Declining the COVID-19 vaccination: An evaluation of why some high risk cancer patients decline vaccination

ABSTRACT

The COVID-19 pandemic has created many challenges and barriers to care for patients on active cancer treatments including increased risk for morbidity and mortality from COVID-19 infection and restricted access to care. Specific patient groups, such as the uninsured and patients of underrepresented minority communities, have experienced this burden disproportionately. The rapid development and emergency authorization of COVID-19 vaccinations present an opportunity to mitigate some of this increased risk and improve health outcomes for patients on active cancer treatments. However, little is known regarding the rate of vaccination in this patient group. We study the rate of COVID-19 vaccination in a single institution infusion therapy clinic for cancer patients at a large academic county hospital in San Antonio which serves a high-risk patient population with a high representation of minority patient and uninsured patients. Patients were surveyed on arrival to the University Health System outpatient infusion clinic between May 2021 and June 2021. COVID-19 vaccinations became available to this patient population in February 2021. Starting the survey process three months after the first vaccination availability allowed sufficient time for patients to become fully vaccinated. Of the 194 patients surveyed between May 3, 2001 and June 25, 2021, 56% reported receiving at least one dose of a COVID-19 vaccination which is lower than the community vaccination rate of 76%. Patients were given 6 options to choose from for declining the vaccination. They included 1. I do not think it is safe for me because I have cancer 2. My doctor has not told me to get the vaccine 3. I want the vaccine but have not been able to schedule an appointment 4. I'm afraid of the side effects 5. I already had COVID, so I do not think I need the vaccine 6. Other The most common reason given for declining the vaccination was "My doctor has not told me to get the vaccine" by 30% of patients and the second most common was "I do not think it is safe for me because I have cancer" by 28% of patients. "I'm afraid of the side effects" was thethird most common response given by 23% of patients. Interestingly, access to the vaccine was not a common reason with only 10% of patients reporting this reason for not getting vaccinated. The three most common reasons cancer patients declined the COVD-19 vaccination can all be addressed by improvement in patient/physician communication regarding the known safety of the novel COVID-19 vaccinations and the recommendation for cancer patients to be vaccinated to help improve overall safety of giving immunosuppressive medications during the pandemic. This study shows the impact that healthcare works can make in increasing the COVID-19 vaccination rate in a high-risk population.