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.

• Authors: James L Klosky, Melissa M Hudson, Yanjun Chen, James A Connelly, Karen Wasilewski-Masker, Can-Lan Sun, Liton Francisco, Laura Gustafson, Kathryn M Russell, Gina Sabbatini, Jessica S Flynn, Jocelyn M York, Anna R Giuliano, Leslie L Robison, F Lennie Wong, Smita Bhatia, Wendy Landier
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 35 Issue 31 Pg. 3582-3590 (11 01 2017) ISSN: 1527-7755 [Electronic] United States
• PMID: 28837404 (Publication Type: Journal Article)

Chemical References

• Papillomavirus Vaccines

Topics

• Adolescent
• Adult
• Child
• Female
• Humans
• Male
• Neoplasms (epidemiology, therapy, virology)
• Papillomavirus Infections (prevention & control)
• Papillomavirus Vaccines (administration & dosage)
• Survivors
• United States (epidemiology)
• Vaccination (statistics & numerical data)
• Young Adult