Coronavirus and cancer – guidance for young people aged 19+

Getting your head around cancer is difficult. Add to that the challenges of coronavirus and suddenly you’ve got a whole lot more guidance to get to grips with. We’ve reviewed the Government advice to help you understand what it means for young adults with cancer.

Last reviewed: 22 December 2021

(Updated information is highlighted in red)

The rapid increase in cases of the new Omicron variant has led to the UK Covid Alert Level being increased from Level 3 to Level 4 as of 12 December 2021. The latest data suggests Omicron is extremely transmissible and will become the dominant variant by mid-December. We understand that this will be causing concern for families with children and young people with cancer. 

Cancer and avoiding infection

Before anyone had ever heard of COVID-19 or terms like ‘shielding’ or ‘extremely clinically vulnerable’, people with cancer whose immune systems were affected (lowered) by cancer treatments always had to take steps to reduce their risks of catching bacterial and viral infections. It continues to be really important to maintain your ‘normal’ cancer care and infection prevention, which is a higher level of infection prevention and awareness than the general public may have.

Following these steps will help you avoid infection:

  • Regular and thorough handwashing
  • Limiting contact with anyone who has obvious signs of infections (such as coughs, colds, diarrhoea and vomiting, fevers, skin infections, chicken pox, measles, or unwell with unknown cause)
  • Maintaining good standards of general health through hygiene, eating a healthy diet, keeping well hydrated and getting enough sleep and exercise
  • Contacting your cancer team for advice if you feel unwell especially if you have a fever
  • Avoiding very crowded places and close contact with non-family members when your blood counts are extremely low (defined by your local cancer team)
  • Considering how to minimise infection risks with sexual partners (ask your clinical team for advice).

And because of the ongoing presence of coronavirus:

  • Follow government recommendations on wearing face coverings, meeting outdoors when possible or in well ventilated indoor spaces, and follow guidance on vaccination and testing
  • Your local hospitals and healthcare providers may continue to have local rules on COVID-19 testing, social distancing, visiting and face coverings. See our #Hand2Hold campaign for information on your rights to visitors
  • You may want to consider asking visitors to your home to wear face coverings or to take a lateral flow test before visiting
  • As a general guide, most people take about 6-12 months to recover a more normal immune system after cancer treatment ends and about 12-24 months after a bone marrow transplant. However, there are individual and treatment related variations, and your cancer team will give you guidance specific to you, including how long you need to take extra precautions for.

As a general guide, most people take about 6-12 months to recover a more normal immune system after cancer treatment ends, and about 12-24 months after a bone marrow transplant. However, there are individual and treatment related variations, and your cancer team will give you guidance specific to you, including how long you need to take extra precautions for.

Government guidance

Advice for young people with cancer

With restrictions lifting across the UK, it can be difficult to know if you should be taking extra precautions. If you’re unsure, make sure you talk to your clinical team – they know your individual circumstances and will advise on what is right for you.

Whether you’re in the clinically extremely vulnerable group or not, if you’re undergoing cancer treatment you are still likely to be advised to take extra precautions to protect you from all types of infections, not just COVID-19. If your immune system is severely affected (lowered) by your cancer treatment your local clinical team may still advise you to avoid crowds, not attend university, college or work, and distance yourself if household members are unwell with things like flu, diarrhoea and vomiting, chickenpox, shingles or cold sores, and certainly if they have any COVID-19 symptoms.

What about the third primary vaccine dose for people over 12 years old?

The JCVI recommends that a third Pfizer BioNTech vaccine dose be offered to individuals aged 12 years and over who had severe immunosuppression at the time of their first or second COVID-19 doses, including those with leukaemia.

These people may not mount a full response to vaccination and therefore may be less protected than the wider population. The third primary dose is an extra ‘top-up’ dose for those who may not have generated a full immune response to the first 2 doses. In contrast, a booster dose is a later dose to extend the duration of protection from the primary course of vaccinations.

The decision on the timing of the third dose should be made by your treating team. As a general guide, the third dose should usually be at least 8 weeks after the second dose but with flexibility to adjust the timing so that, where possible, immunosuppression is at a minimum when the vaccine dose is given.

What about booster vaccine doses for young people over 16 years old?

Those aged 16 years and above will also require a booster dose to extend protection from their primary course. Following the recognition of the Omicron variant in South Africa, JCVI has now advised that a reinforcing dose should be offered from three months after the third dose. Those who have not yet received their third dose may be given their third dose now to avoid further delay. A further booster dose can be given in three months, in line with the clinical advice on optimal timing.

What if I’m undergoing treatment for cancer and have a healthy sibling between 12 and 17 years old? Should the sibling receive the vaccine?

The recommendation is now that all healthy young people aged over 12 years can receive their first dose of COVID-19 vaccine. The JCVI recommends that children and young people aged 12 years and over who are household contacts of people who are immunosuppressed should be offered two doses of Pfizer-BNT162b2 vaccine eight weeks apart.

This is to indirectly protect their immunosuppressed household contacts, who are at higher risk of serious disease from COVID-19 and may not generate a full immune response to vaccination. Healthy siblings of children or young people undergoing treatment for cancer are now eligible to receive the vaccine.

Should adult household contacts of immunosuppressed children and young people receive a booster vaccine?

Yes. All adult household contacts of immunosuppressed individuals should receive a booster vaccine as soon as possible. Following the emergence of the Omicron variant, JCVI have now advised accelerating the booster deployment in order of age and risk status. Reinforcing doses should not be given within three months of completion of the primary course.

Should people 12 years and over who are immunosuppressed receive new treatments (monoclonal antibodies) for COVID-19 infection?

Casirivimab and imdevimab is a neutralising monoclonal antibody (nMAB) combination that binds specifically to two different sites on the spike protein of the SARS-CoV-2 virus particle, blocking its entry into the host cell and therefore inhibiting its replication. This treatment has been recommended following the results of the adult RECOVERY trial that showed this nMAB combination reduced the relative risk of death in hospitalised patients with COVID-19 who had not mounted an antibody response of their own to the virus at the time of treatment.

This treatment has been approved for use for immunocompromised patients over 12 years old who have been hospitalised for the management of acute symptoms of COVID-19 and do not have their own antibodies against SARS-CoV-2.

As evidence to date has shown that most young people with cancer tend to have a mild course of COVID-19, your treating team will decide whether this nMAB treatment is likely to benefit you.  

The casirivimab and imdevimab nMAB combination is not intended to be used as a substitute for vaccination against COVID-19.