Real-World Assessment of Recommended COVID-19 Vaccination Waiting Period after Chemotherapy

Author:

Cheng Kai-Wen1ORCID,Yen Chi-Hua23,Chang Renin456ORCID,Wei James Cheng-Chung678910,Wang Shiow-Ing611ORCID

Affiliation:

1. Department of Emergency Medicine, China Medical University Hospital, Taichung 40447, Taiwan

2. School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan

3. Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan

4. Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan

5. Department of Recreation and Sports Management, Tajen University, Pintung 90741, Taiwan

6. Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan

7. Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan

8. Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan

9. Graduate Institute of Integrated Medicine, China Medical University, Taichung 40447, Taiwan

10. Office of Research and Development, Asia University, Taichung 41354, Taiwan

11. Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan

Abstract

There is a knowledge gap concerning the proper timing for COVID-19 vaccination in cancer patients undergoing chemotherapy. We aimed to evaluate the suitability of the guidelines that recommend waiting at least three months after undergoing chemotherapy before receiving a COVID-19 vaccine. This retrospective cohort study used aggregated data from the TriNetX US Collaboratory network. Participants were grouped into two groups based on the interval between chemotherapy and vaccination. The primary outcome assessed was infection risks, including COVID-19; skin, intra-abdominal, and urinary tract infections; pneumonia; and sepsis. Secondary measures included healthcare utilization and all causes of mortality. Kaplan–Meier analysis and the Cox proportional hazard model were used to calculate the cumulative incidence and hazard ratio (HR) and 95% confidence intervals for the outcomes. The proportional hazard assumption was tested with the generalized Schoenfeld approach. Four subgroup analyses (cancer type, vaccine brand, sex, age) were conducted. Sensitivity analyses were performed to account for competing risks and explore three distinct time intervals. Patients receiving a vaccine within three months after chemotherapy had a higher risk of COVID-19 infection (HR: 1.428, 95% CI: 1.035–1.970), urinary tract infection (HR: 1.477, 95% CI: 1.083–2.014), and sepsis (HR: 1.854, 95% CI: 1.091–3.152) compared to those who adhered to the recommendations. Hospital inpatient service utilization risk was also significantly elevated for the within three months group (HR: 1.692, 95% CI: 1.354–2.115). Adhering to a three-month post-chemotherapy waiting period reduces infection and healthcare utilization risks for cancer patients receiving a COVID-19 vaccine.

Funder

Chung Shan Medical University Hospital

Publisher

MDPI AG

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