CANSA COVID Vaccination and Cancer Patients webinar Dr Zainab Mohamed

1. Cancer patients and
Covid-19 Vaccination
13 July 2021
Department of Radiation Oncology
Groote Schuur Hospital
University of Cape Town
Dr Zainab Mohamed

4. Life can be normal again

6. Covid-19 effects on Cancer services
Cancer screening
Diagnosis
 Reduced access to primary and secondary level services
 Limited access to imaging, biopsies and other investigations
Treatment
 Fewer surgical lists
 Less hospital beds
 Staff shortages
Follow up
 Telephone consultations
Palliative care
 Inpatient care and home visits affected

7. DOI: 10.1200/CCI.20.00134 JCO Clinical Cancer Informatics no. 4
(2020) 1059-1071. Published online November 30, 2020.

8. DOI: 10.1200/CCI.20.00134 JCO Clinical Cancer Informatics no. 4
(2020) 1059-1071. Published online November 30, 2020.

9. Covid-19 challenges for cancer patients in
South Africa
Accessing medical care
 Transport issues during hard lockdown
 Economic: no money to get to hospital
 Cancelled routine appointments, Telemedicine not ideal for elderly, vulnerable
 Primary and secondary hospitals overrun with C-19 cases
 Risk of exposure to Covid-19
Fear of contracting Covid-19
 More patients present with advanced disease or in extremis
Treatment delays
 Stage migration

12. Groote Schuur Hospital Dept of Radiation Oncology
new cancer patient referrals
0
500
1000
1500
2000
2500
3000
3500
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Breast
Bronchus
Gynae
Colorectal
Urology
ENT H&N
Lymphoma
Total

13. Groote Schuur Hospital Dept of Radiation Oncology
annual statistics
0
100
200
300
400
500
600
700
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Breast
Bronchus
Gynae
Colorectal
Urology
ENT H&N
Lymphoma
Kaposi

14. Covid-19 effect on breast cancer services at
Groote Schuur Hospital
0
10
20
30
40
50
60
New Breast Cancers Diagnosed
2019 2020
0
5
10
15
20
25
30
35
40
45
Breast Cancer Surgeries
2019 2020

15. Office for National Statistics data on weekly registrations of deaths in the England and Wales
from 3 January 2020 to 15 May 2020.
Alvina G Lai et al. BMJ Open 2020;10:e043828
©2020 by British Medical Journal Publishing Group

16. Covid collateral damage
Psychosocial
 No visitors
 No face-to-face family counselling
 Unemployment, food insecurity
 Anxiety
Cancer patients with fever or respiratory tract symptoms
become PUI’s
Cancer patients contracting Covid
 Delayed treatment
 Severe illness
Oncology drug supply issues

17. Covid-19 loss
and
bereavement
Suffering
Pain
Trauma
Anxiety
Stress
Burnout

18. The key ingredient in all vaccines is trust.
Prof Barry R Bloom. Harvard School of Public Health

19. Covid-19 vaccinations administered
worldwide
As at 10 July 2021
• 3.42 Billion have had
at least 1 jab
• Fully vaccinated: 940
million
• 29.58 million
administered daily
• Canada 69.4%
• India 22%
• Only 1% in low-
income countries
• South Africa 2.3%
fully vaccinated

21. What about variants?

24. Islam MS, Kamal AHM, Kabir A, Southern DL, Khan SH, et al. (2021) COVID-
19 vaccine rumors and conspiracy theories: The need for cognitive
inoculation against misinformation to improve vaccine adherence. PLOS ONE
16(5): e0251605. https://doi.org/10.1371/journal.pone.0251605
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251605

25. From Islam et al:
“Whether a person believes the
misinformation or not is dependent on the
individual’s level of health literacy and their
risk perceptions. However, continuous
exposure to social media and online anti-
vaccine movement may influence people to
share and communicate vaccine
misinformation and conspiracy theories”
Islam MS, Kamal AHM, Kabir A, Southern DL, Khan SH, et al. (2021) COVID-19
vaccine rumors and conspiracy theories: The need for cognitive inoculation
against misinformation to improve vaccine adherence. PLOS ONE 16(5):
e0251605. https://doi.org/10.1371/journal.pone.0251605
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251605

27. Thank You to my Colleagues
Professor Jeannette
Parkes, Dr Francious
Malherbe, All
consultants,
registrars, physicists,
RTTs, nurses,
management and
support staff

28. Ivermectin
• Broad-spectrum antiparasitic drug
• Active against Covid-19 in-vitro (in the laboratory)
• Dose required to inactivate Covid-19 in humans is 9 times the
recommended dose
• Some small studies claim efficacy in the prevention or treatment of mild to
moderate Covid-19
• The 2 largest studies do not show benefit over placebo

29. Ivermectin
• Safe at recommended doses although it can interact with blood thinners
and severe adverse effects like seizures and ataxia have been reported
• Overdose can result in nausea, vomiting, diarrhoea, low blood pressure,
allergic reaction, dizziness, ataxia, seizures, coma and death
• It is not recommended for treatment of Covid-19 by the FDA or WHO
• SAHPRA: There is insufficient scientific evidence to support the use of
Ivermectin in the prevention or treatment of Covid-19

33. Johnson & Johnson Ensemble Study

34. Thank You to my Colleagues
Professor Jeannette
Parkes, Dr Francious
Malherbe, All
consultants,
registrars, physicists,
RTTs, nurses,
management and
support staff