Risk Factors for Non-initiation of the Human Papillomavirus Vaccine among Adolescent Survivors of Childhood Cancer

Klosky, James L.; Russell, Kathryn; Canavera, Kristin; Gammel, Heather L.; Hodges, Jason R.; Foster, Rebecca; Parra, Gilbert R.; Simmons, Jessica L.; Green, Daniel M.; Hudson, Melissa M.

doi:10.1158/1940-6207.capr-13-0127

Cited by 28 publications

(20 citation statements)

References 49 publications

(48 reference statements)

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“…Despite this increased susceptibility, rates of HPV vaccination initiation and completion for adolescent survivors of childhood cancer are slightly lower when compared to controls [25]. Moreover, there is a paucity of research examining factors associated with vaccine uptake and completion among young adult cancer survivors.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

et al. 2015

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Purpose Human papillomavirus (HPV) is a sexually transmitted infection and the cause of cervical and other cancers. Vaccination is available to protect against genital HPV and is recommended for individuals aged 9-26 years. This study aimed to estimate the prevalence of HPV vaccination among childhood cancer survivors and to identify factors associated with vaccine outcomes. Methods Young adult females with (n = 114; M age =21.18 years, SD =2.48) and without (n = 98; M age = 20.65 years, SD = 2.29) a childhood cancer history completed surveys querying HPV vaccination initiation/completion, as well as sociodemographic, medical, and health belief factors. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for vaccine outcomes. Results Among survivors, 38.6% (44/114) and 26.3% (30/114) initiated or completed vaccination compared to 44.9% (44/98) and 28.6% (28/98) among controls, respectively. In the combined survivor/control group, physician recommendation (OR = 11.24, 95% CI, 3.15 – 40.14), and familial HPV communication (OR = 7.28, 95% CI, 1.89 – 28.05) associated with vaccine initiation. Perceptions of vaccine benefit associated with vaccine completion (OR = 10.55, 95% CI, 1.59 – 69.92), whereas perceptions of HPV-related severity associated with non-completion (OR = 0.14, 95% CI, 0.03 – 0.71). Conclusion Despite their increased risk for HPV-related complication, a minority of childhood cancer survivors have initiated or completed HPV vaccination. Modifiable factors associating with vaccine outcomes were identified. Implications HPV vaccination is a useful tool for cancer prevention in survivorship, and interventions to increase vaccine uptake are warranted.

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Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

et al. 2015

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“…Given that a large number of adolescents with CMCs are at increased risk of HPV infection and related complications, 12–17 that many perceive a subspecialist as their main provider, 37–39 and that physician recommendation plays a critical role in HPV vaccine acceptability and uptake, 26,27,49 it is concerning that this study found that half of all pediatric subspecialists surveyed do not routinely recommend HPV vaccination to these patients. This finding may help to explain why many adolescents with CMCs remain under-immunized against HPV.…”

Section: Discussionmentioning

confidence: 87%

“…24,25 Small studies among adolescent cancer survivors have demonstrated low HPV vaccination coverage (32–33% with ≥1 dose; n=66 and n=235). 26,27 Similarly, a recent study found that significantly fewer patients with systemic inflammatory diseases had initiated HPV vaccination than those without these diseases (20.6% vs . 23.1%).…”

Section: Introductionmentioning

confidence: 97%

Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists

Hofstetter

Lappetito

Stockwell

et al. 2017

Journal of Pediatric and Adolescent Gynecology

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Study Objective Many adolescents with chronic medical conditions (CMCs) are at risk of HPV infection, associated complications, and under-immunization and often identify a pediatric subspecialist as their main provider. This study aimed to assess the HPV-related understanding, beliefs, and practices of pediatric subspecialists, which are largely unknown. Design and Setting National cross-sectional study. Participants Pediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile. Interventions Subspecialists caring for adolescents with CMCs in the outpatient setting were recruited to complete a web-based survey examining their HPV-related knowledge, attitudes, comfort, and practices. Main Outcome Measures HPV vaccination recommendation. Results Of respondents (n=418), 50.4% reported sometimes or always recommending HPV vaccination to adolescent patients with CMCs. Factors positively associated with recommendation included hematology/oncology (AOR 4.69, 95% CI 1.86–11.81) or rheumatology (AOR 6.55, 95% CI 1.67–25.74) specialization, seeing more adolescent patients with CMCs (AOR 1.01, 95% CI 1.00–1.02), and sometimes or always discussing sexual health (AOR 2.53, 95% CI 1.05–6.08) or checking vaccine status (AOR 3.83, 95% CI 1.59–9.20) with these patients. Those who thought it was important, but were uncomfortable discussing sexual health when recommending HPV vaccination (AOR 0.28, 95% CI 0.12–0.70) or who reported insufficient HPV vaccine information (AOR 0.45, 95% CI 0.23–0.88) or lack of primary-subspecialty care provider communication (AOR 0.38, 95% CI 0.16–0.93) as barriers to HPV vaccination were less likely to recommend HPV vaccination. Conclusions This study reveals that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.

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“…44 A similar but larger study was performed at St. Jude Children's Research Hospital, and it showed 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. 45 Multivariate logistic regression analyses found vaccine initiation to be associated with older daughter age and physician recommendation of vaccination, whereas mothers who perceived greater barriers to having their daughters receive the HPV vaccine (eg, financial or religious conflicts and concerns about the vaccine promoting sexual activity) were less likely to have initiated vaccination. Among those who initiated vaccination, risk factors for noncompletion included being nonwhite, increased perceived severity of HPV, and increased perceived barriers to vaccination.…”

Section: Vaccine Uptake Amongst Paya Cancer Survivorsmentioning

confidence: 93%

Are we missing an opportunity for cancer prevention? Human papillomavirus vaccination for survivors of pediatric and young adult cancers

Temkin

Seibel

2015

Cancer

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Survivors of pediatric and young adult cancers remain at risk for subsequent diseases, including those related to human papillomavirus (HPV) infection. Prevention of HPV acquisition through vaccination has become possible over the last decade. HPV vaccines have been shown to be safe and effective, yet rates of vaccination among childhood cancer survivors have remained low. Multiple factors, including stronger advocacy for this intervention from providers, could potentially increase vaccination and lead to lower HPV disease burdens for childhood cancer survivors. Health care providers for survivors of pediatric and adolescent cancers should prioritize counseling for HPV vaccination at follow-up visits. Cancer 2015;121:3395-402.

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Risk Factors for Non-initiation of the Human Papillomavirus Vaccine among Adolescent Survivors of Childhood Cancer

Cited by 28 publications

References 49 publications

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists

Are we missing an opportunity for cancer prevention? Human papillomavirus vaccination for survivors of pediatric and young adult cancers

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