Certificate requirement makes it difficult for cancer patients to get vaccinated

Certificate requirement makes it difficult for cancer patients to get vaccinated
Certificate requirement makes it difficult for cancer patients to get vaccinated
Vaccination against Covid-19 (Photo: Rosa Ravena / Agência Brasil)
By Cláudia Collucci, from Folhapress

SÃO PAULO – The requirement for a medical certificate is hampering the access of cancer patients to immunization against Covid-19 despite being in the age group indicated to receive the vaccine.

The alert is from entities that support cancer patients. The obligation is contained in the National Plan for the Operationalization of the Vaccine Against Covid-19 of the Ministry of Health.

For the entities, the requirement is unnecessary and constitutes a barrier to the SUS patient, who have difficulty accessing their doctor. In addition, it forces patients to travel to hospitals in search of the certificate, often more than once, exposing them to risks of infection with the coronavirus.

Femama (a federation that brings together more than 70 NGOs to support breast health) sent a letter to the ministry asking for the immediate suspension of the measure, but did not obtain a return.

In the document, the entity says that there is no different risk observed when immunizing people with a history of cancer and that all available vaccines are safe and effective, including for cancer patients.

“Infectologists are adamant: vaccines do not use the live virus and, therefore, do not cause the disease under any circumstances. They can be administered to all immunocompromised patients with peace of mind ”, says mastologist Maira Caleffi, president of Femama.

The doctor says that no other country has demanded the certificate. “Millions of people with cancer have already been vaccinated in the world, and the safety of the vaccine is more than established. There is no reason to continue with this requirement ”, she says.

In his opinion, the measure increases health disparities. “Patients in the private health system can obtain a medical certificate much more easily, while SUS users do not have direct contact with the health professional who accompanies them”.

Caleffi recalls that many may have to wait months for a new consultation to request the document.

The cases of retired women Maria Aparecida, 84, from Porto Alegre (RS), and Maria José, 78, from São Paulo (SP), illustrate the scenario well. Both are undergoing breast cancer treatment and only learned at the vaccination post that they needed a medical certificate to receive the vaccine.

Maria Aparecida was in the family car and was taken to the private hospital where she is undergoing treatment. His doctor was not, but the assistant pulled out his electronic medical record and handed it to him on the certificate authorizing the vaccination. An hour later, she was already being vaccinated.

Maria José, on the other hand, arrived with her daughter by bus at the Anhembi Exhibition Center. Upon learning of the requirement, they did not know what to do. “I had no credit on my cell phone. We had to go home, ”says daughter Lucia Helena.

The next day, still without her cell phone, she went to the clinic where her mother had chemotherapy at SUS until last month, but the doctor was already gone. It was only two days later that she managed to get the document and her mother was finally able to be vaccinated.

In the opinion of psychologist Luciana Holtz, from the Oncoguia Institute, it is worrying to see cancer patients, within the age allowed for immunization, facing barriers to taking the vaccine.

“If the technicians are unsure, we need a technical note from the Ministry of Health’s Surveillance Secretariat to clarify this”.

In the opinion of oncologist Drauzio Varella, although it is recommended that the patient consult their doctor before vaccination, the requirement for a medical certificate does not make sense because it can, in fact, hinder access to the vaccine.

“Lymphoma-type cancers or leukemias are associated with an immunological deficiency, so in these patients the vaccine may be contraindicated, but in the case of solid tumors, such as stomach, head and neck and intestine tumors, there is, in general, no this problem”.

The vaccination plan itself says that, although the efficacy and safety of vaccines against Covid-19 have not been evaluated in the population of cancer patients, considering the available vaccine platforms (non-replicating viral vector and inactivated virus) it is unlikely to exist increased risk of adverse events.

Even so, the text recommends that the risk-benefit assessment and the decision regarding vaccination or not should be made by the patient in conjunction with the doctor, “and vaccination should only be carried out with a medical prescription”. The ministry did not respond to Folha’s question about whether or not it intends to change the requirement.

For oncologist Bruno Ferrari, from the Oncoclínicas group, it is important that the patient has the approval of the oncologist who accompanies him. He does not see the requirement as a limiting factor to access, even in SUS.

“It has been very frequent to provide the certificate. No one better than the doctor himself to clear any doubts from the patient. But, of course, faced with an impossibility [de acesso ao médico], it is safer to get the vaccine than not to get it ”.

For Maira Caleffi, instead of requiring the certificate, the Ministry of Health should facilitate access, giving priority to cancer patients in vaccination. Those with metastatic cancer, using oral drugs, who are undergoing chemotherapy and radiotherapy, who have finished treatment in the past six months and who are scheduled surgeries would be the priority candidates.

The doctor recalls that the suspension of elective procedures because of the pandemic has ruled out cancer patients being monitored and those with suspected cancer. “This increased the possibility of more advanced tumors due to a lack of early diagnosis.”

For Ferrari, the drop in diagnostic tests for cancer will have a major impact on the health system. “With more advanced cases, the cost of treatment is higher and the chances of a cure also decrease a lot”. He is the author of a study that identified an increased risk of death for a cancer patient infected with Covid-19.

When it is time for vaccination of priority groups of patients with comorbidities, such as cancer, it will be necessary to prove the disease at the time of vaccination, by means of a prescription, a cancer center card or a doctor’s statement.

“All cancer patients should be anticipated and, in the next consultation with the professional who accompanies them, already request a medical certificate or any other document that proves their situation”, guides Caleffi.

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