Study offers insight into why many young cancer survivors opt out of HPV vaccination
Click Here to Manage Email Alerts
Young survivors of pediatric cancers are at increased risk for a host of short-term and late health conditions, including HPV-related malignancies such as cervical and oropharyngeal cancers.
Despite these risks, young cancer survivors have lower rates of uptake for the HPV vaccine, which is known to be effective in preventing the HPV types most commonly linked to cervical cancer.
To better understand the factors that may cause young cancer survivors to forgo the HPV vaccine, Brooke Cherven, PhD, MPH, RN, CPON, a researcher at Emory University's Winship Cancer Institute and Children’s Healthcare of Atlanta’s Aflac Cancer and Blood Disorders Center, and colleagues reviewed data from an open-label clinical trial of the HPV vaccine among cancer survivors aged 9 to 26 years 1 to 5 years after cancer treatment.
“We recruited patients for participation in a clinical trial that evaluated the immunogenicity and safety of the HPV vaccine in cancer survivors,” Cherven told Healio. “When patients declined to participate in the trial, their reasons for not participating were recorded, so we included the 301 survivors who were approached for trial participation. The reasons for refusal served as our data set.”
Cherven spoke with Healio about her study’s findings and discussed how oncologists, pediatricians and other providers can work to increase vaccination among young cancer survivors.
Healio: How did you conduct your study and what did you find?
Cherven: We were aware that there is a much lower uptake of the HPV vaccine in cancer survivors compared with the general population, but we wanted to explore some of those reasons in the survivors’ own words. It was a powerful approach. During the recruitment process for the HPV vaccine trial, survivors and parents of survivors said that they didn’t want to participate. It was a good opportunity to use that data to delve into a better understanding.
We found that the majority of survivors (71.4%) declined trial participation due to concerns about the HPV vaccine. These survivors were hesitant or maybe just not interested in the vaccine. Another factor was external influences, including whether or not the vaccine was mandated or required for school, or that a health care provider had advised them not to get the vaccine or to wait to initiate vaccination. We also found vaccine-related information deficits, such as parents believing their child was too young to receive the vaccine, or that it wasn’t really necessary for them.
Finally, in the category of health beliefs and decisional processes, families expressed negativity toward vaccines, or toward the HPV vaccine in particular. Maybe they had talks together as a family, or did research, and had already decided they didn’t want to do it. Some of these reasons overlap with what we see in the general population.
However, we were surprised by some of the refusal reasons that were more specific and unique to this population, such as survivors stating that they had already been through so much, and they didn’t want to have any additional medical interventions or anything they viewed as unnecessary.
Then there were families managing different kinds of chronic health issues that happen after cancer treatment, or who had other cancer-related concerns that they wanted to focus on. So, they wanted to wait to get the vaccine. In some cases, providers recommended delaying or forgoing the vaccine because of the patient’s previous cancer treatment.
Healio: You mentioned information deficits at the patient level. Are there also information deficits at the provider level?
Cherven: Yes, I think that’s a reality. From a clinical perspective, we hear that general pediatricians are sometimes hesitant or don’t know when to recommend vaccination for cancer survivors after treatment. Sometimes, they look to the oncology team to recommend it, and the oncology team perhaps assumes that the pediatrician has recommended it. So, there can be a deficit in communication, as well.
Healio: Do you think the reluctance to vaccinate is at all related to controversies around COVID-19 vaccination?
Cherven: These data were collected before the pandemic. However, we think these reasons for refusal are likely still relevant during the pandemic, but there might be additional concerns or barriers that we weren’t able to access.
We did see that refusal reasons related to safety concerns increased over the time period of the clinical trial. This increase is similar to the patterns seen in the general population, where vaccine concerns have also increased over time. That was predating the pandemic, and I think vaccine hesitancy and concerns about safety in general have become even more relevant during COVID.
Healio: What needs to be done to change this? What message should clinicians be giving to patients?
Cherven: The most important thing is for health care providers to strongly recommend the HPV vaccine, and to emphasize that the HPV vaccine is cancer prevention. For patients and families who have concerns, we have data to support that the vaccine is safe and protective in cancer survivors. The leaders of our research team, James L. Klosky, PhD, and Wendy Landier, PhD, have an implementation study that’s focused on oncology providers and supporting their recommendation to survivors for getting vaccinated. It’s important for clinicians to recognize that we do have evidence-based messaging that can address these concerns. Making oncology providers or pediatricians aware of these common concerns may be helpful in increasing their confidence in these patient conversations.
Healio: Is there anything else you’d like to add?
Cherven: I’d like to reemphasize that the vaccine is widely recommended for cancer survivors, and it’s part of the Children’s Oncology Group’s long-term follow-up guidelines for survivorship care. I encourage providers in all settings who are seeing survivors to discuss and recommend the HPV vaccine. This will be important in increasing vaccination in this population.
For more information:
Brooke Cherven, PhD, MPH, RN, CPON, can be reached at 2015 Uppergate Drive, 4th floor, Atlanta, GA 30322; email: bcherve@emory.edu.
Collapse
Read more about
Click Here to Manage Email Alerts