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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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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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van Thiel Berghuijs KM, Kaddas HK, Warner EL, Fair DB, Fluchel M, Knackstedt ED, Verma A, Kepka D, Green AL, Smitherman AB, Draper L, Johnson RH, Kirchhoff AC. Vaccination practices of pediatric oncologists from eight states. BMC Health Serv Res 2023; 23:1215. [PMID: 37932718 PMCID: PMC10629174 DOI: 10.1186/s12913-023-10160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 10/16/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Vaccinations are a vital part of routine childhood and adolescent preventive care. We sought to identify current oncology provider practices, barriers, and attitudes towards vaccinating childhood and adolescent cancer patients and survivors. METHODS We conducted a one-time online survey distributed from March-October 2018 to pediatric oncologists at nine institutions across the United States (N = 111, 68.8% participation rate). The survey included 32 items about vaccination practices, barriers to post-treatment vaccination, availability of vaccinations in oncology clinic, familiarity with vaccine guidelines, and attitudes toward vaccination responsibilities. Descriptive statistics were calculated in STATA 14.2. RESULTS Participants were 54.0% female and 82.9% white, with 12.6% specializing in Bone Marrow Transplants. Influenza was the most commonly resumed vaccine after treatment (7030%). About 50%-60% were familiar with vaccine guidelines for immunocompromised patients. More than half (62.7%) recommended that patients restart most immunizations 6 months to 1 year after chemotherapy. Common barriers to providers recommending vaccinations included not having previous vaccine records for patients (56.8%) or lacking time to ascertain which vaccines are needed (32.4%). Of participants, 66.7% stated that vaccination should be managed by primary care providers, but with guidance from oncologists. CONCLUSIONS Many pediatric oncologists report being unfamiliar with vaccine guidelines for immunocompromised patients and almost all report barriers in supporting patients regarding vaccines after cancer treatment. Our findings show that further research and interventions are needed to help bridge oncology care and primary care regarding immunizations after treatment.
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Affiliation(s)
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
- University of Arizona Cancer Center, Tucson, AZ, 85719, USA
| | - Douglas B Fair
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT, 84108, USA
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, 84113, USA
| | - Mark Fluchel
- Seattle Children's Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Elizabeth D Knackstedt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, 84113, USA
| | - Anupam Verma
- Pediatric Specialists of Virginia, Center for Cancer and Blood Disorders, Fairfax, VA, 22031, USA
- Center for Cancer and Blood Disorders, Division of Oncology, Children's National Hospital, Washington DC, 20010, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
| | - Adam L Green
- Children's Hospital of Colorado/University Colorado, Aurora, CO, 80045, USA
| | - Andrew B Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA
| | | | | | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT, 84108, USA
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Garcia M, McGillicuddy C, Rodriguez EM, Attwood K, Schweitzer J, Coley S, Rokitka D, Schlecht NF. Human papillomavirus vaccination uptake among childhood cancer survivors in Western New York. Pediatr Blood Cancer 2022; 69:e29962. [PMID: 36094384 PMCID: PMC9529834 DOI: 10.1002/pbc.29962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The risk of human papillomavirus (HPV)-associated cancers is significantly higher among survivors of a childhood cancer compared to the general population. Despite this, their HPV vaccine uptake rates are lower. We examined factors related to HPV vaccine uptake among childhood cancer survivors from Western New York over 13 years following the introduction of HPV vaccines. METHODS Retrospective review of patients diagnosed with invasive or noninvasive cancerous conditions at age 9 or younger treated at Roswell Park Oishei Children's Cancer and Blood Disorder Program. We matched vaccine date information for patients aged 9-26 years between 2006 and 2020 from the New York State Immunization Information System. Demographic and cancer-related information was abstracted from electronic medical records. Cumulative vaccine uptake was assessed by Kaplan-Meier and Cox proportional hazards regression models. RESULTS A total of 284 patients were included in the analyses. Most were non-Hispanic/White (80.3%) and resided in a metropolitan area (81.7%). Approximately half had leukemia or lymphoma (54.9%), and most received chemotherapy. Females were more likely to initiate the HPV vaccine and did so sooner (median = 5.5 years) than males (median = 5.7 years; log-rank p = .301). Patients who were older at vaccine eligibility and males who received blood product transfusions were significantly less likely to initiate the HPV vaccine. CONCLUSION While rates of HPV vaccine initiation have been increasing with time among childhood cancer survivors, they remain low overall, with differences seen by treatment and diagnosis. Our findings support the need for further research to optimize HPV vaccine delivery in cancer care.
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Affiliation(s)
- Melany Garcia
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Cailey McGillicuddy
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Elisa M. Rodriguez
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Kristopher Attwood
- Roswell Park Comprehensive Cancer Center, Biostatistics and Bioinformatics, Buffalo, NY, United States of America
| | - Jennifer Schweitzer
- Roswell Park Comprehensive Cancer Center, Clinical Research Services, Buffalo, NY, United States of America
| | - Scott Coley
- New York State Department of Health, Bureau of Immunization, NY, United States of America
| | - Denise Rokitka
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Nicolas F. Schlecht
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
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Waters AR, Mann K, Vaca Lopez PL, Kepka D, Wu YP, Kirchhoff AC. HPV Vaccine Experiences and Preferences Among Young Adult Cancer Survivors and Caregivers of Childhood Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1519-1524. [PMID: 33740231 PMCID: PMC8454692 DOI: 10.1007/s13187-021-01992-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 05/23/2023]
Abstract
Cancer survivors are at higher risk of developing HPV-associated cancers later in life, yet their HPV vaccination rates remain lower than the general population. Improving HPV vaccination uptake among survivors is essential to preventing second malignancies. We interviewed HPV vaccine eligible adolescent and young adult (AYA) cancer survivors (18-26 years) and caregivers of HPV vaccine eligible childhood cancer survivors approaching the AYA age range (9-17 years) about their HPV vaccine experiences and preferences as informed by the HPV Vaccination Roundtable Best Practices. Interviews (N = 20) were recorded, transcribed, and analyzed using interpretive description. Of AYA survivors (n = 10), 50% had received at least one HPV vaccine dose. Of caregivers (n = 10), 30% reported their child had received at least one HPV vaccine dose. Three distinct categories emerged including (1) HPV vaccine knowledge, (2) HPV vaccination recommendation preferences, and (3) HPV vaccination reminder preferences. The first two categories were oncology focused. Participants lacked knowledge regarding HPV vaccine safety and applicability due to their complex cancer history. Most participants strongly preferred that their oncologist provide an HPV vaccine recommendation. The third category was mixed, with some participants preferring oncology-based HPV vaccine reminders while others preferred primary care-based reminders. Almost all participants preferred digital reminders (e.g., text messages). Our results suggest that oncologists play an essential role in recommending the HPV vaccine and providing information to assist survivors and caregivers with vaccine decision-making. Additionally, HPV vaccination uptake among pediatric and childhood and AYA survivors could be improved through the use of tailored, electronically delivered vaccine reminders.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Karely Mann
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
| | - Yelena P Wu
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, 84112, USA
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Vanderpool RC, Gaysynsky A, Chou WYS, Tonorezos ES. Using Behavioral Science to Address COVID-19 Vaccine Hesitancy Among Cancer Survivors: Communication Strategies and Research Opportunities. J Behav Med 2022; 46:366-376. [PMID: 35305205 PMCID: PMC8933612 DOI: 10.1007/s10865-022-00304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
Due to cancer survivors’ increased vulnerability to complications from COVID-19, addressing vaccine hesitancy and improving vaccine uptake among this population is a public health priority. However, several factors may complicate efforts to increase vaccine confidence in this population, including the underrepresentation of cancer patients in COVID-19 vaccine trials and distinct recommendations for vaccine administration and timing for certain subgroups of survivors. Evidence suggests vaccine communication efforts targeting survivors could benefit from strategies that consider factors such as social norms, risk perceptions, and trust. However, additional behavioral research is needed to help the clinical and public health community better understand, and more effectively respond to, drivers of vaccine hesitancy among survivors and ensure optimal protection against COVID-19 for this at-risk population. Knowledge generated by this research could also have an impact beyond the current COVID-19 pandemic by informing future vaccination efforts and communication with cancer survivors more broadly.
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Affiliation(s)
- Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA.
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA.,ICF Next, Rockville, MD, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA
| | - Emily S Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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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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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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Zimet GD, Osazuwa-Peters N. There's Much Yet to be Done: Diverse Perspectives on HPV Vaccination. Hum Vaccin Immunother 2020; 15:1459-1464. [PMID: 31365327 PMCID: PMC6746479 DOI: 10.1080/21645515.2019.1640559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Gregory D Zimet
- a Department of Pediatrics, School of Medicine, Indiana University , Indianapolis , IN , USA
| | - Nosayaba Osazuwa-Peters
- b Department of Otolaryngology-Head and Neck Surgery, Saint Louis University , St Louis , MO , USA
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Castellino SM, Allen KE, Pleasant K, Keyes G, Poehling KA, Tooze JA. Suboptimal uptake of human papillomavirus (HPV) vaccine in survivors of childhood and adolescent and young adult (AYA) cancer. J Cancer Surviv 2019; 13:730-738. [PMID: 31342304 DOI: 10.1007/s11764-019-00791-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/13/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To estimate the population-based incidence of HPV vaccination after childhood cancer. METHODS Pediatric and young adult cancer survivors identified in the institutional Comprehensive Cancer Center registry were linked to the North Carolina Immunization Registry (NCIR). Initiation and completion of any HPV vaccine was evaluated in survivors born between 1984 and 2002 with an NCIR record by December 2014. Descriptive statistics and Kaplan-Meier estimates of cumulative incidence were stratified by sex and age at eligibility for vaccine. Cox proportional hazards were conducted and stratified by sex. RESULTS Among 879 (n = 428 female; n = 451 male) study-eligible cancer survivors without prior HPV vaccination (n = 501 < 18 years, n = 378 ≥ 18 years at the time of eligibility), the cumulative incidence of HPV vaccine initiation following cancer therapy was 48.1% among females at 8.2 years and 29.2% among males at 5.0 years after vaccine eligibility among those < 18 years, and 6.2% among females at 8.1 years and 2.0% among males at 4.2 years after vaccine eligibility among those ≥ 18 years. Among those who initiated vaccination, 53% of females and 43% of males completed a 3-dose series. Younger age at cancer diagnosis (≤ 10 and 11-14 years vs. ≥ 15 years) and shorter interval from diagnosis to vaccine eligibility were more likely to initiate vaccination in models adjusted for age at eligibility, race/ethnicity, cancer type, relapse, and transplant. CONCLUSIONS Despite the benefit of a cancer prevention strategy, cancer survivors are sub-optimally vaccinated against HPV. IMPLICATIONS FOR CANCER SURVIVORS Immunization registries can help oncologists and primary care providers identify gaps in vaccination and target HPV vaccine delivery in survivors.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Pediatrics - Hematology/Oncology, Emory University School of Medicine; The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Kristen E Allen
- Department of Pediatrics - Hematology/Oncology, Emory University School of Medicine; The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Katherine Pleasant
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Graham Keyes
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine A Poehling
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
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