(Here is my take on this article Therapeutic Use of Cannabis and Cannabinoids A Review JAMA Network, 11/26/25. On a personal side, I use CBD to help me sleep, and with a little (5%) addition of THC, it is a great anxiety calmer – Sally Torgeson, AnCan Blood Cancer Moderator & Multiple Myeloma Coach)
Unapproved Cannabis
The FDA has NOT approved the cannabis plant (botanical marijuana) for any medical use or indication.
Because it is classified as a Schedule I controlled substance under federal law, the FDA has not found it to be safe or effective for the treatment of any disease or condition [1.1, 1.7].
It is currently illegal to market CBD by adding it to food or labeling it as a dietary supplement in interstate commerce [2.1, 2.5].
FDA-Approved Cannabinoid Drugs
The FDA has approved a small number of prescription drugs containing either a purified cannabis-derived compound or synthetic cannabinoids:
Epidiolex (Cannabidiol or CBD): The only FDA-approved drug that contains a purified substance derived directly from the cannabis plant. It is approved to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and Tuberous Sclerosis Complex in patients one year of age and older [1.8, 2.1].
Marinol and Syndros (Dronabinol): Contain synthetic Δ9-tetrahydrocannabinol (THC). Approved for:
Nausea and vomiting associated with cancer chemotherapy in patients who have not responded to conventional antiemetic treatments [2.2, 2.3].
Anorexia associated with weight loss in patients with HIV/AIDS [2.3].
Cesamet (Nabilone): Contains a synthetic substance that is chemically similar to THC. Approved for chemotherapy-induced nausea and vomiting [1.1, 2.3].
Regulatory Context
The FDA maintains its authority to regulate products containing cannabis or cannabis-derived compounds, even those derived from hemp (cannabis with less than 0.3% THC), under the Federal Food, Drug, and Cosmetic (FD&C) Act [1.4].
The FDA supports the development of new drugs through proper clinical trials to ensure they meet standards for safety and effectiveness [1.1, 2.4].
FDA-Approved Cannabinoid Drugs and Their Conditions
* Nausea and vomiting caused by cancer chemotherapy (when other antiemetics have failed) * Anorexia (loss of appetite) associated with weight loss in patients with HIV/AIDS
Cesamet (Nabilone)
Synthetic cannabinoid (similar to THC)
* Nausea and vomiting caused by cancer chemotherapy (when other antiemetics have failed)
Key Takeaway
Epidiolex is the only drug approved that contains a substance derived directly from the Cannabis plant (CBD). It represents the strongest evidence for cannabinoid efficacy in reducing seizure frequency in certain rare forms of epilepsy [1.1, 1.2].
The synthetic THC compounds (Dronabinol and Nabilone) are used primarily as a last resort for severe nausea/vomiting related to chemotherapy and for appetite stimulation in AIDS patients [1.2, 2.8].
The FDA has not approved the use of the whole cannabis plant for any medical condition, stressing the importance of standardized, tested pharmaceuticals for patient safety and proven effectiveness [1.7].1
Off-Label Use vs. Unapproved Use
1. Off-Label Use (Legal and Regulated)
This applies only to drugs that the FDA has already approved.
What it is: Using an FDA-approved drug (like Epidiolex, Marinol, or Cesamet) for a condition, dose, or patient population that is not specifically listed on the drug’s official label.
Legality: It is legal for a licensed physician to prescribe an approved drug for an off-label use if they believe it is medically appropriate for their patient.
FDA Position: The FDA does not regulate the practice of medicine; however, the manufacturer cannot market or promote the drug for the off-label use. The safety and efficacy for the off-label use have not been verified by the FDA’s rigorous testing process.
Example: A doctor prescribing Marinol (Dronabinol), which is approved for nausea from chemotherapy, to a patient for chronic pain. The drug is approved, but the condition (chronic pain) is not on the label.
2. Unapproved Use (Non-FDA Approved Products)
This applies to the cannabis plant itself and most CBD/cannabinoid products on the market.
What it is: Using the whole cannabis plant (botanical marijuana) or non-FDA-approved cannabis-derived products (like most CBD oils, edibles, or topicals) for any medical purpose.
Legality:
Federal: The whole plant is a Schedule I controlled substance and is not federally approved for any medical use.
State: Use may be legal under state medical or recreational cannabis laws, but this does not change its status as an unapproved drug under federal FDA law.
FDA Position: The FDA considers these products unapproved drugs and/or illegally marketed products (especially when CBD is added to food or marketed as a dietary supplement), as they have not been tested for safety, effectiveness, or quality assurance.
Example: A patient using a CBD tincture (which is not Epidiolex) to treat anxiety, or using THC flower to help with multiple sclerosis symptoms.
To correspond with Sally, please send an email to info@ancan.org, and we’ll be sure to send along.
“Someone I once loved gave me a box of darkness” –Mary Oliver
I was at a 12-Step-oriented workshop about grief recently, and it made me think about Men Speaking Freely (MSF). We are vaguely aware of grief in all MSF groups, it hangs over us, and we have at times focused on some specific griefs/losses, such as vitality, or a longer life. It is commonly thought that not thinking about a loss, not talking about it is the manly thing to do. Here in MSF we get relief by sharing our common losses with each other.
The presenter of that workshop, Marcia C., had some ways to specifically talk about grief that were new to me. She gave me permission to use some of her material here. She pointed out some types of losses that I hadn’t realized. For example, the loss of who I would have been if cancer didn’t happen, the grief of estrangement, loss of work, of status, of friendship; the loss of never having had something, that of aging, of trust, or of giving up something.
She said there is “unacknowledged grief” when such losses are never fully brought to consciousness. When I looked at her long list of examples I saw many that I have. We ought to watch for unacknowledged grief.
She described “non-finite” grief, which has no end-point other than death. Ours could be in that category, since as time goes by our loss increases instead of lessens.
Marcia said, ‘’Sharing your grief is a way to receive validation and compassionate witnessing. It can help you begin a path to healing and/or finding a way to live with grief.
Consider the questions below:
1. Are there griefs you haven’t realized you have or have been afraid to face?
2. Are there griefs about which you’d like to share?
3. Do you have grief practices that might be helpful to others?
4. Make a list of griefs you’ve experienced.
5. Choose a tool from the list that might help you process your grief.”
That list of “tools” was long; it included things like: write a letter or poem describing our loss…Create a ritual of letting go…Share with others who have had similar losses…Visit a place that is meaningful…Make or buy a talisman that helps you feel protected…Dance, run, yell to get your feelings out of your body…Plant something in remembrance or as a new beginning…Start a new tradition…Do an intentional funeral… These are ways to bring acknowledged, unacknowledged, and non-finite grief out for a conscious conversation. Moving from covert to overt, with the goal of making a relationship with the loss, and getting rid of the unconscious silent prolonged scream that I, for example, think I harbor.
We think of grief as emotional, but in “Dealing With the Physical Impact of Intense Grief” by Batya Swift Yasgur, the author describes the variety of physical reactions to grief. Ranging from elevated blood pressure to takotsubo cardiomyopathy — sometimes called “broken heart syndrome” — which is a “stress response that balloons the heart.” We often wonder about the reaction on our immune system, and its implications to our overall survival. In fact, probably nearly all our systems react to grief in some way.
There is a fairly new grief-related diagnosis in the Diagnostic and Statistical Manual and the International Classification of Diseases, describing a “persistent and pervasive grief response” that goes on longer than a year., and is now called Prolonged Grief Disorder. In order to be diagnosed with Prolonged Grief Disorder, a person must experience at least three of eight additional symptoms that include “disbelief, intense emotional pain, feeling of identity confusion, avoidance of reminders of the loss, feelings of numbness, intense loneliness, meaninglessness, or difficulty engaging in ongoing life” according to Columbia University’s Center for Prolonged Grief. For an adult to meet the criteria for a PGD diagnosis, the death of a loved one must have occurred at least one year ago, and the symptoms must be present most days since the loss and nearly every day for at least the last month.
Our situation is different from losing a loved one (although it includes that) and waiting for the grief to go away. Instead of a major loss which goes farther and farther into the past, our major loss is in the future. We have sort of a reverse Prolonged Grief Disorder. For instance, I expect my losses to get worse and worse until death.
Has eating become a challenge due to fatigue or a lack of interest in food? Have you noticed a significant change in your or your loved one’s appearance since starting treatment or diagnosis?
It’s a common misconception that weight loss during cancer treatment is solely due to treatment side effects. While this can certainly be a factor, a more serious condition known as cachexia (kuh·kek·see·uh) can significantly impact a patient’s health.
What is Cachexia and Who is at Risk?
Cachexia, often referred to as cancer cachexia or wasting syndrome, is a complex condition characterized by severe weight loss, muscle wasting, and loss of appetite. It’s not a direct side effect of cancer treatment but rather a consequence of the cancer itself. While it’s commonly associated with cancer, it’s important to note that cachexia can affect individuals with various chronic illnesses, including: Multiple Sclerosis, Sarcoidosis, heart failure, chronic kidney disease, COPD, and more. Certain types of cancer are more likely to lead to cachexia than others. These include: Pancreatic, Lung, Head and Neck, Colorectal, Ovarian, and Liver.
Signs and Symptoms of Cachexia: What Should You Look For?
Recognizing the signs of cachexia is crucial for early intervention and effective management. Here are some key symptoms to watch for:
Unexplained weight loss: A significant and unintentional decrease in weight.
Muscle loss: A noticeable loss of muscle mass, often leading to weakness and fatigue.
Decreased appetite: A reduced desire to eat, even when hungry.
Fatigue: Persistent tiredness and a lack of energy.
Metabolic changes: Alterations in metabolism, including changes in appetite, weight, and energy levels.
Changes in Routine: Unable to do the activities you once could.
If you or a loved one is experiencing these symptoms, it’s important to let your care team know your concerns as soon as possible.
Managing Cachexia
While there’s no one-size-fits-all solution, a multidisciplinary approach can help manage the condition. This may involve:
Dietary interventions: A registered dietitian can provide personalized meal plans to maximize nutrient intake.
Medical treatments: In some cases, medications may be prescribed to stimulate appetite or reduce inflammation.
Supportive care: This includes strategies to manage pain, fatigue, and other symptoms.
Psychological support: Counseling can help address emotional challenges associated with cachexia.
This may mean adding more people to your careteam to support you, such as a dietician (as shown above), physical or occupational therapist, endocrinologist, or palliative care (editors note: we hope you already have a palliative care doctor, AnCan loves them and they can offer you so much support during your treatment!)
Coping with the Emotional Impact
Cachexia can take a significant toll on both physical and emotional well-being for the patient, care-partner, and their families. It’s important to seek support to manage the emotional side effects of the condition. Consider:
Counseling: Individual, couples, or family therapy can provide guidance and coping strategies.
You can also ask your social worker (or for a social worker if you do not have one) for additional resources.
Want to Learn More?
We highly recommend this webpage and fact sheet from our friends at Cancer Support Community / Gilda’s Club. While it is cancer centric, all of the information will be of helpful no matter what your diagnosis is.
By understanding the complexities of cachexia and seeking appropriate support, individuals can significantly improve their quality of life. Effective management of cachexia can help alleviate debilitating symptoms, enhance overall well-being, and improve the ability to participate in daily activities.
Special thanks to CSC for their assistance and incredible resources with this blog post.
A couple of weeks back, we posted Medicare Health Insurance Choices that explained the differences and pitfalls between traditional Medicare Part A and B plus Medigap insurance plans to Part C, Medicare Advantage. Click the link earlier in the previous sentence if you missed it.
As many already know, there is a Part D that covers drug costs. It is either purchased as a separate plan or rolled into Part C Advantage. Drug coverage is significantly changing this year, and AnCan has learnt that many of our participants are not yet aware. Hardly surprising because CMS as well as the various stakeholders like Payers and providers have done very little to let us patients know. Why should they? – we’re only the ultimate consumer!
The same cannot be said of JnJ who started educating patient advocate organizations this past May. In October and November JnJ created more education that includes a webinar and a round table coming up hosted by NAMAPA, the National Association for Medication Access and Patient Advocacy. Likely you have never heard of them. I hadn’t and it hardly rolls off the tongue. Nonetheless, the webinar was very instructive and you can watch it here.
The BIG difference for us patients is that no matter what, out-of-pocket drug costs for 2025 cannot exceed $2000. You heard right – for those of you on specialty oral medications like Nubeqa (darolutamide for prostate cancer) or Aubagio (teriflunomide for MS), normally sourced via specialty pharmacies, you will meet this cap January. And you’ll even be able to spread the payment over 12 months! More on that to follow.
But first, how is this coming about. Well it tracks back tot he changes brought about by the Inflation Reduction Act signed by President Biden in 2022. He promised to make drugs more affordable, and this is a part of the plan. As you can see in the slide to the left comparing 2024 to 2025, the donut hole has been eliminated. In its place, the Payer (Plan Sponsor) and Pharma (manufacturer) are paying more. While the cost saving is very positive, it will likely impact us patients in other ways:
Your formulary choice may be reduced – so CHECK your medications before you renew.
Premiums for Part D may increase – even though out of pocket is capped. If you are unlikely to spend $2,000, look for a plan that defers your co-pay as long as possible
Higher premium plans should cover a larger portion of drug costs earlier. Your premium does NOT count towards the $2,000, so include premiums in your cost calculation to figure your exposure.
If you have a co-pay or co-insurance on your drugs, no matter if it’s Part C or D, it cannot exceed $2,000. However the amount you pay and who you pay it to may become a bit of a moving target. We mentioned earlier that you will now have the opportunity to spread your payments over the calendar year – or the remainder of it, if you sign up late or incur costs late in the year. The Medicare Prescription Payment Plan (M3P) takes your share of drug costs, up to a maximum of $2,000, and spreads them over the remainder of the year.
The simple example is for those on specialty pharmaceutical drugs like Nubeqa or Aubagio. Since your share of the drug cost is almost certainly going to be greater than $2,000 in January, if you opt in for M3P BEFORE going to the pharmacy or ordering from your mail order pharmacy, you’ll pay nothing on picking up/shipping the drugs. Subsequently, you’ll get a separate bill from your Payer for $167.67 monthly over 12 months, and pay no more for any of your drugs the rest of the year. There is NO interest, no late fee penalties, and you get a couple of months leeway, but there are penalties if you never pay. You can sign up for MP3 with your Medicare Payer/Plan Holder BUT not in the pharmacy for 2025. So if you arrive at the drug store prior to enrollment, you’ll be charged $2,000 to take your pills home. You can leave the pills, go home, enroll and return to the pharmacy 24 hours later and pick up without payment to the pharmacy..
If you don’t start this expensive drug until mid year, say September, and you’ve spent nothing on drugs prior, then the $2,000 is billed over the last 4 months at $500/month.
But what if your drug costs are more lumpy – they go up and down the whole year. In that case, the payments get recalculated each month and the monthly bill will vary.
There is a strange case too, if you know your co-pay is the same each month – say $55. This really throws M3P, and as you can see to the left, you’ll pay the same $660 (12x $55) either way but in different amounts each month if enrolled in M3P.
Finally, let’s address the Drug Benefit plans that many of you enjoy through PAN, PAF and others. Even the drug discount cards from Pharma that some receive. Whatever you receive, or however you receive it, does NOT reduce your $2,000 exposure. You advise the pharmacy that you have a benefit, and they bill the Benefit Provider (PAN, PAF, Pharma ??). The credit will be applied against your drug cost, although eventually you may still be liable for up to $2,000 co-pay when the benefit runs out.
Looking at the first slide, it seems to AnCan that these benefits that are often funded by Pharma, eventually flow back to Pharma and the Payer. How they will credit them against what the patient owes is not yet clear. Before you get too crazed, our guess is the system has to change. These benefits need to be channeled directly to patients who cannot afford $2,000 p.a. AnCan is on it and already reaching out to NAMAPA and others to promote more of a direct, income based subsidy possibly reaching more beneficiaries. One thing we have heard – APPLY EARLY for 2025 in the event you are in line to receive a subsidy.
PLEASE BE SURE TO SIGN UP FOR THE M3P PROGRAM UPFRONT. EVEN IF YOU OWE $2,000 IT WILL BE BILLED IN 12 INSTALLMENTS. WE STILLL HAVE TO FIGURE HOW YOU WILL BE REIMBURSED IF YOU RECEIVE ASSISTANCE.
IF YOU HAVE A GRANT BE SURE TO PROVIDE DETALS TO THE PHARMACY ASAP. NOTWITHSTANDING, ALSO REACH OUT TO YOUR GRANTOR TO FIND HOW THEY WANT TO COORDINATE THE GRANT. IT’S STILLL A MOVING TARGET!
Helpful Tips to be Your Own Best Medical Researcher
AnCan asked Mike Wyn, a valued AnCan Frequent Flyer and intrepid researcher, to provide a little navigation to those who are new to research… as well as useful tips for some old hands like myself. I’ve already gathered some research nuggets from Mike’s wisdom… thank you, Mr. W.
Here are a few tips ensure the medical information you are researching is reliable and accurate
Book Research
Check the publication date: authors may need at least a year to write a book, and the average time between a book’s acceptance and its publication is typically between 9 to 12 months. Hence, the data may already be outdated when it hits the shelves
Professional Presentations
Check the credentials, disclaimers, and disclosures of the presenters. Who is the author? What is the sponsoring organization providing the information? Preferred sources are from reputable institutions, such as universities, hospitals, or government health agencies.
Google Web Searches
Use command “site:” to limit you search to top-level domains like .gov, ,org and ,edu. For example, type: latest NCCN guidelines for prostate active surveillance site: .gov OR site: .org OR site: .edu
Be cautious with .com sites unless they are from recognized and credible entities. Medical databases such as PubMed, Cochrane Library, and Google Scholar are good sources for cross-referencing scientific research.
Articles, Online Posts
Check articles, online posts, videos etc. for their sources, including scientific studies, medical journals, or clinical trials. Information from peer-reviewed journals is typically more reliable than content from non-peer-reviewed sources. Poor reviewed means that other people similarly qualified to the author have reviewed teh article adn provided comments.
Anecdotal Evidence
Anecdotal evidence is information that has been observed by the person reporting but not verified. Be skeptical of anecdotal evidence such as personal stories. It is not scientifically reliable. Focus on information supported by scientific evidence and clinical studies. The quality levels of evidence from highest to lowest for medical data are:
Systematic reviews: collect and evaluate all available data/evidence within the researchers’ criteria. An example is the “Cochrane Database of Systematic Reviews”. Meta studies are a systematic review.
Randomized controlled trials: participants are randomly assigned to experimental and control arms. The double-blind trial is the gold-standard of medical research where neither the participants nor the researchers know the placebo or medication/treatment is given. This is to prevent bias and to ensure the validity and reliability of the study.
Cohort observational study: participants with common traits or exposure to the proposed medications or treatments are followed over a long period of time.
Case study or report: a detailed report of result after treatment of an individual. This is formalized and reviewed anecdotal evidence.
Medical Trial Reports
The phases of medical trial studies cited by published medical papers are:
Pre-clinical studies: laboratory experiments using cell cultures, animal or computer models. In vitro means tested In Vitro – literally ‘in glass’ means testing outside a living organism, in a test tube or petri dish, In Vivo – literally in life -means testing in a living organism, often mice. Then studies move on to humans…
Phase I trials: assess safety, dosage and side effects of the proposed medications or treatment.
Phase II trials: expand P 1 to evaluate efficacy of the proposed medications or treatment – how well it works..
Phase III trials: confirm efficacy, safety, dosage and to evaluate side effects of the proposed medications or treatment in much larger samples. This is often where randomized blind and double blind design is used. Blind means the patient does not know what they are getting; double blind means neither the patient nor the clinician know what is being dosed.
Phase IV trials: monitor long term effectiveness and safety of the medication or treatment.
Statistical Terms
Some terms regarding statistical data cited in medical journals are explained as follows:
N = the number of participants: be wary of studies with a very low N.
HR = hazard ratio: HR=1 – there is no change in the proposed medication/treatment compared to control baseline. HR<1 – there is a reduction of risks with the proposed medication/treatment. HR>1 – there is an increase risk with the proposed medication/treatment.
CI = Confidence Interval: A trial shows that a particular drug has a 20% effect within a certain time frame with 95% CI. This shows that the study, if repeated many times, it will be 95% confident that the 20% reduction will be consistently observed.
P-value = Probability Value: This measures how strong the evidence is that the hypothesis, or effect being tested, is correct, rather than the result being random, or incorrect (null hypothesis). We seek a P-value that is <=0.05 meaning that there is a 95% or better likelihood the result is attributable to what is being tested..
Oh it’s not that kind of shot. It’s the other kind of shots, which require some modification for people with cancer. It just
so happens that ASCO (American Society of Clinical Oncology) has come out with new guidelines regarding vaccines for cancer patients.
The guidelines include a recommendation for doctors to take vaccination histories at the start of cancer treatment, followed by provision of recommended vaccines, re-vaccination after cancer treatments that wipe out immunity (for instance stem cell transplant), as well as vaccination of household contacts in order to protect the cancer patient.
We are more vulnerable to infection, because our immune system is injured by chronic inflammation, by the cancers, and by our treatments. Also, we don’t get as good an immune boost from some vaccines as people without cancer do.
If our immune system is “compromised” we can’t take live vaccines at all, and non-live vaccines aren’t as effective. Live vaccines contain weakened but still replicating virus or bacteria. They cause a mild infection in normal people, which triggers an immune
response. But for those of us with a weakened immune system, live vaccines, such as chicken pox/shingles, measles, mumps, oral typhoid, and German measles, can cause a real infection. Non-live vaccines are safe, including the new RNA vaccines. Non-live vaccines for different conditions can be given on the same day.
Here is a summary of recommendations, which I have shortened for prostate cancer:
“Clinicians should determine vaccination status and ensure that adults newly diagnosed with cancer and about to start treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines
Vaccination should ideally precede any planned cancer treatment by 2-4 weeks. However, nonlive vaccines can be administered during or after chemotherapy or immunotherapy, hormonal treatment, radiation, or surgery
Adults with solid and hematologic cancers traveling to an area of risk should follow the CDC standard recommendations for the destination Note. Hepatitis A, intramuscular typhoid vaccine, inactivated polio, hepatitis B, rabies, meningococcal, and nonlive Japanese encephalitis vaccines are safe
It is recommended that all household members and close contacts, where feasible, be up to date on vaccinations “
Here are some specific recommended immunizations for adults with Cancer:
One dose of Tdap, followed by Td or Tdap booster every 10 years
Hepatitis B
19-59 years: eligible 60 years and older: immunize those with other risk factorsc
For adults 20 years and older, use high antigen (40 µg) and administer as a three-dose Recombivax HB series (0, 1, 6 months) or four-dose Engerix-B series (0, 1, 2, 6 months)18
Recombinant zoster vaccine
19 years and older
Two doses at least 4 weeks apart
Pneumococcal vaccine
19 years and older
One dose PCV15 followed by PPSV23 8 weeks later OR One dose PCV20d
HPV
27-45 years: shared decision making
Three doses, 0, 1–2, 6-monthsAbbreviations: HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria and pertussis.
a Live attenuated influenza vaccine, which is administered as a nasal spray, cannot be given to patients with cancer.
bTdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria, and pertussis, is only for children younger than 7 years.
cHIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals.
dPatients who have previously received PCV13 only can receive one dose of PCV 20 after an interval of 1 year.
Abbreviations: HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria and pertussis.
a Live attenuated influenza vaccine, which is administered as a nasal spray, cannot be given to patients with cancer.
bTdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria, and pertussis, is only for children younger than 7 years.
cHIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals.
dPatients who have previously received PCV13 only can receive one dose of PCV 20 after an interval of 1 year.
Now, a few further details about some common shots:
COVID
The COVID-19 vaccines protect patients with cancer, reducing the risk of severe COVID-19 illness and hospitalization. The recommendation is to receive at least one dose of the updated 2023-2024 COVID-19 vaccine. For those on therapies which diminish the immune response, ASCO recommends additional vaccine doses after 2 months. It is recommended to postpone immunization for 2-3 months for individuals who have recently had a COVID-19 infection.
FLU
It is safe to vaccinate during chemotherapy or while white cells are low. But the nasal spray flu vaccine should not be given to patients with cancer.
Pneumonia
Patients with cancer are at higher risk for pneumonia. (Blood cancers 50 times the risk!) Pneumonia vaccines reduce the chances of getting pneumonia and the need for hospitalization.
Shingles
There is a new vaccine called RZV. It is non-live so OK for us. (the previous vaccine, a live attenuated type, is not recommended for patients with cancer.) RZV should be made available to all adults with cancer. This vaccine remains immunogenic even after cancer treatment has begun.
RSV
Patients aged 60 years and older with cancer are eligible to receive the respiratory syncytial virus vaccine.
Our immunity to tetanus, diphtheria, and pertussis weakens as we age, and this decline may be accelerated after cancer treatment. It is strongly recommended that individuals diagnosed with cancer receive the Tdap vaccine if they have not been vaccinated as adults.
Why bother?
“Infections are the second most common cause of non–cancer-related mortality within the first year after a cancer diagnosis, with most of these deaths attributed to influenza and pneumonia, deaths that can be prevented throughimmunization. While patients with cancer have lower immune responses to influenza and pneumococcal vaccines, evidence supports the safety and benefits of vaccinations in reducing the severity of infections and associated hospitalizations.”
Often we will see the term “immunocompromised.” Does this apply to us? This term is not, to my knowledge, precisely defined. For those of us with prostate cancer, it usually means neutrophils (a type of white blood cell) are down below 1000 cells per microliter of blood, and is usually due to our treatments. The immune system is complex, and there are many ways to become “immunocompromised.” Anyone on chemotherapy could be considered to be immunocompromised. .Ask your oncologist if you fit this category, and if you know of a clear generally accepted definition, please write to me.
The authors sum up: “A cancer diagnosis can be overwhelming, and vaccination may not be an immediate priority in the treatment plan. However, numerous studies consistently highlight the best protection when vaccines are administered before starting cancer treatment, emphasizing the need for early vaccination.”
Off-Label Use vs. Unapproved Use
and this is a part of the plan. As you can see in the slide to the left comparing 2024 to 2025, the donut hole has been eliminated. In its place, the Payer (Plan Sponsor) and Pharma (manufacturer) are paying more. While the cost saving is very positive, it will likely impact us patients in other ways:
But what if your drug costs are more lumpy – they go up and down the whole year. In that case, the payments get recalculated each month and the monthly bill will vary.
Oh it’s not that kind of shot. It’s the other kind of shots, which require some modification for people with cancer. It just