Are we missing an opportunity for cancer prevention? Human papillomavirus vaccination for survivors of pediatric and young adult cancers

Abstract

Survivors of pediatric and young adult cancers remain at risk for subsequent diseases, including those related to human papillomavirus (HPV) infection. Prevention of HPV acquisition through vaccination has become possible over the last decade. HPV vaccines have been shown to be safe and effective, yet rates of vaccination among childhood cancer survivors have remained low. Multiple factors, including stronger advocacy for this intervention from providers, could potentially increase vaccination and lead to lower HPV disease burdens for childhood cancer survivors. Health care providers for survivors of pediatric and adolescent cancers should prioritize counseling for HPV vaccination at follow-up visits. Cancer 2015;121:3395-402.

The importance of immunization in cancer prevention, treatment, and survivorship

“…A study conducted among patients and maternal caregivers attending a survivor clinic at St. Jude Children's Research Hospital found that 32.6% (75 of 230) of cancer survivors initiated and 17.9% completed the 3‐dose vaccine series, whereas 34.3% (24 of 70) of healthy controls initiated and 20.0% completed the HPV vaccine series . Although these studies suggest that HPV vaccination rates among survivor populations are similar to those in the general population, the prevalence of HPV vaccination in this vulnerable population should be higher …”

“…HPV immunization rates are substantially lower than rates of other childhood and adolescent immunizations. In addition to cost and parental concerns about vaccine safety, barriers to HPV vaccine uptake among adolescents and young adults include the misperceptions among some parents that HPV immunization is not needed for children who are not sexually active and that the receipt of the vaccine might increase promiscuity . Strategies to increase HPV vaccination include reminder/recall systems; practice‐focused interventions targeting staff, clinicians, and parents; assessment and feedback activities; and school‐based HPV vaccination programs …”

“…HPV vaccination is important for pediatric, adolescent, and young adult cancer survivors because of the increased incidence of subsequent HPV‐associated malignancies among long‐term survivors . Survivors with a history of hematopoietic stem cell transplantation, treatment with pelvic irradiation, and other cancer treatments resulting in sustained immunosuppression are at the greatest increased risk for HPV persistence and complications . Analyses of Surveillance, Epidemiology, and End Results data from 1973 to 2010 demonstrated that female pediatric and young adult cancer survivors had a 40% relative excess of HPV‐associated malignancies overall compared with females in the general US population.…”

“…Most children who are undergoing cancer treatment at the age when HPV vaccination is recommended can be vaccinated, because current guidelines recommend administration of nonliving vaccine administration on schedule, even during chemotherapy, if the patient is not severely neutropenic . Additional research is needed to assess the need for boosters in patients who receive vaccinations during periods of immunological compromise.…”

HPV vaccination knowledge, intentions, and practices among caregivers of childhood cancer survivors

“…The over 400,000 survivors of childhood cancer in the U.S. represent a growing population with unique human papillomavirus (HPV)-related health risks. 1,2 Survivors of childhood cancer face a substantial risk of developing second cancers, 3,4 including HPV-related cancers. Nationally, the relative excess of HPV-associated malignancies was 40% among female survivors of childhood cancer and 150% among male survivors compared to the general population.…”