Prevalence and Impact Factors of COVID-19 Vaccination Hesitancy Among Breast Cancer Survivors: A Multicenter Cross-Sectional Study in China

Abstract

Cancer patients are at a high risk of being infected with COVID-19 and have a poor prognosis after infection. Breast cancer is one of the most common cancers. Since vaccination is an effective measure to prevent the spread of COVID-19, we studied the vaccination rate among breast cancer survivors and analyzed their characteristics to provide evidence for boosting the vaccination rate. The researchers conducted a multicenter, cross-sectional study on 747 breast cancer survivors from six hospitals in Wuhan city between June 5, 2021, and June 12, 2021. The self-administrated questionnaires based on relevant studies were distributed. The researchers then compared differences in characteristics among vaccinated patients, hesitant patients, and non-vaccinated patients. Moreover, they performed univariable and multivariable logistic regression analyses to identify potential factors associated with vaccination hesitancy. The researchers assessed a total of 744 breast cancer survivors −94 cases in the vaccinated group, 103 in the planning group, 295 in the hesitancy group, and 252 in the refusal group. The vaccination rate was 12.63% (95% CI 10.25–15.02%) and 37.23% (95% CI 27.48–47.82%) patients reported adverse reactions. The vaccination hesitancy/refusal rate was 73.52% (95% CI 70.19–76.66%), which was independently associated with current endocrine or targeted therapy (odds ratio [OR] = 1.52, 95% CI 1.03–2.24), no notification from communities or units (OR = 2.46, 95% CI 1.69–3.59) and self-perceived feel (general vs. good, OR = 1.46, 95% CI 1.01–2.13; bad vs. good, OR = 4.75, 95% CI 1.85–12.16). In the hesitancy/refusal group, the primary reason was “I did not know who to ask whether I can get vaccinated” (46.07%), the person who would most influence decisions of patients was the doctor in charge of treatment (35.83%). Effective interaction between doctors and patients, simple and consistent practical guidelines on vaccination, and timely and positive information from authoritative media could combat misinformation and greatly reduce vaccine hesitancy among breast cancer survivors.

Adherence to Sars-CoV2 vaccination in hematological patients

“…Only 53.7% reported their intent to be vaccinated as soon as the vaccine becomes available, 29.7% considered they were not ready yet but likely to change their mind and 16.6% definitely refused vaccination (9). Later surveys of cancer patients conducted in 2021 also assessed patient attitudes towards vaccination and reported hesitancy or refusal rates ranging from only 6% refusal to 74% hesitancy/refusal at various periods and in various countries (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Besides the large survey of patients with blood cancers already discussed (5), very few surveys specifically analyzed hematologic patients such as patients (n=147) with sickle cell anemia (23) or parents of children (n=113) undergoing hematopoietic transplantation (24).…”

Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population

“…This concern is further amplified if a patient with COVID-19 is not only unvaccinated but also has comorbidities such as cancer, predisposing them to higher risk of morbidity and mortality. COVID-19 vaccine hesitancy has been studied previously in cancer patients worldwide [ 25 , 26 , 27 , 28 , 29 , 30 , 32 , 39 , 40 , 41 , 42 , 43 , 44 ] and in the United States [ 31 , 33 , 35 , 36 , 45 ], including multiple studies of ethnic minorities in the US [ 21 , 22 , 23 , 24 , 46 , 47 , 48 , 49 , 50 , 51 ], but no known research exists specifically examining ethnic minority cancer patients and their views on the COVID-19 vaccine. This study helps address this gap in the knowledge by uniquely examining two different time-points of vaccination status 6-months post-initial survey, employing a vaccine knowledge score composite and exploring a brief educational intervention to raise patients’ awareness, to gain valuable insight into this distinctly disadvantaged population in the US.…”

“…Additionally, a positive predictor of vaccination uptake as seen previously was having access to information about COVID-19 vaccines [ 26 , 33 , 44 ], and trusting medical advice on vaccination [ 29 , 35 , 39 ]. Yet, only 60% trusted the information they had received, reflecting wide prior research [ 25 , 27 , 28 , 29 , 33 , 43 , 45 ], and highlighting concerns around the need to acquire more information [ 21 , 46 , 47 , 49 , 50 , 51 ]. These results present another avenue where increased awareness of the issue can help alleviate this problem, and suggest that a focus on correcting misinformation may help increase vaccination rates.…”

“…Previous studies surveying cancer patients were conducted mainly during December 2020–February 2021 when the vaccines were not widely available, in predominantly non-Hispanic White patient populations or in countries other than the United States (US) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. In these studies, overall, the main factors of increased hesitancy included similar reasons such as safety, side effects, process of development, lower education level, history of prior COVID-19, conservative political leaning, mistrust in health care systems, belief COVID is not harmful, and younger age [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

Cancer Patients and the COVID-19 Vaccines: Considerations and Challenges

“…A general distrust in the country’s healthcare system and its ability to effectively rollout a vaccination program has also been associated with vaccine hesitancy [ 96 ]. A study conducted in China that included 744 breast cancer survivors revealed that vaccine hesitancy or refusal was expressed by over 73% of the respondents [ 97 ]. The primary reason for hesitancy or refusal in 46% of patients was the lack of knowledge about the safety of the vaccines for cancer patients.…”