The power of support groups in addressing vaccine hesitancy among patients with cancer in the Philippines

Dear Editor,

In a recent article published in this journal, the authors interestingly shared the result of their survey about the frequency of vaccine hesitancy among patients with advanced cancer. They concluded that vaccine hesitancy is present among patients with advanced cancer, and the high value given to the doctor’s recommendation suggests that universal precautions regarding vaccine recommendation may be an effective intervention (Tang et al. 2023). This paper is indeed helpful since patients with cancer are in a dilemma and need a lot of appropriate advice about the vaccine’s efficacy and safety due to their comorbid conditions. With this, aside from doctor’s recommendation, I will highlight another intervention that can address the problem of hesitancy for this population – support groups. I will contextualize my proposal using the Philippine setting during the COVID-19 pandemic.

A series of nationwide surveys show that many Filipinos are hesitant to receive COVID-19 vaccines, with almost half of Filipinos not willing or unsure whether they should be vaccinated. The level of hesitancy is higher in the Philippines compared with other countries in the region. The reasons for this hesitancy include lack of information about vaccines, misinformation about their efficacy or side effects, mistrust, and underestimation of benefits compared to overestimation of risks and costs of vaccination (Cho et al. 2021). Among the immunocompromised, patients with cancer are included in this vaccine hesitancy. According to experts, a patient with cancer may be moderately or severely immunocompromised under the following situations: currently receiving treatment for cancer, had an organ transplant and are taking medicine to suppress the immune system, had Chimeric Antigen Receptor (CAR) T-cell therapy or a stem cell transplant within the last 2 years, are taking high-dose corticosteroids or other drugs that may suppress the immune system, have a moderate or severe primary immunodeficiency syndrome, and have advanced or untreated HIV infection (National Cancer Institute 2023). It is important to note that people with certain cancers may have a weaker response to COVID-19 vaccines than people whose immune systems are not compromised.

Is it really needed for patients with cancer to get vaccinated with the COVID-19 vaccine? The Philippine Society of Medical Oncology strongly recommends that patients with cancer be vaccinated against SARS-CoV-2, the causative agent behind COVID-19. This recommendation is aligned with guidance from international and national professional organizations and government agencies that have a stake in the care of people living with cancer. Although vaccine effectiveness may be lower among patients who may be immunocompromised because of cancer or its therapy, vaccination can still reduce hospitalizations and deaths from COVID 19 (Philippine Society of Medical Oncology 2021). Even with the availability of different COVID-19 vaccine brands, some patients are still confused and afraid to decide to get vaccinated due to the reasons mentioned above.

What can be done to lessen, if not totally eradicate, vaccine hesitancy among patients with cancer? In the Philippines, support groups can be a powerful force in helping patients to decide getting vaccinated. Among such groups include Akbay Inc., Amuma Cancer Support Group Foundation, Inc., Alay Kapwa Kilusang Pankalusugan (AKAP), Alabang Cancer Support Group, Breast Cancer Society of Manila, Inc., Touched by Max, Inc., Breast Friends-East Avenue Medical Center, CanSurvive, Cradle of Hope Cancer Support Group, Project Pink, Petals of Hope, ICanServe Foundation, and many others. Studies have shown that participation in support groups makes patients feel less isolated and improve the perception of their condition. It is useful to talk to other people with the same condition (Magnani et al. 2017). These groups can be an avenue for people to share common concerns like making health decisions, which include medication/vaccination, rehabilitation, therapy, etc. Since these support groups understand what is going through with the patient, the fears, worries, joys, and all other sentiments, the value of trust is gradually established. High levels of trust have been associated with many benefits, including a perception of better care, greater acceptance to recommended treatment and adherence to that treatment, lower anxiety in relation to any treatment taken, and reportedly facilitating access to health service (Allinson and Chaar 2016). Having trust is tantamount to accepting what the group believe as beneficial. This is where vaccine acceptance can be proposed, explaining all its benefits that outweigh the adverse effects. In the end, if the doctor’s recommendation is coupled with the encouragement from support groups, there will be a bigger chance to lessen if not totally end vaccine hesitancy.