Childhood cancer survivors not getting HPV vaccinations

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Childhood cancer survivors in the US are much less likely to have had human papillomavirus (HPV) vaccinations compared to their peers, despite being at increased risk from the virus, Reuters Health reports according to a new study.

Only 24% of teen and young adult cancer survivors, versus 41% of their age group in the general population, had received the vaccine, researchers found. Not getting a recommendation from a healthcare provider and concerns that the vaccine wouldn’t be covered by insurance were the two biggest predictors of being unvaccinated.

HPV infections are the most common sexually transmitted disease in the US, and several subtypes of the virus are responsible for cancers of the cervix, vagina, penis, tongue, throat and anus, according to the Centres for Disease Control and Prevention. The CDC estimates that 90% of sexually active men and 80% of sexually active women will be infected with HPV at some point in their lives.

A vaccine to prevent HPV infection has been available since 2006 and is recommended for all adolescents, the study team notes. “The HPV vaccine is effective in preventing infection with the cancer-causing types of HPV responsible for the large majority of HPV-related cancers,” senior study author Wendy Landier is quoted in the report as saying.

“Survivors of childhood cancer, particularly those who experienced prolonged suppression of their immune system during cancer treatment, are at increased risk for developing HPV-related cancers, and thus stand to gain particular benefit from initiating and completing the vaccine series,” said Landier, a researcher at the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham’s school of medicine.

The HPV vaccine is recommended by the Children’s Oncology Group (COG) and has been endorsed by many leading health organisations, including the American Society of Clinical Oncology, the American Academy of Paediatrics, the US Centres for Disease Control and Prevention, and all 69 of the National Cancer Institute-designated Cancer Centres, Landier added.

To assess vaccination rates among young cancer survivors, Landier and her colleagues surveyed 982 childhood cancer survivors between the ages of 9 and 26. All the participants were in remission or had completed therapy at least a year before the study.
Researchers asked whether the participant had received the HPV vaccine, and also assessed general knowledge about HPV infection and related health risks, as well as perceived barriers to vaccination.

They found that about 22% of 13-to-17-year-olds reported having received at least one of the recommended three doses of the HPV vaccine, compared to about 43% of their age group in the general public. Just one in four young adult cancer survivors aged 18 to 26 had completed HPV vaccination.

“Only 28% of the survivors in our study reported receiving a recommendation from their healthcare provider regarding the HPV vaccine; of these, over half had been vaccinated,” Landier said. “However, among the remaining 72% of patients who did not report receiving a healthcare provider recommendation for the vaccine, only 1 in 20 had been vaccinated.”

Perceived lack of insurance coverage was another common predictor of lack of vaccination. The odds of being unvaccinated despite the recommendation were over seven times greater for survivors who believed they lacked insurance coverage for the vaccine.

It’s important to know that the HPV vaccine can typically be secured by young people at no or minimal cost, Landier said.

Purpose: Cancer survivors are at high risk for human papillomavirus (HPV)-related morbidities; we estimated the prevalence of HPV vaccine initiation in cancer survivors versus the US population and examined predictors of noninitiation.
Methods: Participants included 982 cancer survivors (9 to 26 years of age; 1 to 5 years postcompletion of therapy); we assessed HPV vaccine initiation, sociodemographic and clinical characteristics, and vaccine-specific health beliefs; age-, sex-, and year-matched US population comparisons were from the National Immunization Survey-Teen and the National Health Interview Survey (2012-2015).
Results: The mean age at the time of the study was 16.3 ± 4.7 years; the mean time off therapy was 2.7 ± 1.2 years; participants were 55% male and 66% non-Hispanic white; 59% had leukemia/lymphoma. Vaccine initiation rates were significantly lower in cancer survivors versus the general population (23.8%; 95% CI, 20.6% to 27.0% v 40.5%; 95% CI, 40.2% to 40.7%; P < .001); survivors were more likely to be HPV vaccine–naïve than general population peers (odds ratio [OR], 1.72; 95% CI, 1.41 to 2.09; P < .001). Initiation in adolescent survivors (ages 13 to 17 years) was 22.0% (95% CI, 17.3% to 26.7%), significantly lower than population peers (42.5%; 95% CI, 42.2% to 42.8%; P < .001). Initiation in young adult survivors and peers (ages 18 to 26 years) was comparably low (25.3%; 95% CI, 20.9% to 29.7% v 24.2%; 95% CI, 23.6% to 24.9%). Predictors of noninitiation included lack of provider recommendation (OR, 10.8; 95% CI, 6.5 to 18.0; P < .001), survivors’ perceived lack of insurance coverage for HPV vaccine (OR, 6.6; 95% CI, 3.9 to 11.0; P < .001), male sex (OR, 2.9; 95% CI, 1.7 to 4.8; P < .001), endorsement of vaccine-related barriers (OR, 2.7; 95% CI, 1.6 to 4.6; P < .001), and younger age (9 to 12 years; OR, 3.7; 95% CI, 1.8-7.6; P < .001; comparison, 13 to 17 years).
Conclusion: HPV vaccine initiation rates in cancer survivors are low. Lack of provider recommendation and barriers to vaccine receipt should be targeted in vaccine promotion efforts.

James L Klosky, Melissa M Hudson, Kathryn M Russell, Gina Sabbatini, Jessica S Flynn, Leslie L Robison, Yanjun Chen, Liton Francisco, Jocelyn M York, Smita Bhatia, Wendy Landier, James A Connelly, Karen Wasilewski-Masker, Can-Lan Sun, Laura Gustafson, F Lennie Wong, Anna R Giuliano

Reuters Health report
Journal of Clinical Oncology abstract

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