Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration

Abstract

Rates of Human papilloma virus (HPV) vaccination among pediatric survivors of cancer and patients with sickle cell disease are lower than the national average. While recent attention has focused on patient HPV vaccine hesitancy and refusal, less is known about provider-level and system-level barriers to vaccinations in pediatric hematology/oncology (PHO) populations. Applying thematic analysis to qualitative interviews with 20 pediatric hematology/oncology physicians and nurse practitioners, we examine their views regarding HPV vaccination, with a focus on access and barriers to providing HPV vaccination in PHO practices. Results demonstrated that despite 90% of interviewees supporting HPV vaccination in their population, the number of pediatric hematology/oncology providers who reported that they counsel about HPV or provide HPV vaccination was 45%, even in stem cell and sickle cell clinics, where other childhood vaccines are commonly provided. Clinicians identified provider-level, clinic-level, and system-level barriers to giving the HPV vaccination, including but not limited to time/flow constraints, lack of resources, and continued education regarding the HPV vaccine. These barriers impede the ability for pediatric hematology/oncology providers to counsel and provide HPV vaccination to this specialized population.

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

“…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 ].…”

“…Although vaccination is not usually a priority in oncology practices, the oncology care team can play a critical role in recommending HPV vaccination to PYAC survivors since they can effectively discuss vaccine safety concerns following cancer therapy and refer survivors to a PCP who can administer the HPV vaccine [ 68 ]. As with the general population, providers treating PYAC survivors reported beliefs that patients or parents are vaccine-hesitant and about being uncomfortable discussing sexual topics [ 41 , 70 , 71 , 79 ]. However, reports that PYAC survivors are more likely to engage in high-risk sexual behaviors, as described above, highlight the importance of having a conversation about HPV vaccination with PYAC patients early [ 73 , 77 ].…”