A total of 329 patients participated to the survey. Median age was 54 years old (SD = 13.4), 78.7% (n = 259) were female. Patients were married in 76.6% (n = 252), 39.2% (n = 129) had university educational level, 30.1% (n = 99) high school. Most patients (88.1%, n = 290) were from north cities of Tunisia. Medical history evaluation showed presence of other comorbidities besides cancer in 36.4% (n = 120). Fifty-nine percent of patients (n = 194) were undergoing chemotherapy and/or radiation therapy. Seventy-one percent of patients were treated in the public sector (n = 234). Only 16.1% (n = 53) received the Influenza Vaccine in the last year, 8% (n = 28) had the COVID-19 in the past months. Patients thought that COVID-19 is a severe disease in 78.1% (n = 257) and 14.9% (n = 49) have lost a loved one because of it. Cancer was considered more dangerous than COVID-19 by 34.3% (n = 113) of patients, 59% (n = 194) thought that COVID-19 is more severe in cancer patients. Forty-five point six percent of patients (n = 150) reported that the pandemic negatively affected their cancer care (Table 1).
Twenty-four percent of patients (n = 79) were registered in the Tunisian vaccine platform (EVAX) and 28.2% (n = 93) did not know about it. All patients knew about the vaccine and 61.4% (n = 202) knew that there are many types of vaccines available. About half of the patients (53.8%, n = 175) reported having confidence in the government, and 77.5% having confidence in their physician.
Among the respondents, 50.5% (n = 166) reported their intent to be vaccinated as soon as the vaccine was available, 28.3% (n = 93) reported to definitely refuse the vaccine, and 21.2% (n = 70) did not make their decision yet. In patients in favor of the vaccination, the reasons of their choice was to protect themselves and their families in 64.1% (n = 211), to protect everyone else in 43.1% (n = 142), and 37.3% (n = 123) would do it to get back to normal life, 35.2% (n = 116) did not give any reason.
In patients who did not support the vaccination, 53.1% (n = 175) did not explain why, 33.1% (n = 109) would not take the vaccine because they fear side effects, 24.9% (n = 82) because they do not believe it is effective, and 3% (n = 10) because the COVID-19 is not such a severe disease that worth a vaccine.
Seventy-one percent (n = 233) of patients agreed that they should keep the freedom to get vaccinated or not, and 31.6% (n = 104) agreed that it is legitimate for the government to mandate the vaccination.
Patients agreed that the vaccine may affect the efficacy of anti-cancer therapy (15.5%, n = 51) while 57.4% (n = 189) did not know if it may have this affect. Patients agreed that it may affect the course of the cancer disease in 10.9% (n = 36), and 61.4% (n = 202) did not know if it could.
Patients were asked about their opinion on several items and responded as follows according to the 5-point Likert scale: 39.5% (n = 130) agreed about the idea that the vaccine is not necessary because COVID-19 is not a severe disease. Forty-three percent (n = 144) of patients reported that not all vaccines were created equal and that they would prefer some types over others. Nineteen point seven percent (n = 65) agreed that the vaccine is not safe, and 40.7% (n = 134) did not know if it is safe or not, 10.5% (n = 32) agreed that the vaccine might change their DNA, and 28.5% (n = 94) agreed that it contains toxic ingredients.
Thirty-three percent (n = 110) agreed that getting COVID-19 will not give a better immunity than that induced by the vaccine and 46.8% (n = 154) did not know what gives better immunity. Thirty-four point eight percent (n = 115) agreed that the vaccine will reduce the contagion but 42.2% (n = 139) did not know if it does. Fifty-two percent (n = 172) agreed that patients with cancer must have the priority to get the vaccine because it is an at-risk condition.
Twenty percent (n = 68) agreed that the vaccine is necessary to end the pandemic.
Thirty-eight percent (n = 127) reported preferring to receive the vaccine after the others to ensure its safety.
Multinomial logistic regression was performed to evaluate predictive factors of vaccine resistance in cancer patients as shown in Fig. 1. High educational level, history of comorbidities, history of influenza vaccination, and patient’s opinion about the severity of COVID-19 did not predict vaccine resistance. However, patients who think that the vaccine may interfere with treatment efficacy (OR = 7.28, 95%CI [2.5–12.32]), or would impact cancer outcome (OR = 6.14, 95%CI [2.27–16.7]), were significantly more likely to refuse the vaccine. Patients who did not agree that the vaccine is a major weapon against the pandemic (OR = 6.07, 95%CI [2.34–9.52]) and that it could reduce the virus transmission (OR = 7.34, 95%CI [4.22–11.81]), and were also significantly more likely to reject the vaccination. Safety concerns were also predictive factors (Fig. 1). Confidence level in the authorities played a significant role is patients’ acceptance of the vaccine; indeed, patients not registered (OR = 5.9, 95%CI [1.58–8.7]) or not informed about the national vaccination platform EVAX (OR = 5.51, 95%CI [2.1–7.9]) were more likely to be against the vaccine.