COVID vaccine safe even after previous chemotherapy

DEAR DR. ROACH

» I am over 60. I have some concerns about the COVID-19 vaccine. I was treated back in 2006-07 for breast cancer. Is there anything about COVID or any of the vaccines that could impact me?

— R.I.T.

DEAR READER » I see many questions about the COVID-19 vaccine. Unfortunately, we have no longterm data to guide us, so individual patients and physicians often need to do a risk assessment. That requires a thorough knowledge of a person’s medical conditions. Your own doctor needs to go over your situation.

Even though the body’s immune system mostly recovers after cancer chemotherapy, there are often “holes” in the immune system, making a person more susceptible to certain infections. It is not possible to predict what infections these may be in any given person. Consequently, making sure you are up-to-date with all recommended vaccines is important. You should also call your physician if you experience an infection.

The available COVID-19 vaccines are not live vaccines and are considered safe for people with immune system problems. The only clear reasons not to vaccinate are a history of severe allergic reactions.

My opinion is that it is more important that a person with a history of cancer chemotherapy receive the COVID-19 vaccine.

DEAR DR. ROACH » I am 81 years old and in good health. I am concerned about my GFR level. In 2018 my level dropped below normal at 58.5. In 2019 my level was 54.9, then 39.7, and back up to 58.5 six days later. In 2020 my level was 51.3. The level so far in 2021 is 50.1.

The doctor says she will monitor the level and doesn’t know what caused it to be 39.7. How concerning are my GFR levels, and is it normal for the GFR to fluctuate? Does the amount of water you drink help?

— J.

DEAR READER » All body functions fluctuate. The GFR is a measurement of the kidney function, and uses a measurement of creatinine, a muscle breakdown product, to estimate the kidney’s filtering ability. A temporary increase in creatinine, from not having enough fluids, can make the kidney function appear worse. Drinking more fluid than necessary does not help GFR, and can cause problems in older people by reducing the blood sodium level.

If you plot your values on a chart, it makes it easier to ignore the fluctuations. It appears that you have had only a small decrease in GFR. Kidney function does go down over time, but I think it unlikely you will have problems for at least 10 years.