In the spirit of upholding the patient navigation competency that directs navigators to “facilitate patient-centered care that is compassionate, appropriate, and effective for the treatment of cancer and the promotion of health,” the Academy of Oncology Nurse & Patient Navigators (AONN+) Policy and Advocacy committee signed a letter this week addressed to President Joe Biden. The letter, created by the Cancer Leadership Council, focused on the special needs of cancer patients and other immune-compromised individuals during the COVID-19 pandemic and urged action to increase the supply and improve the distribution of monoclonal antibodies and antiviral treatments for pre-exposure prophylaxis and treatment of COVID-19 in immune-compromised individuals.
Some cancer patients are less likely than other people to enjoy the protections provided by the Covid vaccines. For example, blood cancer patients’ antibody levels may not be as strong as those in fully vaccinated, healthy adults, and this makes them more susceptible to a COVID-19 breakthrough infection. Their risk is that blood cancers attack the immune system since their cancer arises in cells that create antibody-producing cells. Then, the drugs that attack the leukemia, lymphoma, and multiple myeloma cancer remove not just malignant cells but also benign immune cells. Think of the bone marrow transplants that wipe out an individual’s entire immune system and the rebuilding which takes months. Bone marrow transplant patients have to start over with all vaccinations—not just against Covid—to teach those new immune cells to fight the invading coronavirus, flu, or other pathogens.
AONN+ is proud of the stance the leaders in Policy & Advocacy are taking in support of oncology patients!
February 1, 2022
The President
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Mr. President:
The undersigned organizations represent cancer patients, healthcare professionals, caregivers, and researchers. We are writing you about the special needs of cancer patients and other immune compromised individuals during the COVID-19 pandemic. We urge specific steps to address these needs, including increasing the supply and improving the distribution of monoclonal antibodies and antiviral treatments for pre-exposure prophylaxis and treatment of COVID-19 in immune compromised individuals.
The development of COVID-19 vaccines, monoclonal antibodies, and antivirals, and the approval of existing therapies for COVID-19 use have been impressive achievements during the pandemic. These accomplishments are a testament to the work of talented biomedical researchers and the commitment of innovative biopharmaceutical companies, as well as a statement about the benefits of public and private sector collaboration.
Despite the promise of vaccines and therapeutics, the COVID-19 virus has proven to be a daunting adversary. Patients with hematologic cancers, many cancer patients in treatment, and certain other cancer patients can offer their experience to underscore the challenges associated with COVID-19. Cancer patients, because of their disease or the treatments for their disease, may be immune compromised. This has put them at special risk of contracting COVID-19 and at risk of poor outcomes if they do contract COVID-19.
Cancer patients have sought out vaccination to protect themselves against COVID-19. Many cancer patients and other immune compromised individuals have completed a two-dose series of mRNA vaccine and have taken the third recommended dose for immune compromised individuals. They are also prepared to take a fourth vaccine booster dose.
However, many cancer patients–as a result of their immune compromised status–have a modest response to vaccines. Despite their own efforts to protect themselves against COVID-19, these patients find themselves much as they did at the beginning of the pandemic. They are vaccinated but not protected. They are closely adhering to mitigation strategies including masking, distancing, and working from home where possible. But this means that they are often unable to see family, work in some circumstances, or live as other fully vaccinated individuals can. Of great concern is the impact of their immune compromised status on their ability to undertake and successfully complete cancer treatment.
Fortunately, a monoclonal antibody combination and antivirals might offer additional tools to immune compromised cancer patients. However, the supplies of both the monoclonal antibody combination and antiviral medications are very limited, and available supplies are not consistently distributed to those who could benefit most, according to available evidence.1
During the pandemic, federal health officials have communicated constructively with healthcare professionals and researchers, including cancer experts, on topics related to the immune compromised and COVID-19. The approach of federal officials led to prompt action to recommend a third dose of mRNA vaccine as part of the primary series for those who are immune compromised and to the recommendation of a fourth dose as a booster dose.2
We urge you to continue this approach to collaboration and communication to meet the needs of the most vulnerable during the pandemic.
Although we are presenting the urgent needs of cancer patients and other immune compromised individuals who would benefit from monoclonal antibodies and antivirals but cannot obtain them, we understand that there is currently lower use of monoclonal antibody treatment among black, Asian, Hispanic, and other races with positive SARS-CoV-2 tests results relative to white and non-Hispanic patients.3 This disparity in access must also be addressed. These disparities in access are likely experienced by cancer patients who would benefit from monoclonal antibodies. We realize that we, as healthcare professionals and patient advocates, must be engaged in efforts to address the disparities in COVID-19 treatment access. If the issues related to supply and allocation for cancer patients and other immune compromised individuals are addressed, as we urge below, we understand that important actions will still be necessary to ensure that disparities in access to monoclonal antibodies by black, Asian, and Hispanic patients–including those with cancer–are addressed.
We recommend that the federal government increase as much as possible its procurement of the monoclonal antibody combination and antiviral treatments. We also recommend that you consider an allocation and distribution system that would rely on the best available evidence regarding those who would benefit from these products. We can offer the expertise and experience of scientists, researchers, and patient advocates from our organizations to assist in this process. We can also recommend that distribution of these products to cancer centers and hospitals would help ensure better access for cancer patients who are immune compromised and who would benefit from these products.
We stand ready to offer our expertise and experience to address these difficult issues. We know that we share an interest in employing all responsible public health strategies to help vulnerable cancer patients and other immune compromised individuals survive this pandemic.
Sincerely,
Cancer Leadership Council
References
- On January 24, 2022, the Food and Drug Administration (FDA) limited the use of certain monoclonal antibodies due to their limited efficacy against the omicron variant. FDA press release accessed on January 25, 2022: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-limits-use-certain-monoclonal-antibodies-treat-covid-19-due-omicron. As a result, our recommendations relate to the monoclonal antibody combination marketed as Evusheld.
- On January 4, 2022, the Centers for Disease Control and Prevention (CDC) updated its recommendation for a fourth dose, as a booster, for moderately or severely immunocompromised individuals. Recommendation on website accessed on January 25, 2022: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-limits-use-certain-monoclonal-antibodies-treat-covid-19-due-omicron. Despite the recommendation, immune compromised individuals are being turned away from pharmacies when they seek the fourth dose booster. Liz Szabo of Kaiser Health News reported on January 25, 2022. Article accessed on January 25, 2022: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-limits-use-certain-monoclonal-antibodies-treat-covid-19-due-omicron.
- Wiltz JL, Feehan AK, Molinari NM, et al. Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 – United States, March 202-August 2021. MMWR Morb Mortal Wkly Rep 2022; 71:96-102. Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021 | MMWR (cdc.gov).
About the Academy of Oncology Nurse & Patient Navigators, Inc. (AONN+)
The Academy of Oncology Nurse & Patient Navigators, Inc. (AONN+), is the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurse and patient navigators. The organization, which has more than 8900 members, was founded in 2009 to provide a network for all professionals involved and interested in patient navigation and survivorship care services in order to better manage the complexities of the cancer treatment process. www.aonnonline.org.
