Medical and sociodemographic factors associated with human papillomavirus (HPV) vaccination adherence among female survivors of childhood cancer

Abstract

Background Among those 9-26 years of age, vaccination can prevent specific types of genital human papillomavirus (HPV), the most common sexually transmitted infection and cause of cervical and other cancers. The objective of this study was to estimate the prevalence of and factors associated with HPV vaccine initiation and completion among females surviving childhood cancer. Procedure One-hundred fourteen young adults and 230 mothers with daughters surviving childhood cancer completed surveys querying HPV vaccination history along with medical and sociodemographic factors potentially associated with vaccination outcomes. Vaccination rate differences by age necessitated analysis of outcomes by age group: 9-13 years (preadolescents), 14-17 years (adolescents), and 18-26 years (young adults). Multivariable logistic regression was utilized to identify factors associated with HPV vaccination outcomes. Results Overall, 34.6% (119/344) of survivors initiated and 20.9% (72/344) completed HPV vaccination. Preadolescents were least likely to have initiated vaccination (P<0.001). Physician recommendation was associated with initiation across age groups (OR=6.81–11.96, Ps<0.001-.01), whereas older age at diagnosis (≥12 years of age) was associated with lower vaccination initiation among young adults only (OR=0.28; 95% CI, 0.10–0.76, P=0.012). Physician recommendation (OR=7.54; 95% CI, 1.19–47.69, P=0.032; adolescent group) and greater treatment intensity (OR=5.25; 95% CI, 1.00–27.61, P=0.050; young adult group) were associated with vaccine completion, whereas being non-White was associated with decreased vaccination completion (OR=0.17; 95% CI, 0.05–0.66, P=0.010; adolescent group). Conclusions A minority of youths surviving childhood cancer have initiated or completed HPV vaccination. Strategies to increase vaccination among survivors are discussed.

Provider communication about HPV vaccination: A systematic review

“…16,19,61 Among studies focusing on young adult patients, provider recommendations declined slightly in frequency for patients in their twenties. 35,41,56,62 Two studies suggested that a minority of providers continued to recommend HPV vaccine for older adults, ages 27 and over, who fell outside of the recommended age range for catch up vaccination. 52,63 Provider communication was consistently associated with patients' sex such that providers' recommendation intentions and behavior were more supportive of HPV vaccination for girls versus boys.…”

Human Papillomavirus Vaccine Is Crucial for Adolescent and Young Adult Cancer Survivors

“…Vaccine uptake has been examined through observational studies in two cohorts of female cancer survivors. [14][15][16] These studies demonstrate low HPV vaccine initiation rates in female cancer survivors, ranging from 36% to 45% in adolescents 15,16 to 39% in young adults. 14 Discussion of the vaccine with a healthcare provider and receiving a physician recommendation for the vaccine were identified as consistent predictors of vaccine initiation among AYA female survivors in these studies.…”

“…14 Discussion of the vaccine with a healthcare provider and receiving a physician recommendation for the vaccine were identified as consistent predictors of vaccine initiation among AYA female survivors in these studies. [14][15][16] To our knowledge, no studies of male survivors or interventions to increase HPV vaccination in cancer survivors have been published to date.…”

The importance of immunization in cancer prevention, treatment, and survivorship

“…A survey of parents of female cancer survivors 5 or more years after their diagnosis and 2 or more years after therapy (age range, 11‐18 years) at Texas Children's Hospital found that that 32% of cancer survivors had initiated the 3‐dose series . A study conducted among patients and maternal caregivers attending a survivor clinic at St. Jude Children's Research Hospital found that 32.6% (75 of 230) of cancer survivors initiated and 17.9% completed the 3‐dose vaccine series, whereas 34.3% (24 of 70) of healthy controls initiated and 20.0% completed the HPV vaccine series . Although these studies suggest that HPV vaccination rates among survivor populations are similar to those in the general population, the prevalence of HPV vaccination in this vulnerable population should be higher …”