News

Effect of Distress, Anxiety, and Depressive Symptoms on SARS-CoV-2 mRNA BNT162b2 Vaccine Efficacy in Cancer Patients
Simple Summary
This study aimed to address an urgent issue: about 20% of cancer patients undergoing treatment do not respond adequately to the standard two-dose COVID-19 vaccination. This highlights the need to identify factors influencing vaccine efficacy in this vulnerable group, including psychological conditions such as distress, anxiety, and depression. The primary objectives were to determine whether these psychological factors, along with clinical variables such as metastatic stage and smoking, influenced antibody response and vaccine activation six months post-vaccination. This study also examined changes in psychological distress over time in relation to gender and education. The results showed that 14.2% of patients did not achieve an antibody response at six months, with high distress and metastatic cancer as significant predictors of non-response (OR = 2.46, p = 0.04). These findings suggest that integrating distress management strategies into oncology care could enhance vaccine response, supporting improved health outcomes for cancer patients.
Abstract
Background/Objectives: Our previous study of 291 cancer patients, we showed that 20% did not respond to two doses of COVID-19 vaccine administered six weeks apart. Methods: Here, we investigated if psychological factors (distress, anxiety, and depressive symptoms) affected antibody response and markers of vaccine activation (D-dimer) after 6 months from initial vaccination. Results: Overall, 31 subjects (14.2%) had no antibody response at 6 months. Our analysis revealed significant predictors of vaccine failure, including the stage of metastatic disease and high-stress levels (OR = 2.46, 95% CI, 1.05–5.77, p = 0.04). Notably, nonresponders showed twice the prevalence of distress than responders (21% vs. 10%, p = 0.04). Longitudinal measurements of IgG levels indicated that participants with high depressive symptoms at baseline maintained lower antibody levels over six months (p = 0.003). In addition, women with high anxiety showed reduced levels of D-dimer at 6 months (p = 0.03). These data also showed that smokers and former smokers had significantly lower antibody levels than their nonsmoking counterparts (p = 0.0004). At baseline, the high discomfort rate (≥5) was 34.4% in women and 23.8% in men; only men experienced an increase in median discomfort during the observation period. Moreover, a higher educational level was related to increased distress among women (p = 0.046). Conclusions: These findings underscore a critical association between elevated psychological distress and reduced immune responses to the COVID-19 vaccine, emphasizing the urgent need for targeted psychological and behavioral support within this vulnerable population.
Keywords: COVID-19 vaccines; immunogenicity; vaccine; neoplasms; psychological distress; depressive disorder; anxiety disorders; C reactive protein; D dimer