromised because of cancer or cancer treatments. However, in principle there are no theoretical safety concerns for either the Pfizer COVID-19 vaccine (a non-live vaccine) or the AstraZeneca COVID-19 Vaccine (a non-replicating viral vector vaccine) in people who are immunocompromised, on the basis of a general understanding of the vaccines.5 Information is being collected from COVID-19 vaccination programs internationally, and so far, there have been no reports of any significant safety issues for people with cancer receiving the COVID-19 vaccines in other countries. This will continue to be monitored.

The Australian Technical Advisory Group on Immunisation (ATAGI) recommend people who are immunocompromised should be among the priority groups to receive the COVID-19 vaccines because of their increased risk of severe illness with COVID-19.5

The decision about whether to receive a COVID-19 vaccine should be made on an individual basis by the person affected by cancer, in consultation with their healthcare team.

Do the COVID-19 vaccines work for people affected by cancer (are they effective)?

Although there is currently limited evidence about whether the COVID-19 vaccines work for people affected by cancer, we do have a lot of similar evidence from use of other vaccines that suggests the COVID-19 vaccines may be effective for people affected by cancer:

  • Evidence from flu vaccinations suggests that people affected by cancer can mount a protective immune response from COVID-19 vaccines (that is, whether their immune system becomes trained to recognise and fight against specific germs). However, the level of immunity may be affected by a range of factors (such as cancer type, therapies, and immune function).10
  • There is evidence from other vaccinations used to prevent infection to support their use for people affected by cancer, even in those undergoing immunosuppressive therapy.10,21,22,23

However, the immune response to vaccination may be reduced in people who are immunocompromised, which may result in lower vaccine effectiveness and protection compared to people who are not immunocompromised.5

Even after receiving the vaccine, it is important for people affected by cancer (especially those who are immunocompromised) and any close contacts, to continue taking other protective measures against COVID-19, including  practising good hygiene and maintaining physical distancing. 

What factors should a person affected by cancer consider when deciding about when to get the COVID-19 vaccine?

For people with cancer, the decision about when to receive a COVID-19 vaccine should be made on an individual basis by the person affected by cancer in consultation with their healthcare team. Factors to consider include:

  • The type of cancer the person has/had
  • The type of treatment they are receiving/received
  • The timing of their treatment
  • The type(s) of vaccine(s) available
  • How their immune system is working.9

For example, some cancer treatments (like chemotherapy, radiation therapy, or immunotherapy) can affect the immune system, which might make the vaccine less effective in some people.9

 

Risks and side effects

If I have allergies, should I avoid any of the COVID-19 vaccines?

People who have had an allergic reaction or a severe allergic reaction (anaphylaxis) to any ingredients contained in the COVID-19 vaccines should avoid the specific COVID-19 vaccine(s) that contain those ingredients. Talk to your healthcare team if you have had an allergic reaction or anaphylaxis to any medication (including chemotherapy) in the past.

The ingredients for each of the COVID-19 vaccines can be found in the ‘Product details’ section of their ‘Consumer Medicines Information’ leaflet, available on the TGA website:

  • Click here for the Pfizer/BioNTech (Cominarty) Consumer Medicines Information leaflet
  • Click here for the University of Oxford/AstraZeneca Consumer Medicines Information leaflet.

Allergies that may be particularly relevant to people affected by cancer include allergies to polysorbate 80, which is one of the ingredients in the University of Oxford/AstraZeneca vaccine, and polyethylene glycol (PEG) which is one of the ingredients in the Pfizer/BioNTech vaccine. These ingredients are also used in cancer treatments, such as chemotherapy medications, docetaxel and paclitaxel. If you have had an allergic reaction or anaphylaxis in response to polysorbate 80 or PEG, speak to your health professional or seek expert advice on COVID-19 vaccination before being vaccinated.24

What are the side effects of the COVID-19 vaccines for people affected by cancer?

Currently, there is no evidence to suggest that people affected by cancer will experience different or worse side effects to the COVID-19 vaccines.

In general, common side effects from the COVID-19 vaccines are similar to those of other vaccines, including:

  • pain, redness and/or swelling where you received the needle
  • muscle pain/aches
  • mild fever
  • headache.25

These side effects are usually mild and usually go away within one or two days.

Thrombosis (clotting) and the AstraZeneca vaccine 

On 8 April 2021, the Australian Technical Advisory Group on Immunisation (ATAGI) issued a statement on the AstraZeneca vaccine in response to new vaccine safety concerns.

ATAGI noted further evidence of a rare but serious side effect involving thrombosis (clotting) with thrombocytopenia (low blood platelet count) after receiving the AstraZeneca vaccine.

ATAGI recommends that the Pfizer/BioNTech vaccine is preferred over the AstraZeneca vaccine in adults aged under 50 years. This recommendation is based on the increasing risk of severe outcomes from COVID-19 in older adults (and hence a higher benefit from vaccination) and a potentially increased risk of thrombosis with thrombocytopenia following the AstraZeneca vaccine in those under 50 years. 

The AstraZeneca vaccine can be used in adults aged under 50 years where the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits. 

People who have had the first dose of the AstraZeneca vaccine without any serious adverse effects can be given the second dose, including adults under 50 years. 

For more information, visit the following information on the Australian Government Department of Health website:

The Therapeutic Goods Administration (TGA) is monitoring the ongoing safety of the COVID-19 vaccines, and this webpage will be updated as new information emerges.

What do I do if I have a side effect (adverse event) after receiving the COVID-19 vaccine?

Serious reactions to the COVID-19 vaccines are extremely rare. If they do happen, they usually occur within 15 minutes of receiving a vaccine.

All people who receive the COVID-19 vaccine should wait at least 15 minutes before leaving the vaccination clinic in case a serious reaction occurs. If you have a history of anaphylaxis (a severe allergic reaction) to anything, you should wait at least 30 minutes before leaving.

If you experience a side effect (adverse event) after receiving the vaccine, you should contact a member of your treating healthcare team, or call the National Coronavirus Helpline on 1800 020 080, available 24 hours a day.

Adverse events should be reported to the Therapeutic Goods Administration (TGA). This helps the TGA monitor the ongoing safety of the vaccine, and if any safety risks become evident, the TGA can inform the community and health providers as soon as possible. Adverse events can be reported to the TGA by you or a health professional, and can be done via an online form, by email, or by phone.

For more information, visit Report a problem or side effect on the TGA website.

Are there any potential risks for people who have, or are at risk of, lymphoedema (swelling)?

Lymphoedema is swelling of a part of the body and can be a side effect of cancer treatment. Within the areas of the body affected by lymphoedema, the immune cells which fight infection may not work as well. Vaccination into these areas may therefore result in a weaker immune response and less protection from COVID-19. Damage to the skin within an area of lymphoedema can also act as an entry site for infection, so careful skin care and protection is advisable for areas of swelling. As a precaution the COVID-19 vaccine should be given in the untreated limb if possible.26,27

Are there any potential risks relating to people with bleeding disorders and people who are taking blood thinners?

People with bleeding disorders, those receiving antiplatelet or anticoagulant therapy (blood thinners) and those with low platelet counts may have an increased risk of bleeding or significant bruising at the site where the COVID-19 vaccine was given,28 which can be painful for the person. Talk to your health professional if you are concerned about any medication you are taking, before being vaccinated.

 

Impacts and interactions

Will the COVID-19 vaccines affect or interact with my cancer treatment(s)? 

Currently, there is no information available from the COVID-19 vaccines clinical trials about whether the COVID-19 vaccines will affect or interact with cancer treatments. This is because most clinical trials for the COVID-19 vaccines did not include people with cancer.

Recommendations vary and there are a number of factors to consider for every individual, including:

  • The type of cancer you have/had
  • The type of treatment you are receiving/received
  • The timing of the treatment you are receiving/received
  • The type(s) of vaccine(s) available
  • How your immune system is working. 

There are some theoretical risks of immune-related side effects for COVID-19 vaccination for people receiving immunotherapy, including checkpoint inhibitors such as pembrolizumab, nivolumab and ipilimumab. However, international cancer organisations and Australian experts recommend vaccination after weighing the benefit of vaccination against risk.11,29

Optimal responses to the vaccine are more likely more than 3-6 months after stem cell transplant or CAR-T cell therapy.30

If you are having treatment for cancer, speak to your healthcare team about the best timing for you based on your own situation.

Some organisations have provided recommendations for health professionals about the timing of the COVID-19 vaccines and cancer treatments. These are located at COVID-19 vaccines and cancer – health professional guidance on Cancer Australia’s website.

Does the COVID-19 vaccine impact screening and diagnostic mammograms?

There have been some reports internationally about people who have received a COVID-19 vaccine having lymph node swelling which is being mistaken for possible breast cancer. This swelling occurs in the lymph glands in the underarm area and is known as lymphadenopathy. Lymphadenopathy is an immune system response to an infection or a vaccine. However, as lymphadenopathy is also a symptom of breast cancer, this may lead to a false positive mammogram result; that is, that the mammogram may look abnormal even though there is no cancer actually present.

Clinical experts in Australia are working to develop guidance around whether the timing of a screening mammogram or diagnostic imaging for breast cancer symptoms should be impacted for any people who have had a COVID-19 vaccination recently. This FAQ will be updated when information becomes available.

Can people with cancer get the COVID-19 vaccine at the same time as the influenza (flu) vaccine?

No, it is not recommended that any people receive the flu vaccine (or any other vaccine) at the same time as the COVID-19 vaccine.

At least 14 days between the COVID-19 vaccine and the flu vaccine (or any other vaccine) is recommended.31

This advice is provided by the Australian Technical Advisory Group on Immunisation (ATAGI). The advice is based on a lack of evidence (not enough data) about how the COVID-19 vaccines and flu vaccines affect each other, or whether it is safe to give the two vaccines at the same time. This is precautionary advice, and may change as further information becomes available.

For more information, visit COVID-19 vaccination - ATAGI advice on influenza and COVID-19 vaccines.

 

Collecting information about the use of the COVID-19 vaccines in people affected by cancer

Is any data being collected about the COVID-19 vaccines for people affected by cancer?

Data about the use of the COVID-19 vaccines can help us better understand the safety and effectiveness of the COVID-19 vaccines for people affected by cancer.

To get this information, Cancer Australia is monitoring data from international vaccination programs. We are also exploring options for the collection of data about the use of COVID-19 vaccines for people affected by cancer in Australia. We will provide more information here as it becomes available.

 

References

1 Australian Department of Health. How COVID-19 vaccines work [Internet]. Canberra ACT: Australian Department of Health; 2021 [updated 2021 Jan 29, cited 2021 Feb 04]. Available from:   https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/about-covid-19-vaccines/how-covid-19-vaccines-work

2 Australian Department of Health. Australia’s vaccine agreements [Internet]. Canberra ACT: Australian Department of Health; 2021[updated 2021 Feb 3, cited 2021 Feb 04]. Available from: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/about-covid-19-vaccines/australias-vaccine-agreements

3 Therapeutic Goods Administration. TGA provisionally approves Pfizer COVID-19 vaccine [Internet]. Canberra ACT: Therapeutic Goods Administration; 2021 Jan 25 [cited 2021 Feb 04]. Available from: https://www.tga.gov.au/media-release/tga-provisionally-approves-pfizer-covid-19-vaccine

4 Therapeutic Goods Administration. COVID-19 Vaccine: AstraZeneca ChAdOx1-S. Canberra ACT: Therapeutic Goods Administration; 2021 Feb 16 [cited 2021 Feb 17]. Available from: https://www.tga.gov.au/covid-19-vaccine-astrazeneca-chadox1-s

5 Australian Technical Advisory Group on Immunisation (ATAGI). COVID-19 vaccination – ATAGI clinical guidance on COVID-19 Vaccine in Australia in 2021. ATAGI; 2021. Available from: https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021

6 Australian Department of Health. Priority groups for COVID-19 Vaccination Program: Phase 1b. Canberra ACT: Australian Department of Health; 2021 [updated 2021 Mar 19, cited 2021 Mar 19] Available from: https://www.health.gov.au/resources/publications/priority-groups-for-covid-19-vaccination-program-phase-1b

7 Australian Department of Health. Mobilising Australia’s COVID-19 vaccine workforce [Internet]. Canberra ACT: Australian Department of Health; 2021 Jan 21 [cited 2021 Feb 04]. Available from: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/mobilising-australias-covid-19-vaccine-workforce

8 King’s College London. Delaying second vaccine dose leaves cancer patients vulnerable to virus [Internet]. UK: King’s College London; 2021 [updated 2021 March 11, cited 2021 March 12]. Available from: https://www.kcl.ac.uk/news/delaying-second-vaccine-dose-cancer-patients-vulnerable-virus

9 American Cancer Society. COVID-19 Vaccines in People with Cancer [Internet]. USA: American Cancer Society; 2021 [updated 2021 Jan 29, cited 2021 Feb 04]. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/covid-19-vaccines-in-people-with-cancer.html

10 European Society for Medical Oncology. COVID-19 vaccination in cancer patients: ESMO statements [Internet]. Lugano: European Society for Medical Oncology; 2020 [cited 2021 Feb 04]. Available from: https://www.esmo.org/covid-19-and-cancer/covid-19-vaccination

11 National Comprehensive Cancer Network. Preliminary Recommendations of the NCCN COVID-19 Vaccination Advisory Committee [Internet]. USA: National Comprehensive Cancer Network; 2021 Jan 22 [cited 2021 Mar 01]. Available from: https://www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf

12 Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020 Mar 01;21(3):335-7.

13 Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Clinical characteristics and outcomes of cancer patients with COVID-19. J Med Virol. 2020 Oct;92(10):2067-2073.

14 Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020 Jul;31(7):894-901.

15 Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak. Cancer Discov. 2020 Jun;10(6):783-91.

16 Lai AG, Pasea L, Banerjee A, Denaxas S, Katsoulis M, Chang WH, et al. Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency. medRxiv. 2020; doi:10.1101/2020.05.27.20083287.

17 Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol. 2020 Jun;150:102972.

18 Wang Q, Berger NA, X R. Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection. JAMA Oncol. 2020 Dec 10;doi:10.1001/jamaoncol.2020.6178

19 Rüthrich MM, Giessen-Jung C, Borgmann S, Classen AY, Dolff S, Grüner B, et al. COVID-19 in cancer patients: clinical characteristics and outcome – an analysis of the LEOSS registry. Ann Hematol. 2021;100(2)383-393

20 Venkatesulu BP, Chandrasekar VT, Girdhar P, Advani P, Sharma A, Elumalai T, et al. A systematic review and meta-analysis of cancer patients affected by a novel coronavirus. medRxiv. 2020 May 29;doi: 10.1101/2020.05.27.20115303

21 Cordonnier C, Einarsdottir S, Cesaro S, Di Blasi R, Mikulska M, Rieger C, et al. Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019; 19(6):e200-e212.

22 Mikulska M, Cesaro S, de Lavallade H, Di Blasi R, Einarsdottir S, Gallo G, et al. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019 Jun; 19(6):e188-e199.

23 Rieger CT, Liss B, Mellinghoff S, Buchheidt D, Cornely OA, Egerer G, et al. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors-Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol. 2018 Jun 01; 29(6):1354-1365.

24 COVID-19 Vaccine AstraZeneca (ChAdOx-1-S) solution for injection 5mL multidose vial [CMI]. Macquarie Park, NSW: AstraZeneca Pty Ltd; 2021 [cited 2021 Feb 23]. Available from: https://tga-search.clients.funnelback.com/s/search.html?collection=tga-artg&profile=record&meta_i=349072

25 Australian Department of Health. What happens after I am vaccinated for COVID-19?? [Internet]. Canberra ACT: Australian Department of Health; 2021 [updated 2021 Feb 22, cited 2021 Feb 23] Available from: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/learn-about-covid-19-vaccines/what-happens-after-i-am-vaccinated-for-covid-19

26 British Lymphology Society and The Lymphoedema Support Network. Consensus document on COVID-19 vaccination for patients with lymphoedema [cited 2021 Feb 24]. Available from: https://www.thebls.com/documents-library/consensus-document-on-covid-19-vaccination-for-patients-with-lymphoedema

27 Cancer Australia. Lymphoedema — what you need to know. Cancer Australia, Surry Hills, NSW, 2012

28 Haematology Society of Australia and New Zealand. COVID-19 Vaccination in Haematology Patients: An Australia and New Zealand Consensus Position Statement [cited 2021 Feb 24]. Available from: https://www.hsanz.org.au/news/10054698

29 UK Chemotherapy Board. Clinician Frequently Asked Questions (FAQs) and guidance on COVID19 vaccine for patients receiving Systemic Anti-Cancer Therapy. Accessed 2 Mar 2021. https://4bd2316d-e45d-4e90-96b5-431f1c12dd3e.filesusr.com/ugd/638ee8_bc24796daf974cfa830a432248401191.pdf

30 Australia and New Zealand Transplant and Cellular Therapies. COVID19 Vaccination Consensus Position Statement [updated 2021 Feb 02, cited 2021 Mar 08]. Available from: https://anztct.org.au/wp-content/uploads/2021/02/FINAL-ANZTCT-COVID19-Vaccination-Position-Statement-Version2-2-Feb-2021.pdf

31 Australian Technical Advisory Group on Immunisation (ATAGI). COVID-19 vaccination – ATAGI advice on influenza and COVID-19 vaccines. ATAGI; 2021 [updated 2021 Mar 12; cited 2021 Apr 08]. Available from: https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-advice-on-influenza-and-covid-19-vaccines