The study objective was to identify sociodemographic and coronavirus disease 2019 (COVID-19) factors that are associated with COVID-19 vaccine hesitancy among adolescent and young adult (AYA) cancer survivors. Eligible participants were 18 years or older and were diagnosed with cancer as an AYA (ages 15-39 years) and received services through an AYA cancer program. A total of 342 participants completed a cross-sectional survey. Our primary outcome—COVID-19 vaccine hesitancy—was surveyed as a 5-point Likert scale and operationalized as a binary outcome (agree vs hesitant). A large proportion of participants reported COVID-19 vaccine hesitancy (37.1%). In the multivariable regression, female survivors (odds ratio = 1.81, 95% confidence interval = 1.10 to 2.98) and survivors with a high school education or less (odds ratio = 3.15, 95% confidence interval = 1.41 to 7.04) reported higher odds of vaccine hesitancy compared with their male or college graduate or higher counterparts. COVID-19 vaccine hesitancy persists among AYA survivors despite their recommended priority vaccination status and higher chances of severe COVID-19 outcomes.
Background
For adolescent and young adult (AYA) cancer patients aged 18 to 39 years, health insurance literacy is crucial for an effective use of the health care system. AYAs often face high out-of-pocket costs or have unmet health care needs due to costs. Improving health insurance literacy could help AYAs obtain appropriate and affordable health care. This protocol illustrates a randomized controlled trial testing a virtual health insurance education intervention among AYA patients.
Methods
This is a two-arm multisite randomized controlled trial. A total of 80 AYAs diagnosed with cancer in the Mountain West region will be allocated to either usual navigation care or tailored health insurance education intervention with a patient navigator that includes usual care. All participants will complete a baseline and follow-up survey 5 months apart. The primary outcomes are feasibility (number enrolled and number of sessions completed) and acceptability (5-point scale on survey measuring satisfaction of the intervention). The secondary outcomes are preliminary efficacy measured by the Health Insurance Literacy Measure and the COmprehensive Score for financial Toxicity.
Discussion
This trial makes a timely contribution to test the feasibility and acceptability of a virtual AYA-centered health insurance education program.
Trial registration
ClinicalTrials.gov NCT04448678. Registered on June 26, 2020
Purpose:
We studied the influence of oncology and primary care provider (PCP) recommendations on caregiver intentions to restart vaccines (e.g., catch-up or boosters) after cancer treatment.
Methods:
We surveyed primary caregivers ages 18 or older with a child who had completed cancer treatment 3–36 months prior (N=145) about demographics, child’s vaccination status, and healthcare factors (e.g., provider recommendations, barriers, preferences for vaccination). We compared these factors by caregiver’s intention to restart vaccines (“vaccine intention” vs. “no intent to vaccinate”) using bivariate and multivariable analyses.
Results:
Caregivers were primarily ages 30–39 years (54.9%), mothers (80.6%), college graduates (44.4%), Non-Hispanic (89.2%), and married (88.2%). Overall, 34.5% of caregivers did not know which vaccines their child needed. However, 65.5% of caregivers reported vaccine intention. Fewer caregivers with no intention to vaccinate believed vaccinating their child helps protect others (85.4% vs. 99.0%, p<0.01), that vaccines are needed when diseases are rare (83.7% vs. 100.0%, p<0.01), and that vaccines are safe (80.4% vs. 92.6%, p=0.03) and effective (91.5% vs. 98.9%, p=0.04) compared to vaccine intention caregivers, respectively. Provider recommendations increased caregivers’ likelihood of vaccine intention (oncologist: RR=1.65, 95% CI 1.27–2.12, p<0.01; PCP: RR=1.51, 95% CI 1.19–1.94, p<0.01).
Conclusions:
Provider recommendations positively influence caregivers’ intention to restart vaccines after childhood cancer. Guidelines are needed to support providers in making tailored vaccine recommendations.
Implications for Cancer Survivors:
Timely vaccination after childhood cancer protects patients against vaccine-preventable diseases during survivorship. Caregivers may benefit from discussing restarting vaccinations after cancer with healthcare providers.
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