Ask A Survivor
For the past 300 years, since COVID hit, my usual (and favorite) in-person cancer support group went on hiatus, because an unpredictable disease mixing with immunocompromised people is a terrifying prospect. We’ve recently started meeting, again. And I am incredibly grateful, both because it’s always a treat not to have to focus on my health for an hour a week, and because there’s no better form of trauma processing than helping other folx on their journey (which is my subtle way of saying to my group members, “I love you all, and wish nothing but success and joy for you, but I go largely for what you give me, selfish as that is”). The past few weeks have been dominated not just by the struggles we’ve been forced to face, alone, for the past year, but by the looming presence of COVID surges (bad news, guys; I read a depressing article recently about how most public health experts now believe that herd immunity is going to be beyond the reach of the US). This week marked the initiation of vaccine boosters, so…
Q: Am I immunocompromised? Do I need a COVID booster?
A: Honestly, talk to your medical team. My cancer center recently sent me an e-mail notification that if I was on immunosuppressing drugs (steroids count, people), immunocompromised, or otherwise severely at-risk, come in immediately for a booster. If you aren’t severely immunocompromised, wait eight months since your last vaccination date. Which is all well and good, but pretty much every survivor is told, at some point, that we’re immunocompromised.
I actually have a bit of insight here, as a former EMT and terrible grad student and superb cancer survivor. Way back when I went into chemoradiation, I was told to wear a mask, pretend I was made of glass, stay in an airtight bubble, the whole survivor schtick. However, thanks to some frankness on behalf of my radiation oncologist (this is a survival tip absolutely no one tells you about, but if you take the same informal sort of approach you would take with literally any other profession about which you’re clueless — be it photographer or plumber — physicians tend to meet you in kind, and are a little more frank than they might otherwise be)(whether that’s a good thing or not is entirely dependent upon the individual survivor), I got a somewhat different-but-illuminating answer. She told me to avoid crowds when possible, wash my hands a lot, but not to worry too much. What I now strongly suspect is; all cancer survivors in active treatment are to be considered immunocompromised, because it’s easier to insist that the nurses and radiation techs wear masks and gloves than it is to battle a costly malpractice suit in civil court (another positive aspect about the ultra-casual approach to physicians is, you don’t seem like someone who’d sue them or hold them to their word if their predictions don’t absolutely come true), but, whether or not you’re actually immunosuppressed is very much dependent on an individual case-by-case basis. Which means, you might be minutes from death by the microbes on your cell phone, or you could be fine to perform a safety inspection of a sewage treatment plant in Turkmenistan. It’s a question to ask your medical team, and it’s usually determined by your white blood cell count, so you can just get a blood test if in doubt, and keep in mind, as with all health-related issues; that’s just a snapshot of your blood counts in that instant. I strongly suspect that if were still in treatment (knock on wood), my oncologists would insist I go in for the booster right now, but that’s always between you and your physicians.
So, TLDR; if you are in treatment, you may or may not be immunocompromised, that’s a determination made with each blood draw and check-in. As in any other relationship; communication is key. And oncologists are hesitant to make any firm predictions, so you may have to do some additional research and learn to hear the subtext of each consultation.