Human Papillomavirus Vaccination Rates in Young Cancer Survivors

• Type of Material: Article
• Authors: James L. Klosky, St. Jude Children’s Research Hospital; Melissa M. Hudson, St. Jude Children’s Research Hospital; Yanjun Chen, University of Alabama; James A. Connelly, University of Michigan; Karen Wasilewski-Masker, Emory University; Can-Lan Sun, City of Hope; Liton Francisco, University of Alabama; Laura Gustafson, City of Hope; Kathryn M. Russell, St. Jude Children’s Research Hospital; Gina Sabbatini, St. Jude Children’s Research Hospital; Jessica S. Flynn, St. Jude Children’s Research Hospital; Jocelyn M. York, University of Alabama; Anna R. Giuliano, Moffitt Cancer Center; Leslie L. Robison, St. Jude Children’s Research Hospital; F. Lennie Wong, City of Hope; Smita Bhatia, University of Alabama; Wendy Landier, University of Alabama
• Language: English
• Date: 2017-11-01
• Publisher: American Society of Clinical Oncology
• Publication Version: Final Published Version
• Copyright Statement: © 2017 by American Society of Clinical Oncology
• Final Published Version (URL): http://dx.doi.org/10.1200/JCO.2017.74.1843
• Title of Journal or Parent Work: Journal of Clinical Oncology
• ISSN: 0732-183X
• Volume: 35
• Issue: 31
• Start Page: 3582
• End Page: +
• Grant/Funding Information: Wendy Landier: Research Funding: Merck Sharp & Dohme (Inst); A.R.G. is a member of Merck’s Scientific Advisory Board and Merck’s Global Advisory Board, and her institution has received funds from Merck to conduct research studies unrelated to this research.; Supported by the National Cancer Institute Grant No. R01CA166559 (W.L. and J.L.K.) and supported in part by the Investigator-Initiated Studies Program of Merck Sharp & Dohme (MISP #40083; W.L.) and the American Lebanese Syrian Associated Charities’ support of the Consortium for Pediatric Intervention Research.
• Keywords: HEALTH-BENEFITS; CERVICAL-CANCER; Oncology; ADVISORY-COMMITTEE; AGED 13-17 YEARS; Science & Technology; UNITED-STATES; DECISION-MAKING; MARROW TRANSPLANTATION; Life Sciences & Biomedicine; HPV VACCINE; OF-THE-LITERATURE; IMMUNIZATION PRACTICES ACIP
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

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 Themean age at the time of the studywas 16.36 4.7 years; themean time off therapy was 2.7 6 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-naive 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.