Missed opportunities for concomitant HPV vaccination among childhood cancer survivors

Abstract

Purpose Childhood cancer survivors are at higher risk of human papillomavirus (HPV)‐related second cancers than adolescents without cancer, yet their HPV vaccination uptake is lower. Using a statewide sample, we evaluated whether survivors are at higher risk of missed opportunities for concomitant HPV vaccination. Methods From statewide healthcare data, we identified encounters where vaccines were received. Concomitant HPV vaccine missed opportunities were defined as a vaccine encounter where the HPV vaccine was not administered, although eligibility criteria were met. From these encounters, our sample included 327 survivors identified from the Utah Cancer Registry, diagnosed 2000–2016 at ages 0–9, and a birth year and sex‐matched sample without cancer from the general population (n = 1,911). Mixed‐effects Poisson regression estimated the rate of concomitant missed opportunities per vaccine encounter and 95% confidence intervals by vaccine encounter type (all vaccines, flu shot only, or adolescent/catch‐up) from 2013 to 2016. Results Survivors had more concomitant HPV vaccine missed opportunities than the population sample (70.0% vs. 59.0%). On average, survivors were 12% more likely to have missed opportunities at vaccine encounters and 4% more likely at flu shot only encounters. The predicted excess risk of concomitant missed opportunities for survivors ranged from 0.5 per10 vaccine encounters to 1.1 per10 vaccine encounters. Higher parental education, rurality, younger first vaccine age, and chemotherapy were associated with missed opportunities. Conclusions Childhood cancer survivors have more missed opportunities for concomitant HPV vaccination than a population sample. As flu shots should be administered annually, providers have a regular opportunity to recommend and deliver the HPV vaccine to survivors.

Identifying Barriers to HPV Vaccination for Patients With Sickle Cell Disease and Childhood Cancer Survivors

“…This finding is echoed in various studies finding suboptimal rates of HPV vaccination amongst AYA cancer survivors. 15,[27][28][29] While there is no published literature on HPV vaccination for patients with SCD, we do note a similar lower rate of influenza vaccinations in patients with SCD. 30,31 In addition, systemic racism has enabled discriminatory practices and policies leading to mistrust in the health care system, impacting decisionmaking regarding medical treatments, including vaccinations, in the African American community.…”

Human papillomavirus vaccination uptake among childhood cancer survivors in Western New York

“…This is of concern given the increased risk of HPVassociated secondary cancers among childhood cancer survivors. 8,13,65 Despite missed opportunities for vaccination within this high-risk group, 27…”

“…25 The HPV vaccine is also not regularly offered to cancer survivors, 26 and this population experiences more missed opportunities for HPV vaccination compared to individuals without a prior cancer. 27 Reasons for this include insufficient HPV vaccine awareness and low perceived importance among oncologists. 26 In addition, the vaccine is normally administered by a primary care provider (PCP) as opposed to an oncologist.…”

“…Moreover, most US states have mandates (e.g., school entry requirements) for Tdap and MCV4 vaccines, whereas HPV vaccine mandates are limited and have met with significant resistance 25 . The HPV vaccine is also not regularly offered to cancer survivors, 26 and this population experiences more missed opportunities for HPV vaccination compared to individuals without a prior cancer 27 . Reasons for this include insufficient HPV vaccine awareness and low perceived importance among oncologists 26 .…”

“…This is of concern given the increased risk of HPV‐associated secondary cancers among childhood cancer survivors 8,13,65 . Despite missed opportunities for vaccination within this high‐risk group, 27 there has been relatively little research into barriers and opportunities for HPV vaccination in pediatric oncological care (e.g., at cancer centers). There may be potential to support HPV vaccine delivery as a component of cancer care, working with survivorship and prevention services at cancer centers.…”