Human Papillomavirus Vaccination Rates in Young Cancer Survivors

Abstract

Purpose Cancer survivors are at high risk for human papillomavirus (HPV)-related morbidities; we estimated the prevalence of HPV vaccine initiation in cancer survivors versus the US population and examined predictors of noninitiation. Methods Participants included 982 cancer survivors (9 to 26 years of age; 1 to 5 years postcompletion of therapy); we assessed HPV vaccine initiation, sociodemographic and clinical characteristics, and vaccine-specific health beliefs; age-, sex-, and year-matched US population comparisons were from the National Immunization Survey-Teen and the National Health Interview Survey (2012-2015). Results The mean age at the time of the study was 16.3 ± 4.7 years; the mean time off therapy was 2.7 ± 1.2 years; participants were 55% male and 66% non-Hispanic white; 59% had leukemia/lymphoma. Vaccine initiation rates were significantly lower in cancer survivors versus the general population (23.8%; 95% CI, 20.6% to 27.0% v 40.5%; 95% CI, 40.2% to 40.7%; P < .001); survivors were more likely to be HPV vaccine-naïve than general population peers (odds ratio [OR], 1.72; 95% CI, 1.41 to 2.09; P < .001). Initiation in adolescent survivors (ages 13 to 17 years) was 22.0% (95% CI, 17.3% to 26.7%), significantly lower than population peers (42.5%; 95% CI, 42.2% to 42.8%; P < .001). Initiation in young adult survivors and peers (ages 18 to 26 years) was comparably low (25.3%; 95% CI, 20.9% to 29.7% v 24.2%; 95% CI, 23.6% to 24.9%). Predictors of noninitiation included lack of provider recommendation (OR, 10.8; 95% CI, 6.5 to 18.0; P < .001), survivors' perceived lack of insurance coverage for HPV vaccine (OR, 6.6; 95% CI, 3.9 to 11.0; P < .001), male sex (OR, 2.9; 95% CI, 1.7 to 4.8; P < .001), endorsement of vaccine-related barriers (OR, 2.7; 95% CI, 1.6 to 4.6; P < .001), and younger age (9 to 12 years; OR, 3.7; 95% CI, 1.8-7.6; P < .001; comparison, 13 to 17 years). Conclusion HPV vaccine initiation rates in cancer survivors are low. Lack of provider recommendation and barriers to vaccine receipt should be targeted in vaccine promotion efforts.

Intent and subsequent initiation of human papillomavirus vaccine among young cancer survivors

“…The education level for adolescents (patients 18-19 years old) was categorized as low (less than high school), appropriate (some high school or high school graduate/GED), or exceeds (some college or more). 10 Previously, we reported the relationship between provider recommendation and prior receipt of the HPV vaccine 10 ; in this study, our findings suggest that provider recommendation may play an important role in intent to receive the vaccine. 25 intent subsequently initiated the HPV vaccine during the follow-up period, whereas less than 1 in 5 survivors reporting no vaccine intent initiated the vaccine within the same time period.…”

“…7 For most cancer survivors, vaccinations, including the HPV vaccine, are recommended to be begun 6 months to 1 year after cancer treatment completion. 10 This leaves the majority of young cancer survivors potentially vulnerable to HPV acquisition and subsequent malignancies. 10 This leaves the majority of young cancer survivors potentially vulnerable to HPV acquisition and subsequent malignancies.…”

“…10 Intent to receive the HPV vaccine has been associated with and is predictive of subsequent vaccine initiation in the general population 13 ; however, this relationship has not been explored in cancer survivors. 14 Although provider recommendation has been identified as a critical factor related to HPV vaccine initiation, 11,12 most survivors report not receiving a provider recommendation, 10 and this suggests that survivorship-focused care may not include a discussion of the HPV vaccine. 14 Although provider recommendation has been identified as a critical factor related to HPV vaccine initiation, 11,12 most survivors report not receiving a provider recommendation, 10 and this suggests that survivorship-focused care may not include a discussion of the HPV vaccine.…”

“…Although studies of HPV vaccine initiation among cancer survivors to date have been cross-sectional in design and based on self-report, 10,15,16 state-based immunization registries offer an opportunity to link cross-sectional data with vaccine records to assess HPV vaccine initiation among cancer survivors over time. The primary purpose of this study was to determine the relationship between HPV vaccine intent and subsequent initiation among cancer survivors.…”

“…8,9 Unfortunately, uptake of the vaccine among cancer survivors has remained critically low and below that of the general population; 23.8% of cancer survivors aged 13 to 26 years report 1 or more doses of the vaccine, whereas 40.5% of age-matched peers in the general population do. 10 This leaves the majority of young cancer survivors potentially vulnerable to HPV acquisition and subsequent malignancies.…”