Population-scale study highlights ongoing risk of COVID-19 in some cancer patients despite vaccination

23 May 2022

The UK Coronavirus Cancer Evaluation Project has delivered the world's largest analysis of the effect of COVID-19 vaccination on people with cancer
COVID-19 vaccination is effective in the majority of people with cancer, despite many being immunocompromised due to their cancer and treatments
Cancer patients show a more rapid waning of COVID-19 vaccine effectiveness by 3–6 months compared to the general population
Vaccine effectiveness is much lower in people with the blood cancers leukaemia or lymphoma, those with a recent cancer diagnosis and those who have received anti-cancer treatment within the last year
COVID-19 vaccination boosters are incredibly important for cancer patients.

A study co-led by the Universities of Oxford, Birmingham and Southampton and the UK Health Security Agency (UKHSA), published in Lancet Oncology today by the UK Coronavirus Cancer Evaluation Project, has found that while COVID-19 vaccination is effective in most cancer patients, the level of protection against COVID-19 infection, hospitalisation and death offered by the vaccine is less than in the general population and vaccine effectiveness wanes more quickly.

Dr Lennard Lee, Department of Oncology, University of Oxford who led the study said: ‘We know that people with cancer have a higher risk of severe COVID-19 disease and that the immune response in cancer patients following COVID-19 vaccination is lower. However, no study has looked at vaccine effectiveness and its waning in cancer patients at a population level. We have undertaken the largest real-world health system evaluation of COVID-19 in cancer patients globally.’

This study analysed 377,194 individuals with active or recent cancer who had received two doses of the COVID-19 vaccine and undergone a SARS-CoV-2 PCR test in England1. The numbers of breakthrough COVID-19 infections and COVID-19-associated hospitalisations and deaths2 in this cohort of cancer patients were compared to a control population without active or recent cancer.

The overall vaccine effectiveness against COVID-19 infection in the general population after two doses of the COVID-19 vaccine over the study period was 69.8% whereas, in the cancer cohort, overall vaccine effectiveness was slightly lower (65.5%). This indicates that COVID-19 vaccination is effective in most cancer patients. However, vaccine effectiveness wanes more quickly in cancer patients. At 3–6 months following the second vaccine dose, vaccine effectiveness reduced by nearly a third from 61.4% in the general population to 47.0% in the cancer cohort.

While the vaccine offers higher protection against COVID-19-associated hospitalisation (83.3%) and death (93.4%) than against breakthrough infections in the cancer cohort, this protection also waned by 3–6 months following the second vaccine dose.

Looking at the differences between people with different types of cancer, vaccine effectiveness is lowest and wanes most quickly in those with the blood cancers lymphoma and leukaemia.
The type of treatment that people with cancer receive also impacts both overall vaccine effectiveness and waning. In cancer patients that were treated in the last 12 months with chemotherapy or radiotherapy, vaccine effectiveness is lower and waned more by 3–6 months than in cancer patients that did not receive these treatments or were treated more than a year ago.

Professor Peter Johnson, Professor of Medical Oncology, University of Southampton commented: ‘This study shows that for some people with cancer, COVID-19 vaccination may give less effective and shorter-lasting protection. This highlights the importance of vaccination booster programmes and rapid access to COVID-19 treatments for people undergoing cancer treatments.’

Helen Rowntree, Director of Research, Services and Engagement at Blood Cancer UK said: ‘For our community, COVID-19 very much has not gone away and many people remain in their homes due to the threat of COVID-19 highlighted in this important study. We know how important the vaccines are for people with blood cancer. This study importantly shows that immunity wanes faster in people with blood cancer, who are entitled to five vaccine doses, and we’d encourage everyone with blood cancer to make sure they are getting these doses.’

Notes for editors:

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Dr Lennard Lee, Academic Clinical Lecturer at the Department of Oncology, University of Oxford, and Honorary Senior Research Fellow at the Institute of Cancer and Genomic Sciences, University of Birmingham, who led the study.

This new paper, ‘COVID-19: Vaccination effectiveness against coronavirus breakthrough infections in cancer patients: a population-based study (UKCCEP)’ is published in Lancet Oncology at https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00202-9/fulltext

This study was led by Dr Lennard Lee, Academic Clinical Lecturer at the Department of Oncology, University of Oxford, and Honorary Senior Research Fellow at the Institute of Cancer and Genomic Sciences, University of Birmingham. It was supported by the University of Oxford, National Institute of Health and Care Research Oxford Biomedical Research Centre, University of Southampton, University of Birmingham, UK Health Security Agency and Blood Cancer UK.

This study analysed 377,194 individuals aged over 18 years with active or recent cancer (diagnosed between 1 January 2018 and 30 April 2021) who had received two doses of the COVID-19 vaccine and undergone a SARS-CoV-2 PCR test in England (between 8 December 2020 and 15 October 2021). The analysis controlled for clinically relevant covariates, including age, gender, deprivation index and ethnicity.
Breakthrough infections were defined as a positive SARS-CoV-2 PCR test following the completion of the second vaccination dose. COVID-19 hospitalisation was defined as a hospitalisation episode from -1 to +14 days of a positive SARS-CoV-2 PCR test. COVID-19 death was a death up to 28 days following a positive SARS-CoV-2 PCR test.

About Oxford Cancer
Oxford University’s cancer research is managed through Oxford Cancer: a city-wide network and partnership between Oxford University and Oxford University Hospitals NHS Trust based on the University’s Translational Biomedical Research Campus.
With over 1,000 cancer research scientists spread across the city and beyond, Oxford is ideally placed to enable and combine the best research and clinical resources in order to innovate cancer treatment and care worldwide. Learn more at www.cancer.ox.ac.uk

About Oxford University
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the sixth year running, and 2 in the QS World Rankings 2022. At the heart of this success is our ground-breaking research and innovation.
Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research sparks imaginative and inventive insights and solutions.
Through its research commercialisation arm, Oxford University Innovation, Oxford is the highest university patent filer in the UK and is ranked first in the UK for university spinouts, having created more than 200 new companies since 1988. Over a third of these companies have been created in the past three years. The university is a catalyst for prosperity in Oxfordshire and the United Kingdom, contributing £15.7 billion to the UK economy in 2018/19, and supports more than 28,000 full time jobs.

About the UK Coronavirus Cancer Programme
The UK Coronavirus Cancer Evaluation Project is part of the UK Coronavirus Cancer Programme (UKCCP), one of the longest running pandemic response programmes in the world. It was established in March 2020 with the mission to safeguard, evaluate and protect cancer patients. The work is innovative in bringing expertise from 69 cancer centres across the United Kingdom. The UKCCP was the first to show that chemotherapy could be delivered safely during the coronavirus pandemic. The programme has delivered 7 successful coronavirus projects for cancer patients.