ABSTRACT
Background: The prevalence of moderate or severe emotional distress in cancer patients ranges from 30 to 45%. There is evidence that distress and depression can impair the immune system's response to vaccines, and this effect may be greatest in vulnerable groups such as cancer patients. We have previously shown that chemotherapy, targeted therapy, hormone therapy, lymphocyte count < 1x109/L and increasing age predicted poor antibody response at 6 weeks (Buttiron Webber T. et al, Eur J Cancer. 2021). Here we assessed the effect of psychological distress on the antibody response at 6 months after two doses of vaccine. Material (patients) and methods: Before the first dose of vaccine, after 42 days and at six months the clinical research nurse administered the Distress Thermometer questionnaire to the participants. The main outcome measure was the antibody response at 6 months. Multivariable logistic and linear mixed-effects models for repeatedmeasures analysis were applied adjusting for possible confounding variables. Result(s): Between March and July 2021, 320 subjects were recruited, and 290 were assessable both for distress and antibody response at 6 months. Main patient characteristics were the following: median age 68.2, female 59%, stage IV 59%, no treatment 22%, chemo 39%, hormone 24%, target or immuno 15%. At baseline, high distress (5+) was present in 26% of subjects, with a higher rate in women vs men (34.4% vs 23.8%, p=0.08). Women with the highest educational level (degree) were significantly more distressed during time (p=0.04). Younger age predicted a higher risk of elevated distress in terms of personal relationships (p=0.004) and practical problems (p=0.01). The percentage of non-responders at 6 months was 10.1% in patients with low distress vs 20.6% in those with high distress (Odds Ratio [OR]=2.5;95% Confidence Interval [CI] 1.1-5.8, p=0.04). Also advanced stage and increasing age significantly predicted a poor seroconversion. High distress at baseline was also associated with lower CRP response, a marker of vaccine response (p=0.003). Depression was also associated with lower antibody response at 6 months (p=0.003). Conclusion(s): Distress and depression are important predictor of poor seroconversion to SARS-CoV-2 vaccine. These findings indicate the need for a multidisciplinary approach with the contribution of a psycho-oncologist to manage psychological disorders in cancer patients and further studies by the clinical research nurse.