Klosky James L, Hudson Melissa M, Chen Yanjun, Connelly James A, Wasilewski-Masker Karen, Sun Can-Lan, Francisco Liton, Gustafson Laura, Russell Kathryn M, Sabbatini Gina, Flynn Jessica S, York Jocelyn M, Giuliano Anna R, Robison Leslie L, Wong F Lennie, Bhatia Smita, Landier Wendy
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.
J Clin Oncol. 2017 Nov 1;35(31):3582-3590. doi: 10.1200/JCO.2017.74.1843. Epub 2017 Aug 24.
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.
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).
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).
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.
癌症幸存者患人乳头瘤病毒（HPV）相关疾病的风险很高；我们估计了癌症幸存者与美国普通人群中HPV疫苗起始接种率，并研究了未接种疫苗的预测因素。
参与者包括982名癌症幸存者（年龄9至26岁；治疗结束后1至5年）；我们评估了HPV疫苗起始接种情况、社会人口统计学和临床特征以及特定疫苗的健康观念；年龄、性别和年份匹配的美国普通人群数据来自全国青少年免疫调查和全国健康访谈调查（2012 - 2015年）。
研究时的平均年龄为16.3±4.7岁；平均停止治疗时间为2.7±1.2年；参与者中55%为男性，66%为非西班牙裔白人；59%患有白血病/淋巴瘤。癌症幸存者的疫苗起始接种率显著低于普通人群（23.8%；95%置信区间，20.6%至27.0%对比40.5%；95%置信区间，40.2%至40.7%；P <.001）；与普通人群同龄人相比，幸存者更有可能未接种HPV疫苗（优势比[OR]，1.72；95%置信区间，1.41至2.09；P <.001）。青少年幸存者（13至17岁）的起始接种率为22.0%（95%置信区间，17.3%至26.7%），显著低于普通人群同龄人（42.5%；95%置信区间，42.2%至42.8%；P <.001）。年轻成年幸存者及其同龄人（18至26岁）的起始接种率同样较低（25.3%；95%置信区间，20.9%至29.7%对比24.2%；95%置信区间，23.6%至24.9%）。未接种疫苗的预测因素包括缺乏医生推荐（OR，10.8；95%置信区间，6.5至18.0；P <.001）、幸存者认为HPV疫苗缺乏保险覆盖（OR，6.6；95%置信区间，3.9至11.0；P <.001）、男性（OR，2.9；95%置信区间，1.7至4.8；P <.001）、认可疫苗相关障碍（OR，2.7；95%置信区间，1.6至4.6；P <.001）以及年龄较小（9至12岁；OR，3.7；95%置信区间，1.8 - 7.6；P <.001；对比13至17岁）。
癌症幸存者的HPV疫苗起始接种率较低。疫苗推广工作应针对缺乏医生推荐和疫苗接种障碍等问题。
