Small-Cell Lung Cancer and the COVID-19 Vaccine: Current Recommendations

According to the Centers for Disease Control and Prevention (CDC), people with cancer are at an increased risk of severe illness due to COVID-19. This may be due to the effects of the cancer itself or the side effects from cancer treatment.

A 2021 study analyzed 13 studies of different cancers and COVID-19 outcomes. Outside of China, pooled mortality from COVID-19 was significantly higher in individuals with lung cancer than in individuals with other cancer types (42 percent versus 24 percent, respectively).

Due to the risk COVID-19 poses to people with cancer, the National Comprehensive Cancer Network recommends that all people with cancer receive the COVID-19 vaccine as soon as they can. The American Cancer Society supports this recommendation.

Due to their higher effectiveness and better safety profile, the CDC notes that mRNA vaccines are preferred over adenoviral vector vaccines such as the Johnson & Johnson vaccine. mRNA vaccines are the Pfizer-BioNTech or Moderna vaccines.

The table below shows the current COVID-19 vaccine recommendations for most adults.

Vaccines for immunocompromised adults

COVID-19 vaccine recommendations differ slightly if you’re moderately to severely immunocompromised, which can happen with some types of cancer treatment, such as chemotherapy.

Due to the fact that the immune system of this population is weakened, these individuals may produce a lower immune response to the vaccine. Because of this, an additional vaccine dose is added to the primary series.

The table below shows the current COVID-19 vaccine recommendations for moderately to severely immunocompromised adults.

A 2022 study of 306 people with chest cancers, including SCLC, found that most people produced protective antibodies after two doses of the Pfizer-BioNTech vaccine.

In the 30 participants with low antibody levels after 2 doses, an additional third dose led to improved antibody levels in all but 3 people.

Who should delay or abstain from COVID-19 vaccination?

According to the National Cancer Institute (NCI), COVID-19 vaccination should be delayed for at least 3 months after completing some cancer treatments. These include:

• immunosuppressive treatments
• CAR T-cell therapy
• stem cell transplant

There are only a few circumstances where a person shouldn’t get a COVID-19 vaccine. These include:

• a history of a severe allergic reaction (anaphylaxis) to a previous dose of a COVID-19 vaccine
• a known allergy to an ingredient in a COVID-19 vaccine
• a history of thrombosis with a low platelet count (thrombocytopenia) after receiving an adenoviral vector COVID-19 vaccine (contraindication for adenoviral vector vaccines only)

The treatment of SCLC often focuses on the use of chemotherapy, radiation therapy, or both. In some situations, immunotherapy may be recommended.

According to the NCI, there’s currently no evidence that the COVID-19 vaccines will make cancer treatments, such as those used for SCLC, less effective.

COVID-19 vaccines are safe for people with cancer. While people with cancer shouldn’t get live vaccines, they can, after consultation with a doctor, get other types of vaccines. These include both mRNA and adenoviral vector vaccines.

However, it’s still possible to experience some side effects after vaccination. The most common side effects of COVID-19 vaccines include:

• pain, redness, or swelling at the injection site
• fatigue
• fever
• chills
• muscles aches
• headache
• nausea

A 2021 study surveyed people with cancer about the side effects that they had after getting the COVID-19 vaccine. The most common types of side effects reported included pain at the injection site, fatigue, and muscle pain.

A 2022 study examined the safety of the Pfizer-BioNTech vaccine in 210 people with cancer, some of whom had SCLC. It found that the incidence of vaccine side effects in people with cancer was similar to that of the general public.

The study also included people undergoing various types of cancer treatment. The researchers didn’t find that the type of cancer treatment participants received was linked with the incidence of vaccine side effects.

Side effects from the COVID-19 vaccines go away on their own after a few days. However, if you find that your side effects last longer than a few days or begin to get worse, it’s important to contact a doctor.

Are people with lung cancer more likely to contract SARS-CoV-2?

People with cancer are generally more vulnerable to contracting infections such as SARS-CoV-2, the virus that causes COVID-19. This can be due to the effects of the cancer itself or of certain cancer treatments such as chemotherapy on your body’s defenses against infections.

Are people with lung cancer at a higher risk of severe COVID-19?

A 2021 study found that, compared with people without cancer, having a cancer diagnosis was associated with a higher risk of hospitalization and death due to COVID-19. This effect was greater in people with active cancer.

Individuals with lung cancer, including SCLC, also face some additional challenges from COVID-19. This is due to the fact that they often already have reduced lung function because of factors such as:

• having a history of smoking
• undergoing a surgery for lung cancer
• experiencing lung damage due to the cancer itself
• having other health conditions that impact lung and heart function

Can symptoms of COVID-19 be confused with symptoms of SCLC?

The symptoms of COVID-19 and SCLC do have some overlap. Some examples of symptoms that may happen with either condition are:

• cough
• shortness of breath
• fatigue

However, COVID-19 and SCLC also have unique symptoms as well. For COVID-19, these may include a runny or stuffy nose, a sore throat, or the loss of smell or taste. For SCLC, they may include chest pain, hoarseness, or unexplained weight loss.

Are there any medications you shouldn’t take before a COVID-19 vaccine?

The CDC recommends not to take over-the-counter anti-inflammatory or fever-reducing medications before a COVID-19 vaccine, as they may affect the way that your immune system responds to the vaccine. These include:

• aspirin
• ibuprofen (Advil, Motrin)
• naproxen (Aleve)
• acetaminophen (Tylenol)

If you take medications that suppress the immune system, talk with a doctor about the impact that your medications may have on vaccine effectiveness. They can give you more information about this and the best timing for your vaccination.

Should I get the flu vaccine if I have SCLC?

People with cancer are also at an increased risk of more serious illness due to the flu. Because of this, people with cancer, including SCLC, should receive a flu vaccine each year.

The type of flu vaccine is important. People with cancer should receive the flu shot, which contains an inactivated form of the virus, and not the flu nasal spray vaccine (FluMist) that contains a weakened — but live — form of the virus.

If you have any questions about what type of flu vaccine to get or the timing of your flu vaccine, be sure to talk with a doctor.

Individuals with cancer, including SCLC, are at an increased risk of serious illness due to COVID-19. Because of this, it’s important that they receive their COVID-19 vaccine as soon as they can.

COVID-19 vaccines are both safe and effective for people with SCLC. If you have questions about the COVID-19 vaccine in general, potential side effects, or which vaccine schedule to follow, be sure to consult a doctor.