Anti-COVID vaccination with priority to those who have to undergo surgery, in particular for oncological disease. This is it request that is launched to the international health authorities, Including Italy, through the dissemination of the results of the largest study ever conducted in the world for the number of patients enrolled. The study evaluated the relationship between surgery and the risk of death from complications from Covid-19, which would be avoided by vaccinating cancer patients before surgery. The study was coordinated by the University of Birmingham, with participation in the Dissemination Committee of the National Cancer Institute of Milan.
“The study shows that vaccinating patients who are candidates for surgery (and among these, of course, cancer patients have a priority as they cannot defer the procedure and have to undergo the more complex surgical procedures on average) is a priority compared to vaccinating the general population, because they are more fragile patients for whom contracting the virus in the perioperative period carries a much higher risk of death. ” – explains Marco Fiore, Oncologist Surgeon of the INT Sarcomas Surgery Service and coordinator of the study for the Cancer Institute. – “Potentially, this could help prevent tens of thousands of post-operative deaths related to the virus. In fact, with the same vaccine doses administered, vaccinating cancer patients who are candidates for surgery can prevent 11 to 131 times more deaths from COVID 19, compared to vaccination of the general population of the same age group. The study showed that among the patients who are candidates for surgery, the population that in particular would benefit most is that of cancer patients, the most fragile, with particular attention to those over 70 who in addition have the highest fatality rate from Covid 19 due to age “.
“Although at the moment there are several vaccines with broad indications and which formally allow to vaccinate even patients with cancer, cancer patients were not recruited or were minimally recruited in the studies on which the approvals of the various Regulatory Agencies were based” – comments Giovanni Apolone, Scientific Director of theNational Cancer Institute from Milan. “We do not know with certainty, at the moment, whether the immunological coverage after vaccination in these patients is the same as that of the general population. These data, therefore, are very important as they begin to fill a knowledge gap, of particular importance as it derives from data from the real world. The next priority is therefore to produce this type of data also in non-surgical patients suffering from oncological diseases who receive anti-cancer therapies that can potentially interfere with the immune response after vaccinations. Many studies have been undertaken, one also at a national level in Italy, in which our Institute is one of the Coordinating Centers ”.
The international team of researchers ‘COVIDSurg Collaborative’ completed a study involving it in record time 141,582 patients from 1,667 hospitals in 116 countries, including, in addition to Italy and the United Kingdom, also Australia, Brazil, China, India, the United Arab Emirates and the United States. Italy participated with 115 Centers, second only to the UK with 205.
Researchers have shown that in patients who are candidates for surgery, preoperative COVID vaccination could prevent over 58,000 infection-related deaths per year. This figure is even more relevant if we consider that during the first wave of the pandemic, around seven out of ten interventions in the world were postponed and that 28 million procedures were delayed or canceled.
The situation was certainly no better by analyzing the Italian data alone. A survey involving 54 reference oncological surgical units in 36 hospitals nationwide showed a reduction of about 1/3 in oncological surgeries during the first 5 weeks from the start of the emergency. This percentage reached about 50% fewer surgical procedures in the most affected region, Lombardy.
“With the intention of pursuing the best possible therapeutic strategy for each individual patient, as SICO we believe it is necessary to reorganize the management of surgical cancer patients based on the creation of efficient oncological networks and, where already present, on their enhancement”, – underlines Alessandro Gronchi, Head of the Sarcoma Surgery Service of the National Cancer Institute of Milan and President of the Italian Society of Oncological Surgery. – “The model we propose is based on a collaborative network such as the Comprehensive Cancer Care Network, adapted to face the state of emergency and the subsequent recovery, but also to improve the ordinary quality standard. Furthermore, with the SICO4Regions project, SICO aims to create region-specific programs, which act on three levels: management of the surgical cancer patient, which we would like to include also pre-surgical anti-COVID vaccination, the creation of a disease registry through the involvement of the OncoTeam SICOs, and assistance in defining priorities and redistributing resources upon exiting the health crisis “.