Intent and subsequent initiation of human papillomavirus vaccine among young cancer survivors

Abstract

Background: Despite an increased risk of subsequent human papillomavirus (HPV)-related malignancies, HPV vaccine initiation rates among cancer survivors remain critically low. The purpose of this study was to determine the relationship between HPV vaccine intent and subsequent vaccine initiation among cancer survivors by linking data from a cross-sectional survey with state-based immunization registry records.

Methods: Cancer survivors who were 9 to 26 years old were surveyed 1 to 5 years after their treatment to assess their HPV vaccine initiation status, HPV vaccine intent, sociodemographic factors, and vaccine-related health beliefs. HPV vaccine doses/dates were abstracted from the Georgia Registry for Immunization Transactions for 3.5 years after survey participation. Logistic regression models identified factors associated with vaccine intent and subsequent vaccine initiation.

Results: Among survivors who were HPV vaccine-naive at survey participation (n = 103), factors associated with vaccine intent included the following: 1) provider recommendation for the HPV vaccine (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.4-18.1; P = .014), 2) positive general attitude toward vaccines (OR, 4.8; 95% CI, 2.0-11.2; P < .001), and 3) perceived severity of HPV disease (OR, 3.5; 95% CI, 1.2-9.9; P = .02). Of the vaccine-naive patients, 28 initiated the HPV vaccine at a median of 1.1 years after the survey. Initiation was more likely among survivors who had reported vaccine intent (OR, 3.9; 95% CI, 1.2-12.5; P = .02) and was less likely among older survivors (OR per year, 0.7; 95% CI, 0.6-0.9; P < .001).

Conclusions: These findings suggest that provider recommendation for the HPV vaccine plays a role in establishing intent, which then translates into subsequent initiation.

Trial registration: ClinicalTrials.gov NCT01492582.

Keywords: adolescent; cancer survivors; papillomavirus vaccines; young adult.

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Jocelyn M. York reports stock ownership in Intelligent Medical Objects by an immediate family member. Melissa M. Hudson serves in an advisory role for the following organizations: the Coleman Supportive Oncology Initiative for Children With Cancer, the Oncology Research Information Exchange Network, the Pfizer advisory board for Genotropin, and the Princess Maxima Center. Wendy Landier reports nonfinancial support given to her institution by Merck Sharp & Dohme for a related clinical trial. The other authors made no disclosures.

© 2019 American Cancer Society.

Figures

Figure 1.

Consolidated Standards of Reporting Trials diagram of cohort derivation. GRITS indicates Georgia Registry for Immunization Transactions; HPV, human papillomavirus; HPVCSS, HPV Vaccine in Cancer Survivors Study.

Figure 2.

Subsequent HPV vaccine initiation rates by vaccine intent among survivors who were HPV vaccine–naive at the time of survey participation (n = 103). HPV indicates human papillomavirus.