Examining the Barriers and Opportunities for Human Papillomavirus Vaccine Delivery in Cancer Care Settings: A Mixed-Methods Study

Abstract

While pediatric, adolescent, and young adult (PAYA) cancer survivors are at increased risks for secondary cancers, their HPV vaccine uptake rates are poor. Therefore, we conducted a mixed-methods study to identify the barriers and opportunities for HPV vaccine delivery among PAYA cancer care providers. We distributed a semi-structured questionnaire to a professional organization comprised of PAYA oncology and hematology healthcare providers between April-July 2022. Questionnaire measures included demographic and practice characteristics, HPV vaccine knowledge, willingness, barriers, opportunities, and roles for HPV vaccine delivery. Descriptive characteristics were generated for quantitative data, and content analysis was used to identify themes. A total of 49 providers responded to our survey. A majority were female (68%) and non-Hispanic white (74%). Approximately 76% were oncology or hematology physicians, and most worked in a cancer center or children’s hospital (86%). Over half (63%) had been practicing for >15 years, and a majority saw patients ages 11-17. Although less than half reported discussing HPV vaccination with their patients, 69% were willing to become involved in HPV vaccine delivery. The most frequently reported barriers identified in our content analysis were related to system-level factors. Furthermore, providers identified opportunities within cancer prevention education, transitions in care, and at the system-level. Although barriers to HPV vaccination persist in cancer care, most providers perceived there to be opportunities to become involved in HPV vaccine delivery. Identifying strategies for PAYA oncology and hematology healthcare providers to adopt a stronger role in HPV vaccination remains a significant opportunity for future implementation research.

Human Papillomavirus Vaccination in Pediatric, Adolescent, and Young Adult Cancer Survivors—Opportunity to Address Gaps in Cancer Prevention and Survivorship

“…Many of the patient-/caregiver-reported and clinician-reported barriers to HPV vaccination for the general population [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] overlap with those reported for PYAC survivors [ 41 , 42 , 68 , 69 , 70 , 71 ], whereas some barriers are unique to the PYAC survivor population ( Table 1 ). For instance, PYAC survivors and their caregivers reported concerns about the safety, side effects, and applicability of the HPV vaccine in relation to their cancer history and survivorship [ 41 , 68 , 72 ]. Cherven et al discovered that cancer survivors exhibited a higher tendency to decline participation in an open-label trial investigating the immunogenicity and safety of the HPV vaccine due to concerns regarding its safety [ 72 ].…”

“…Clinicians caring for PYAC survivors reported the following barriers to HPV vaccination: (a) uncertainty regarding which type of provider is responsible for administering vaccines (e.g., PCP versus oncologist); (b) lack of communication between PCPs and oncologists regarding cancer diagnosis, treatment, and follow-up care; and (c) unclear guidelines for administering the HPV vaccine to cancer survivors [ 41 , 70 , 71 ]. In one study, only 30% of PCPs felt confident in their knowledge about immunizations for childhood cancer survivors, which is concerning because PCPs may be missing opportunities for immunizing this vulnerable population [ 78 ].…”

“…In one study, only 30% of PCPs felt confident in their knowledge about immunizations for childhood cancer survivors, which is concerning because PCPs may be missing opportunities for immunizing this vulnerable population [ 78 ]. Clinicians also reported concerns about vaccine safety, costs associated with providing the vaccine or low reimbursement rates, and beliefs that the HPV vaccine is less important than other vaccines [ 41 , 70 , 79 , 80 ]. Oncologists also report feeling overburdened by busy clinic schedules and difficulties in adjusting the workflow in oncology practice to be able to administer the HPV vaccine [ 41 , 70 ].…”

“…Clinicians also reported concerns about vaccine safety, costs associated with providing the vaccine or low reimbursement rates, and beliefs that the HPV vaccine is less important than other vaccines [ 41 , 70 , 79 , 80 ]. Oncologists also report feeling overburdened by busy clinic schedules and difficulties in adjusting the workflow in oncology practice to be able to administer the HPV vaccine [ 41 , 70 ].…”

“…This further emphasizes the need for improving HPV vaccination rates among PYAC survivors, including the potential need for booster doses if initial doses were received before cancer therapy [ 37 , 38 , 39 , 40 ]. Whereas pediatric oncology providers endorse the HPV vaccination of young cancer survivors, many lack the resources or opportunities to intervene [ 41 ]. The responsibility of the HPV vaccination of PYAC survivors, therefore, falls to primary care providers (PCPs), but remains suboptimal, as reflected by the low vaccination rates [ 23 , 31 , 32 , 33 ].…”