The first report on coronavirus disease 2019 (COVID-19) vaccine refusal by patients with solid cancer in Italy: Early data from a single-institute survey


      • High mortality rate related to coronavirus disease 2019 (COVID-19) was observed in patients with cancer.
      • Cancer patients have high priority for COVID-19 vaccination for their vulnerability.
      • A refusal rate of 11.2% was found in our large cohort of eligible cancer patients.
      • Adequate information and clear regulatory decisions are required to promote vaccination.



      Patients with cancer have an increased risk of complications from coronavirus disease 2019 (COVID-19) infection, including death, and thus, they were considered as high-priority subjects for COVID-19 vaccination. We report on the compliance with the COVID-19 vaccine of patients affected by solid tumours.

      Materials and methods

      Patients with cancer afferent to Medical Oncology 1 Unit of Regina Elena National Cancer Institute in Rome were considered eligible for vaccination if they were receiving systemic immunosuppressive antitumor treatment or received it in the last 6 months or having an uncontrolled advanced disease. The Pfizer BNT162b2 vaccine was proposed to all candidates via phone or during a scheduled visit. The reasons for refusal were collected by administrating a 6-item multiple-choice questionnaire.


      From 1st March to 20th March 2021, of 914 eligible patients, 102 refused vaccination (11.2%, 95% confidence interval [CI] 9.1–13.2). The most frequent (>10%) reasons reported were concerns about vaccine-related adverse events (48.1%), negative interaction with concomitant antitumor therapy (26.7%), and the fear of allergic reaction (10.7%). The refusal rate (RR) after 15th March (date of AstraZeneca-AZD1222 suspension) was more than doubled compared with the RR observed before (19.7% versus 8.6%, odds ratio [OR] 2.60, 95% CI 1.69–3.99; P < 0.0001). ECOG-PS 2 was associated with higher RR compared with ECOG-PS 0-1 (OR 2.94, 95% CI 1.04–8.34; P = 0.04). No statistically significant differences in RR according to other clinical characteristics were found.


      Our experience represents the first worldwide report on the adherence of patients with cancer to COVID-19 vaccination and underlines how regulatory decisions and media news spreading could influence the success of the campaign.


      To read this article in full you will need to make a payment


      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kuderer N.M.
        • Choueiri T.K.
        • Shah D.P.
        • et al.
        Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.
        Lancet. 2020; 395: 1907-1918
      1. Agenzia Italiana del Farmaco. COVID-19 vaccines communications. Accessed April 15th, 2021.

        • Barrière J.
        • Gal J.
        • Hoch B.
        • et al.
        Acceptance of SARS-CoV-2 vaccination among French patients with cancer: a cross-sectional survey.
        Ann Oncol. 2021; 32 (773-674)
      2. Open Online. Quanti sono i medici e infermieri No Vax negli ospedali? 35 mila non risultano ancora vaccinati: cosa non torna nelle stime basse dei sindacati Accessed April 15th, 2021.

      3. Corriere della Sera. Vaccini, il sondaggio di Pagnoncelli: italiani ora più cauti, ma il 52% è pronto a farlo subito Accessed April 15th, 2021.

        • Corti C.
        • Crimini E.
        • Tarantino P.
        • Pravettoni G.
        • Eggermont A.M.M.
        • Delaloge S.
        • et al.
        SARS-CoV-2 vaccines for cancer patients: a call to action.
        Eur J Canc. 2021 May; 148: 316-327

      Linked Article