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Waters AR, Weir C, Kramer HS, van Thiel Berghuijs KM, Wu Y, Kepka D, Kirchhoff AC. Implementation barriers and considerations for recommending and administering the human papillomavirus (HPV) vaccination in oncology settings. J Cancer Surviv 2024; 18:1481-1491. [PMID: 37147553 PMCID: PMC10629381 DOI: 10.1007/s11764-023-01391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Survivors of childhood and adolescent cancer experience low human papillomavirus (HPV) vaccination rates-a crucial form of cancer prevention. Oncology provider recommendations may increase young survivors HPV vaccine intent, but HPV vaccination is not typically provided in the oncology setting. Thus, we explored the implementation barriers of providing the HPV vaccine in oncology. METHODS We interviewed oncology providers in a variety of specialty areas about their perceptions of the HPV vaccine and to explore barriers to recommending and administering the vaccine in their clinics. Interviews were audio recorded, quality checked, and thematically analyzed. Emergent themes were then mapped onto the Capability, Opportunity, Motivation, and Behavior (COM-B) Model and the Theoretical Domains Framework. RESULTS A total of N=24 oncology providers were interviewed. Most provided direct clinical care (87.5%) and most commonly specialized in pediatric oncology (20.8%), medical oncology (16.7%), bone marrow transplant (16.7%), and nurse coordination (16.7%). Two themes emerged within each COM-B domain. Capability: 1) educational barriers to HPV vaccination and 2) complicated post treatment HPV vaccination guidelines. MOTIVATION 1) perceived importance of HPV vaccine and 2) concern about blurred scope of practice. OPPORTUNITY 1) hospital administration and time concern barriers and 2) clinical workflow integration concerns. CONCLUSION Implementing HPV vaccination in the oncology setting has the potential to increase HPV vaccination rates among young survivors. Multi-level barriers to providing the HPV vaccine in the oncology setting were identified by participants. Leveraging existing implementation strategies may be an effective way to mitigate provider identified barriers and increase vaccination rates.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Heidi S Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- University of Utah Department of Pediatrics, Salt Lake City, UT, USA
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Teixeira RA, Grimes A, Embry L, Aguilar C, Shay LA. Pediatric Oncology Providers' HPV Vaccine Knowledge, Attitude, Self-Efficacy, and Practice after Communication Training: A Comparison with a National Survey. Vaccines (Basel) 2024; 12:1060. [PMID: 39340090 PMCID: PMC11435773 DOI: 10.3390/vaccines12091060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES Human papillomavirus (HPV) vaccinations prevent HPV infection and related cancers. Despite being at higher risk of secondary cancers linked to HPV, childhood cancer survivors (CCS) are undervaccinated. This study aimed to compare pediatric oncology providers' knowledge, attitudes, self-efficacy, and practices regarding HPV vaccination among those who participated in a multilevel educational HPV vaccine program with those of a national sample of oncology providers. METHODS Between February and March 2023, 39 providers from five pediatric oncology clinics in Texas completed online surveys, assessing knowledge about CCS risk for HPV-related cancers, attitudes towards the HPV vaccine, and confidence in recommending the vaccine to CCS. The results were compared with a national survey of providers conducted in 2019 (n = 195). RESULTS The findings showed that providers who participated in our program had greater knowledge of CCS increased risk for HPV-related cancers (96% vs. 38%; p < 0.001); greater confidence in discussing and recommending the HPV vaccine (100% vs. 66%, p < 0.001) and addressing parental concerns (100% vs. 69%, p < 0.001); and a more positive attitude about oncology providers than general pediatricians, recommending (96% vs. 71%; p = 0.006) and administering the HPV vaccine to CCS (96% vs. 53%, p < 0.001). CONCLUSION This study underscores the importance of educating oncology providers about the increased risk of CCS and improving their self-efficacy to recommend the HPV vaccine, promoting vaccination in the oncology setting.
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Affiliation(s)
- Rejane A. Teixeira
- UT Health Houston School of Public Health in San Antonio, Department of Health Promotion and Behavioral Sciences, San Antonio, TX 78216, USA
| | - Allison Grimes
- UT Health San Antonio, Department of Pediatrics, Division of Pediatric Hematology and Oncology, San Antonio, TX 78216, USA (L.E.)
- Greehey Children’s Cancer Research Institute, San Antonio, TX 78216, USA
| | - Leanne Embry
- UT Health San Antonio, Department of Pediatrics, Division of Pediatric Hematology and Oncology, San Antonio, TX 78216, USA (L.E.)
| | - Christine Aguilar
- UT Health San Antonio, Department of Pediatrics, Division of Pediatric Hematology and Oncology, San Antonio, TX 78216, USA (L.E.)
- Greehey Children’s Cancer Research Institute, San Antonio, TX 78216, USA
| | - L. Aubree Shay
- UT Health Houston School of Public Health in San Antonio, Department of Health Promotion and Behavioral Sciences, San Antonio, TX 78216, USA
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Renduchintala K, Arevalo M, Fonseca G, Haver MK, Gwede CK, Pabbathi S, Christy SM. Vaccination uptake among post-treatment cancer survivors: A multi-vaccine scoping review. Vaccine 2024; 42:125995. [PMID: 38802291 PMCID: PMC11371527 DOI: 10.1016/j.vaccine.2024.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Our goal was to provide an overview of uptake rates across vaccine types and factors associated with vaccine uptake among cancer survivor populations. METHODS A literature search was conducted using Ovid MEDLINE® ALL (Wolters Kluwer), Embase (Elsevier) and CINAHL Complete (EBSCO) databases and according to PRISMA guidelines. Eligible articles were limited to those examining vaccination uptake among cancer survivors who had completed treatment, reported factors associated with uptake (e.g., barriers and facilitators), and published in English between 2011 and 2021. Two independent reviewers screened citations for inclusion and two performed data abstraction, verified by an arbiter. RESULTS The search returned 4,215 total articles, and 271 duplicates were removed. During abstract/title screening, 212 articles were identified. Following full-text screening, 47 articles/abstracts were found to meet inclusion criteria, 16 articles/abstracts were removed, and 31 studies were included in the review. Among the 31 studies, participant age ranged from 9 years to adults of all ages. Vaccine types included: influenza (n = 18), human papillomavirus (n = 10), pneumococcal (n = 8), hepatitis A/B (n = 1), shingles (n = 1), measles (n = 1), tetanus/diphtheria (n = 1), and haemophilus influenza B (n = 1). Vaccine uptake varied greatly across studies, vaccine types, and participant populations. Factors affecting vaccination uptake included sociodemographic variables and social determinants of health, health beliefs/attitudes/knowledge, provider recommendation, and cancer treatment/clinical variables. CONCLUSIONS Our findings highlight the need for further examining factors associated with vaccine uptake, the need for clinical guidelines that specifically address vaccination among cancer survivors, and potential targets for multi-level interventions to improve vaccination rates among cancer survivor populations.
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Affiliation(s)
- Kavita Renduchintala
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of Chicago, 5801 S. Ellis Ave., Chicago, IL 60637, USA.
| | - Mariana Arevalo
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Gabriella Fonseca
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; Edward Via College of Osteopathic Medicine-Carolinas, 350 Howard Street, Spartanburg, SC 29303, USA.
| | | | - Clement K Gwede
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 560 Channelside Dr, Tampa, FL 33602, USA.
| | - Smitha Pabbathi
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 560 Channelside Dr, Tampa, FL 33602, USA
| | - Shannon M Christy
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 560 Channelside Dr, Tampa, FL 33602, USA.
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Okoli GN, Neilson CJ, Grossman Moon A, Kimmel Supron H, Soos AE, Grewal A, Etsell K, Alessi-Severini S, Richardson C, Harper DM. Exploration of individual socioeconomic and health-related characteristics associated with human papillomavirus vaccination initiation and vaccination series completion among adult females: A comprehensive systematic evidence review with meta-analysis. Vaccine 2024; 42:125994. [PMID: 38796328 DOI: 10.1016/j.vaccine.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates among females are lower than the World Health Organization target and vaccination rates specifically among adult females are even much lower. METHODS We systematically evaluated individual socioeconomic and health-related characteristics associated with HPV vaccination initiation and vaccination series completion among adult females (PROSPERO: CRD42023445721). We performed a literature search on December 14, 2022, and supplemented the search on August 1, 2023. We pooled appropriate multivariable-adjusted results using an inverse variance random-effects model and expressed the results as odds ratios with associated 95 % confidence intervals. A point pooled significantly increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥ 70 % was very strongly associated. RESULTS We included 63 cross-sectional studies. There were strongly increased odds of vaccination initiation among White women compared with Black or Asian women, and those with higher education, health insurance, a history of sexually transmitted infection (STI), receipt of influenza vaccination in the preceding year, not married/cohabiting, not smoking, using contraception, and having visited a healthcare provider in the preceding year. We observed very strongly increased odds of vaccination initiation among those younger and having been born in the country of study. Similarly, there were strongly increased odds of completing the vaccination series for the same variables as initiating vaccination, except for higher education, prior STI, smoking and contraception use. Additional variables associated with strongly increased odds of vaccination series completion not seen in initiation were higher annual household income, being lesbian/bisexual, and having a primary care physician. We observed very strongly increased odds of vaccination series completion similar to vaccination initiation but including for White compared with Black women, higher education, and prior cervical cancer screening. CONCLUSIONS These individual characteristics may be the key to identifying women at increased risk of not being vaccinated against HPV and could inform targeted messaging to drive HPV vaccination.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | | | | | - Alexandra E Soos
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Avneet Grewal
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Katharine Etsell
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Richardson
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Diane M Harper
- Departments of Family Medicine and Obstetrics & Gynecology, University of Michigan, Michigan, USA
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Kluczynski MA, Rodriguez EM, McGillicuddy CS, Schlecht NF. Human Papillomavirus Vaccination in Pediatric, Adolescent, and Young Adult Cancer Survivors-Opportunity to Address Gaps in Cancer Prevention and Survivorship. Vaccines (Basel) 2024; 12:114. [PMID: 38400098 PMCID: PMC10892003 DOI: 10.3390/vaccines12020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
The risks of secondary cancers associated with human papillomavirus (HPV) infection are as much as three times higher for survivors of pediatric, adolescent, and young adult cancer (PYAC) compared to the general population. Despite this, HPV vaccination rates among PYAC survivors remain low. Whereas pediatric oncology providers endorse HPV vaccination of PYAC survivors, many lack the resources or opportunities to intervene. The responsibility of HPV vaccination, therefore, falls to primary care providers and practices. This article provides an overview of the challenges with HPV vaccination that are distinct to PYAC survivors and discusses potential strategies to increase HPV vaccine coverage in this population.
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Affiliation(s)
| | | | | | - Nicolas F. Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.A.K.); (E.M.R.); (C.S.M.)
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Rahim MQ, Jacob SA, Coven SL, Miller M, Meagher CG, Lozano G, Zimet G, Ott MA. Identifying Barriers to HPV Vaccination for Patients With Sickle Cell Disease and Childhood Cancer Survivors. J Pediatr Hematol Oncol 2023; 45:e940-e947. [PMID: 37696002 PMCID: PMC10615738 DOI: 10.1097/mph.0000000000002752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023]
Abstract
Human papillomavirus (HPV) vaccination prevents the development of HPV-associated malignancies. Adolescent and young adult survivors of childhood cancers and patients with sickle cell disease (SCD) are vulnerable patient populations who would significantly benefit from HPV vaccination. In this multimethod study, a retrospective chart review found a notable difference between the rate of HPV vaccinations and other age-appropriate vaccinations in 177 childhood cancer survivors and in 70 patients with SCD. We then sought to describe patient and caregiver beliefs regarding HPV vaccination, through semistructured interviews with 21 patients and 48 caregivers. Interviews were analyzed with a thematic content approach to understand attitudes regarding the HPV vaccination. Qualitative interviews noted that many caregivers and adolescents had baseline misconceptions regarding the HPV vaccination in general and in context with their chronic illness. It was found that a strong recommendation from a trusted subspecialty provider would create reassurance about vaccination and reduce misconceptions and concerns about side effects in the context of a chronic illness. Counseling from subspecialists could have a strong impact on understanding the HPV vaccine in the context of chronic illness. This would likely help overcome many of the barriers to vaccination that are encountered by patients with SCD or oncology survivors.
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Affiliation(s)
- Mahvish Q. Rahim
- Riley Hospital for Children Division of Pediatric Hematology and Oncology at Indiana University Health, Indianapolis, Indiana, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | - Seethal A. Jacob
- Riley Hospital for Children Division of Pediatric Hematology and Oncology at Indiana University Health, Indianapolis, Indiana, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 410 W 10 Street, HITS Building, Indianapolis, IN 46202
| | - Scott L. Coven
- Riley Hospital for Children Division of Pediatric Hematology and Oncology at Indiana University Health, Indianapolis, Indiana, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | - Meagan Miller
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Carolyn G. Meagher
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Gabriella Lozano
- Indiana University School of Medicine, 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Mary A. Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
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Garcia MA, Schlecht NF, Rokitka DA, Attwood KM, Rodriguez EM. Examining the Barriers and Opportunities for Human Papillomavirus Vaccine Delivery in Cancer Care Settings: A Mixed-Methods Study. Cancer Prev Res (Phila) 2023; 16:581-589. [PMID: 37258419 PMCID: PMC10810245 DOI: 10.1158/1940-6207.capr-23-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
Although pediatric, adolescent, and young adult (PAYA) cancer survivors are at increased risks for secondary cancers, their HPV vaccine uptake rates are poor. Therefore, we conducted a mixed-methods study to identify the barriers and opportunities for HPV vaccine delivery among PAYA cancer care providers. We distributed a semistructured questionnaire to a professional organization comprised of PAYA oncology and hematology healthcare providers between April and July 2022. Questionnaire measures included demographic and practice characteristics, HPV vaccine knowledge, willingness, barriers, opportunities, and roles for HPV vaccine delivery. Descriptive characteristics were generated for quantitative data, and content analysis was used to identify themes. A total of 49 providers responded to our survey. A majority were female (68%) and non-Hispanic white (74%). Approximately 76% were oncology or hematology physicians, and most worked in a cancer center or children's hospital (86%). Over half (63%) had been practicing for >15 years, and a majority saw patients ages 11 to 17. Although less than half reported discussing HPV vaccination with their patients, 69% were willing to become involved in HPV vaccine delivery. The most frequently reported barriers identified in our content analysis were related to system-level factors. Furthermore, providers identified opportunities within cancer prevention education, transitions in care, and at the system-level. Although barriers to HPV vaccination persist in cancer care, most providers perceived there to be opportunities to become involved in HPV vaccine delivery. Identifying strategies for PAYA oncology and hematology healthcare providers to adopt a stronger role in HPV vaccination remains a significant opportunity for future implementation research. PREVENTION RELEVANCE This mixed-methods study is the first to investigate and assess barriers and opportunities for HPV vaccine delivery among PAYA cancer healthcare providers. Our findings can serve as an important framework for future implementation research targeted towards HPV vaccine delivery in cancer clinical settings. See related Spotlight, p. 545.
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Affiliation(s)
- Melany A. Garcia
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Nicolas F. Schlecht
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Denise A. Rokitka
- Department of Pediatrics; Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Kristopher M. Attwood
- Roswell Park Comprehensive Cancer Center, Biostatistics and Bioinformatics, Buffalo, NY, United States of America
| | - Elisa M. Rodriguez
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
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Kaddas HK, Ramsay JM, Ou JY, Fair D, Kepka D, Kirchhoff AC. HPV Vaccination Initiation and Completion Among Pediatric, Adolescent, and Young Adult Cancer Survivors and a Comparison Population Sample Receiving Primary Care. J Pediatr Hematol Oncol 2023; 45:e236-e243. [PMID: 36219685 PMCID: PMC9974526 DOI: 10.1097/mph.0000000000002484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
Human papillomavirus (HPV) vaccinations can reduce pediatric, adolescent, and young adult (PAYA) cancer survivors' susceptibility to HPV-related subsequent cancers. We examined differences in HPV vaccination initiation and completion among a Utah-based cohort of PAYA cancer survivors and a cancer-free population sample. Participants received primary care at 1 of 2 health care systems during study follow-up: 2006-2016. Vaccination records were identified from these health care systems, statewide vaccination records, and an all-payer claims database. HPV vaccination initiation (1 dose) and completion (3 doses) were compared between cancer survivors (N=1579) and age-matched and sex-matched cancer-free population sample (N=4513). Individuals were 9 to 21 years old at cohort entry. Mixed-effects Poisson regression estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Relative to the population sample, cancer survivors were less likely to initiate vaccination (IRR=0.8, 95% CI: 0.73-0.98). The most severe disparity compared with the population sample for vaccine initiation (IRR=0.5, 95% CI: 0.31-0.74) or completion (IRR=0.5, 95% CI: 0.28-0.89) was observed for Hispanic survivors. PAYA cancer survivors are less likely to initiate HPV vaccination series than noncancer counterparts. Targeted interventions should be directed at PAYA survivors to raise HPV vaccination with emphasis on high-risk groups such as Hispanic survivors.
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Affiliation(s)
- Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Douglas Fair
- Department of Pediatrics, University of Utah
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah
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Thomaier L, Aase DA, Vogel RI, Parsons HM, Sadak KT, Teoh D. HPV vaccination coverage for pediatric, adolescent and young adult patients receiving care in a childhood cancer survivor program. Prev Med Rep 2022; 29:101972. [PMID: 36161114 PMCID: PMC9502284 DOI: 10.1016/j.pmedr.2022.101972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/27/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
Pediatric, adolescent and young adult patients undergoing cancer treatment and/or hematopoietic stem cell transplant are at increased risk for developing a secondary human papillomavirus (HPV)-associated malignancy. The objective of this study was to determine HPV vaccination coverage among individuals participating in a childhood cancer survivor program (CCSP). A retrospective cohort study was conducted among CCSP patients age 11–26 years attending a CCSP visit between 2014 and 2019. Survivors were age-, sex-, and race-matched 1:2 with controls without cancer. Data were abstracted from the electronic health record and state-based vaccination registry. Analysis was limited to Minnesota residents to minimize missing vaccination data. Survivorship care plans (SCPs) were reviewed for vaccine recommendations. 592 patients were included in the analyses (200 CCSP patients; 392 controls). By study design, mean age (18.4 years), race (72 % white), and sex (49 % female) were similar in the two groups. Among CCSP patients 22 % resided in a rural area compared to 3.8 % of controls. Vaccination coverage among CCSP patients was not statistically significantly different from controls [60.0 % vs 66.3 %, OR = 0.82, 95 % CI: (0.55, 1.23), p = 0.35]. Completion of 3 doses was not different between groups even though 3 doses is recommended for all CCSP patients regardless of age at initiation (28.5 % vs 30.1 %, p = 0.09). Only 8.0 % of SCPs recommended HPV vaccination. Although patients participating in a CCSP did not have significantly different HPV vaccination coverage compared to controls, HPV vaccination initiation and 3-dose series completion are still suboptimal in a patient population at high-risk of a secondary HPV-associated cancer.
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Key Words
- Adolescent
- CCSP, Childhood Cancer Survivor Program
- EHR, electronic health record
- HPV vaccination
- HPV, human papillomavirus
- HSCT, hematopoietic stem cell transplant
- IRB, institutional review board
- MIIC, Minnesota Immunization Information Connection
- Pediatric
- SCP, survivorship care plan
- Secondary cancer prevention
- Survivorship
- TDaP, tetanus, diphtheria, and pertussis
- Young adult cancer survivors
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Affiliation(s)
- Lauren Thomaier
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States
| | - Danielle A Aase
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - Rachel I Vogel
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States
| | - Helen M Parsons
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Karim T Sadak
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States
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10
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Ramsay JM, Kaddas HK, Ou JY, Kepka D, Kirchhoff AC. Missed opportunities for concomitant HPV vaccination among childhood cancer survivors. Cancer Med 2022; 11:1181-1191. [PMID: 35032104 PMCID: PMC8855920 DOI: 10.1002/cam4.4492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/31/2021] [Accepted: 10/01/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Childhood cancer survivors are at higher risk of human papillomavirus (HPV)-related second cancers than adolescents without cancer, yet their HPV vaccination uptake is lower. Using a statewide sample, we evaluated whether survivors are at higher risk of missed opportunities for concomitant HPV vaccination. METHODS From statewide healthcare data, we identified encounters where vaccines were received. Concomitant HPV vaccine missed opportunities were defined as a vaccine encounter where the HPV vaccine was not administered, although eligibility criteria were met. From these encounters, our sample included 327 survivors identified from the Utah Cancer Registry, diagnosed 2000-2016 at ages 0-9, and a birth year and sex-matched sample without cancer from the general population (n = 1,911). Mixed-effects Poisson regression estimated the rate of concomitant missed opportunities per vaccine encounter and 95% confidence intervals by vaccine encounter type (all vaccines, flu shot only, or adolescent/catch-up) from 2013 to 2016. RESULTS Survivors had more concomitant HPV vaccine missed opportunities than the population sample (70.0% vs. 59.0%). On average, survivors were 12% more likely to have missed opportunities at vaccine encounters and 4% more likely at flu shot only encounters. The predicted excess risk of concomitant missed opportunities for survivors ranged from 0.5 per10 vaccine encounters to 1.1 per10 vaccine encounters. Higher parental education, rurality, younger first vaccine age, and chemotherapy were associated with missed opportunities. CONCLUSIONS Childhood cancer survivors have more missed opportunities for concomitant HPV vaccination than a population sample. As flu shots should be administered annually, providers have a regular opportunity to recommend and deliver the HPV vaccine to survivors.
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Affiliation(s)
- Joemy M. Ramsay
- Cancer Control and Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Heydon K. Kaddas
- Cancer Control and Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Judy Y. Ou
- Cancer Control and Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Deanna Kepka
- Cancer Control and Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
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Brandt HM, Kepka D, Kirchhoff AC, Daniel CL, Bhatt NS. Human papillomavirus (HPV) vaccination is cancer prevention for childhood cancer survivors. Cancer 2022; 128:237-239. [PMID: 34606629 PMCID: PMC8738104 DOI: 10.1002/cncr.33920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/17/2023]
Abstract
Childhood cancer survivors are at high risk for developing human papillomavirus (HPV)-associated subsequent neoplasms. Henderson et al., 2021 identified risk factors for subsequent HPV-associated malignant neoplasms among enrollees in the Childhood Cancer Survivor Study. The exacerbated risk of subsequent HPV cancers found in the study underscores the need for more stringent surveillance and tracking to inform intervention approaches to ensure maximal protection. In addition, HPV vaccination must be prioritized as part of transitional care and survivorship planning. Limited sources of data on survivor practices and outcomes results in limited information to develop guidelines and provide childhood cancer survivors with information on preventing subsequent HPV cancers. Improved efforts are needed to increase HPV vaccination and HPV-related surveillance among childhood cancer survivors to prevent subsequent neoplasms. Childhood cancer survivors are at increased risk of developing a subsequent cancer caused by human papillomavirus or HPV. HPV is a very common and usually benign sexually transmitted infection. HPV vaccination and screening can prevent most HPV cancers. However, childhood cancer survivors have lower HPV vaccination rates than individuals without a cancer history. To help prevent subsequent HPV cancers among childhood cancer survivors, we must gather better information and work to improve HPV vaccination recommendations and acceptance. Childhood cancer survivors are at high risk for developing subsequent human papillomavirus (HPV)-associated cancers; Henderson et al., 2021, examined risk factors for subsequent malignant neoplasms associated with HPV among enrollees in the Childhood Cancer Survivor Study. Improved, targeted efforts to increase HPV vaccination and HPV-related surveillance among childhood cancer survivors are needed.
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Affiliation(s)
- Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105
| | - Deanna Kepka
- University of Utah College of Nursing, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Anne C. Kirchhoff
- University of Utah Department of Pediatrics, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Casey L. Daniel
- University of South Alabama College of Medicine, 1660 Springhill Avenue, Mobile, AL, 36604
| | - Neel S. Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-390, Seattle, WA, 98109
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12
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Oh NL, Biddell CB, Rhodes BE, Brewer NT. Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med 2021; 148:106554. [PMID: 33857561 DOI: 10.1016/j.ypmed.2021.106554] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
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Affiliation(s)
- N Loren Oh
- University of North Carolina School of Medicine, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Blythe E Rhodes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
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13
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Imburgia TM, Shew ML, Gravitt PE, Katzenellenbogen RA. Considerations for Child Cancer Survivors and Immunocompromised Children to Prevent Secondary HPV-associated Cancers. Transplantation 2021; 105:736-742. [PMID: 32890137 DOI: 10.1097/tp.0000000000003444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Survivors of childhood cancer and other immunocompromised children are at high risk for the development of secondary human papillomavirus (HPV)-associated cancers. In this overview, the authors examine the epidemiology of vaccine efficacy, the natural history of HPV infections, and accelerated HPV-associated cancer development in these populations. The authors highlight the opportunities for preventive care and future research directives.
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Affiliation(s)
- Teresa M Imburgia
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
- Epidemiology Department, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Marcia L Shew
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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14
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Lee JE, Shin DW, Shin J, Cho IY, Lee J, Hwang J, Cho B, Song YM. A cross-sectional study of factors associated with influenza vaccination in Korean cancer survivors. Eur J Cancer Care (Engl) 2021; 30:e13443. [PMID: 33764597 DOI: 10.1111/ecc.13443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/20/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate factors associated with influenza vaccination in cancer survivors. METHODS Study subjects were 1,945 Korean adult cancer survivors. Through medical record review and self-administered questionnaires, social and medical information was collected. Influenza vaccination was defined as ever having received a flu vaccine between one year before cancer diagnosis and the survey date. Multiple logistic regression analysis was used to evaluate factors associated with influenza vaccination. RESULTS Overall, 60.8% of study subjects had received an influenza vaccination. Younger survivors had a significantly lower vaccination rate than did the elderly survivors (80.22% vs. 54.73%). In younger survivors, longer time elapsed since cancer diagnosis, lifestyle modification counselling during cancer treatment, adequate physical exercise (≥150 min/week) and complementary medication use were positively associated with vaccination, whereas extra-pulmonary cancers, multimodality (≥3) cancer treatment and higher educational achievement were inversely associated. In elderly survivors, fewer factors had a positive (adequate physical exercise) or inverse (multimodality cancer treatment and current smoking) association with influenza vaccination. CONCLUSION Influenza vaccination rate was suboptimal, especially among younger cancer survivors. Targeted strategies are necessary to improve influenza vaccination in cancer survivors with consideration of individual characteristics such as age, lifestyle, cancer treatment modality, cancer type and education level.
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Affiliation(s)
- Ji Eun Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - In Young Cho
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JiHye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Hirschey R, Nyrop KA, Mayer DK. Healthy Behaviors: Prevalence of Uptake Among Cancer Survivors. Clin J Oncol Nurs 2020; 24:19-29. [PMID: 32945809 DOI: 10.1188/20.cjon.s2.19-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most cancer survivors adhere to recommendations to refrain from tobacco and minimize alcohol use, survivors of certain cancers are not meeting these recommendations. In addition, most cancer survivors do not achieve optimal recommendations for diet and physical activity, further decreasing survivor health and quality of life. Sun protective and sleep behaviors also tend to be suboptimal among survivors. Uptake of age-appropriate vaccinations is variable among survivors. OBJECTIVES The purpose of this article is to review the prevalence of healthy behavior uptake among cancer survivors and provide nurses with an overview of effective interventions, strategies, and resources to help patients improve these behaviors. METHODS An expert panel was convened to conduct an integrative review and synthesis on the state of the science of healthy behavior uptake among cancer survivors. FINDINGS Not meeting recommendations for healthy lifestyle behaviors increases the risk of second cancers and mortality and decreases overall health and quality of life. Healthy lifestyle behaviors can contribute to improved function, quality of life, and overall survival for cancer survivors. Nurses can help survivors to understand and improve their behaviors.
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16
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Influence of provider recommendations to restart vaccines after childhood cancer on caregiver intention to vaccinate. J Cancer Surviv 2020; 14:757-767. [PMID: 32458248 PMCID: PMC7505103 DOI: 10.1007/s11764-020-00890-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/04/2020] [Indexed: 10/30/2022]
Abstract
PURPOSE We studied the influence of oncology and primary care provider (PCP) recommendations on caregiver intentions to restart vaccines (e.g., catch-up or boosters) after cancer treatment. METHODS We surveyed primary caregivers ages 18 or older with a child who had completed cancer treatment 3-36 months prior (N = 145) about demographics, child's vaccination status, and healthcare factors (e.g., provider recommendations, barriers, preferences for vaccination). We compared these factors by caregiver's intention to restart vaccines ("vaccine intention" vs. "no intent to vaccinate") using bivariate and multivariable analyses. RESULTS Caregivers were primarily ages 30-39 years (54.9%), mothers (80.6%), college graduates (44.4%), non-Hispanic (89.2%), and married (88.2%). Overall, 34.5% of caregivers did not know which vaccines their child needed. However, 65.5% of caregivers reported vaccine intention. Fewer caregivers with no intention to vaccinate believed that vaccinating their child helps protect others (85.4 vs. 99.0%, p < 0.01), that vaccines are needed when diseases are rare (83.7 vs. 100.0%, p < 0.01), and that vaccines are safe (80.4 vs. 92.6%, p = 0.03) and effective (91.5 vs. 98.9%, p = 0.04) compared with vaccine intention caregivers, respectively. Provider recommendations increased caregivers' likelihood of vaccine intention (oncologist RR = 1.65, 95% CI 1.27-2.12, p < 0.01; PCP RR = 1.51, 95% CI 1.19-1.94, p < 0.01). CONCLUSIONS Provider recommendations positively influence caregivers' intention to restart vaccines after childhood cancer. Guidelines are needed to support providers in making tailored vaccine recommendations. IMPLICATIONS FOR CANCER SURVIVORS Timely vaccination after childhood cancer protects patients against vaccine-preventable diseases during survivorship. Caregivers may benefit from discussing restarting vaccinations after cancer with healthcare providers.
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17
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Mann K, Wu YP, Pannier ST, Hacking C, Warner EL, Rosen S, Acharya A, Wright J, Gerdy C, Kirchhoff AC. Healthcare provider perspectives on pediatric cancer survivorship care plans: a single institution pilot study. Support Care Cancer 2020; 29:697-706. [PMID: 32435970 DOI: 10.1007/s00520-020-05522-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Survivorship care plans (SCPs) are used to facilitate communication between oncology and primary care providers (PCPs) after cancer treatment and to assist cancer survivors with healthcare decisions. We evaluated pediatric oncology providers' experiences creating and delivering SCPs. We also evaluated PCPs' opinions of SCPs. METHODS Together, oncology nurses and oncologists created individualized SCPs for leukemia patients treated at a children's hospital in Utah, with nurses in charge of inputting the majority of SCP content. We surveyed providers after each SCP was completed. We also mailed SCPs to PCPs with a survey on SCP content and their knowledge and comfort level caring for cancer survivors. Descriptive statistics were used to summarize survey content. RESULTS A total of 6 nurses and 8 oncologists created 21 SCPs. On average, nurses assisted with 3.5 SCPs and spent 209 min (range 100-600 min) on completing their sections of each SCP, whereas oncologists assisted with 2.6 SCPs and spent 47.4 min (range 15-120). For most SCPs, there was agreement that they should be shared with PCPs (nurse surveys 71.4%, oncologist surveys 100%). Of the 15 participating PCPs, only 28% felt prepared to manage long-term effects in pediatric cancer survivors. They agreed that the SCP would improve communication with their patient's oncologist (80%) and their knowledge for future care (100%). CONCLUSIONS SCPs require substantial clinician time to create, but are seen as useful by PCPs. PCPs require specific guidelines and resources concerning ongoing care for pediatric cancer survivors.
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Affiliation(s)
- Karely Mann
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.
| | - Yelena P Wu
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Samantha T Pannier
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Claire Hacking
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Echo L Warner
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.,University of Utah, College of Nursing, Salt Lake City, UT, USA
| | - Stephanie Rosen
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Akanksha Acharya
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | | | - Cheryl Gerdy
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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18
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Kirchhoff AC, Mann K, Warner EL, Kaddas HK, Fair D, Fluchel M, Knackstedt ED, Kepka D. HPV vaccination knowledge, intentions, and practices among caregivers of childhood cancer survivors. Hum Vaccin Immunother 2019; 15:1767-1775. [PMID: 31116634 PMCID: PMC6746484 DOI: 10.1080/21645515.2019.1619407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The HPV vaccine is an important vaccine for childhood cancer survivors because of their risks of second cancers, yet few survivors receive it. We examined HPV vaccine knowledge among caregivers of childhood cancer survivors, whether their child had received the vaccine, and their intentions to vaccinate. Eligible participants were caregivers (mostly parents) whose child finished cancer treatment at Primary Children’s Hospital in Salt Lake City, Utah 3 to 36 months prior to the start of the study (N = 145). Additional analyses were done among caregivers whose child was age-eligible for the HPV vaccine (ages 11 and up; N = 61). We ran descriptive statistics and fit multivariable generalized linear models to identify factors associated with intention to vaccinate and HPV vaccination uptake. Among caregivers whose child had not yet gotten the HPV vaccine, approximately 30% stated they were not likely to get the vaccine for their child and the most commonly cited reason was not enough information (25.2%). Provider discussion about vaccines and side effects (relative risk (RR) = 1.85, 95% CI 1.16–2.94), along with recommendations regarding vaccines after cancer treatment (RR = 1.35, 95% CI 1.06–1.72), led to greater caregiver intention to get the HPV vaccine for their child with cancer. Approximately 40% of age-eligible survivors had gotten at least one dose of the HPV vaccine. Our findings demonstrate a need for oncology-focused interventions to educate families of childhood cancer survivors about the importance of the HPV vaccine after cancer therapy.
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Affiliation(s)
- Anne C Kirchhoff
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah , Salt Lake City , UT , USA.,b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Karely Mann
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Echo L Warner
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA.,c College of Nursing, University of Utah , Salt Lake City , UT , USA
| | - Heydon K Kaddas
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Douglas Fair
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah , Salt Lake City , UT , USA.,d Primary Children's Hospital , Salt Lake City , UT , USA
| | - Mark Fluchel
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah , Salt Lake City , UT , USA.,d Primary Children's Hospital , Salt Lake City , UT , USA
| | - Elizabeth D Knackstedt
- e Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah , Salt Lake City , UT , USA
| | - Deanna Kepka
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA.,c College of Nursing, University of Utah , Salt Lake City , UT , USA
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19
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Klosky JL, Hudson MM, Chen Y, Connelly JA, Wasilewski-Masker K, Sun CL, Francisco L, Gustafson L, Russell KM, Sabbatini G, Flynn JS, York JM, Giuliano AR, Robison LL, Wong FL, Bhatia S, Landier W. Human Papillomavirus Vaccination Rates in Young Cancer Survivors. J Clin Oncol 2017; 35:3582-3590. [PMID: 28837404 PMCID: PMC5662846 DOI: 10.1200/jco.2017.74.1843] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- James L Klosky
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Melissa M Hudson
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Yanjun Chen
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - James A Connelly
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Karen Wasilewski-Masker
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Can-Lan Sun
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Liton Francisco
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Laura Gustafson
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Kathryn M Russell
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Gina Sabbatini
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Jessica S Flynn
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Jocelyn M York
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Anna R Giuliano
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Leslie L Robison
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - F Lennie Wong
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Smita Bhatia
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
| | - Wendy Landier
- James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL
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Cherven B, Landier W. Human Papillomavirus Vaccine Is Crucial for Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:385-387. [PMID: 28595023 DOI: 10.1089/jayao.2017.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brooke Cherven
- 1 School of Nursing, Robert Wood Johnson Foundation Future of Nursing Scholar, University of Alabama at Birmingham , Birmingham, Alabama
| | - Wendy Landier
- 2 Division of Pediatric Hematology/Oncology, School of Medicine and PhD Program, School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
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