Survivors of childhood cancer have significantly lower rates of vaccination against human papillomavirus (HPV) as compared with the general population.
New findings that show that 24% of age-eligible (up to 26 years) cancer survivors have been vaccinated vs 40% of peers without a cancer history.
The greatest difference in vaccination rates was observed among adolescents aged 13 to 17 years: 22% for cancer survivors vs 42% for teens in the general population. But vaccination rates were similar among older teens/young adults aged 18 to 26 years: 25% for survivors vs 24% for the general population.
Importantly, the authors note, the most significant barrier to vaccination was physician communication.
About three quarters of survivors said that their physician had not recommended the vaccine, and of this group, only 5% had received it.
In contrast, among the 28% of the survivors who reported that their clinician had recommended the vaccine, about half were vaccinated.
“The lack of a physician recommendation had a more robust effect among survivors than is typical for the general population,” said first author, James Klosky, PhD, ABPP, an associate member at St. Jude Children’s Research Hospital in Memphis, Tennessee.
“As clinicians, we need to initiate more conversations about HPV vaccination, especially with childhood cancer survivors because they stand to benefit even more than their peers,” said Dr Klosky in a statement.
The study was published online August 24 in the Journal of Clinical Oncology.
Slow Uptake in the United States
As previously reported by Medscape Medical News, many physicians are not recommending the HPV vaccination or are doing so inconsistently or behind schedule.
Some clinicians report a reluctance to discuss a vaccine that prevents a sexually transmitted disease with the parents of young children, according to a recent Medscape survey that included more than 1500 clinicians. Others responded to parents’ concerns about potential side effects and questioned whether the risks of the vaccine outweigh the benefit.
Clinicians also had their own concerns about the vaccine’s safety, with about a third reporting to be “somewhat to extremely” concerned.
Uptake of the vaccine in the United States also remains low, with only 40% of girls and 21% of boys receiving the recommended three doses, according to a 2015 report from the Centers for Disease Control and Prevention. These rates fall quite short of the goal of 80% by the end of this decade set forth by the US Department of Health and Human Service’s Healthy People 2020 mission.
Survivors Lag Behind Peers
In the current paper, the authors point out that childhood cancer survivors are particularly susceptible to HPV infection because cancer treatment can result in prolonged immunosuppression.
Vaccine uptake in childhood cancer survivors was compared with that of the general US population, and the authors sought to identify factors that were associated with nonitiation of HPV vaccine.
The cohort included 982 childhood cancer survivors aged 9 to 26 years who had completed cancer treatment between 1 and 5 years before the survey. More than half of the participants (59%) had been treated for leukemia or lymphoma.
Comparisons with the general population were made by using age-matched individuals from the National Immunization Survey-Teen and the National Health Interview Survey (2012 to 2015).
For the youngest subgroup, the prevalence of vaccine initiation among 9- to 12-year-old survivors was 5.9% but was nearly double among girls (8.0%) compared with boys (4.2%). A comparative population for this age group was not available.
Stratification by sex for the 13- to 17-year-olds showed a higher intake for females vs males but lower for cancer survivors vs the comparison group: females, 32.6% vs 51.9% (P < 001); males, 14.0% vs 33.8% (P < .001).
But for the older group aged 18 to 26 years, initiation rates among female survivors were higher than in the general population (45.7% vs 38.2%; P = .04) yet similar among males (7.5% vs 8.3%; P = .7).
Risk Factors Affecting Vaccine Decision
Dr Klosky and his team also looked at factors that may have influenced the decision to receive HPV vaccination.
After adjustment for confounders, including cancer diagnosis, treatment type, time from therapy completion, and race/ethnicity, significant predictors of nonitiation of HPV vaccine for the entire cohort included a lack of physician recommendation (odds ratio [OR], 10.8; P < .001), perceived lack of insurance coverage for the vaccine (OR, 6.6; P < .001), male sex (OR, 2.9; P < .001), endorsement of barriers to HPV vaccination (OR, 2.7; P < .001), and age (9 to 12 years: OR, 3.7 [P < .001]; 18 to 26 years: OR, 0.5 [P = .02]).
Cancer survivors in the oldest cohort (18 to 26 years) who had physician recommendations for the vaccine were more likely to be vaccinated than were those aged 13 to 17 years (OR for vaccine noninitiation, 0.24; P < .001).
In a statement, Merry-Jennifer Markham, MD, American Society of Clinical Oncology expert in cancer survivorship, pointed out that young cancer survivors are living long lives after treatment, now more than ever, but their health is more vulnerable.
“It’s concerning that the majority of survivors are not taking full advantage of HPV vaccination, which is widely available and can help them stay cancer-free,” said Dr Markham, who is also an associate professor at the University of Florida, Gainesville. “Oncologists and primary care physicians are trusted resources for young survivors, and while barriers to HPV vaccination certainly exist, this study suggests that starting a conversation can help break down at least one.”
This study received funding from the National Cancer Institute, the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp, and the American Lebanese Syrian Associated Charities. Coauthor Anna R. Giuliano is a member of Merck’s Scientific Advisory Board and Merck’s Global Advisory Board, and her institution has received funds from Merck to conduct research studies unrelated to this research.
J Clin Oncol. Published online August 24, 2017. Abstract
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