University of Alabama at Birmingham, Birmingham, AL.
Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
J Clin Oncol. 2020 Sep 1;38(25):2892-2901. doi: 10.1200/JCO.19.02026. Epub 2020 Jun 18.
Young cancer survivors are at increased risk for morbidities related to infection with the human papillomavirus (HPV), yet their HPV vaccine initiation rates remain low. Patient-/parent-reported lack of health care provider recommendation for HPV vaccination is strongly associated with vaccine noninitiation. We aimed to identify patient-level factors associated with survivor-/parent-reported lack of provider recommendation for HPV vaccination among young cancer survivors.
Cancer survivors ages 9-26 years and 1-5 years off therapy completed a cross-sectional survey (parent-completed for survivors 9-17 years of age). Lack of health care provider HPV vaccine recommendation was the outcome of interest in a multivariable logistic regression model that included relevant patient-level sociodemographic, clinical, and vaccine-related variables.
Of 955 survivors, 54% were male, 66% were non-Hispanic White, and 36% had leukemia. At survey participation, survivors were an average age (± standard deviation) of 16.3 ± 4.7 years and 32.8 ± 14.7 months off therapy. Lack of provider HPV vaccine recommendation was reported by 73% (95% CI, 70% to 75%) of survivors. For the entire cohort, patient-level factors associated with lack of reported provider recommendation included perceived lack of insurance coverage for the HPV vaccine (odds ratio [OR], 4.0; 95% CI, 2.7 to 5.9; < .001), male sex (OR, 2.8; 95% CI, 1.9 to 4.0; < .001), and decreased parent-survivor communication regarding HPV vaccination (OR, 1.7 per unit decrease in score; 95% CI, 1.3 to 2.2; < .001). In the sex- and age-stratified models, perceived lack of insurance coverage (all models) and male sex (age-stratified models) were also significantly associated with lack of reported provider recommendation.
We identified factors characterizing survivors at risk for not reporting receipt of a health care provider HPV vaccine recommendation. Future research is needed to develop interventions that facilitate effective provider recommendations for HPV vaccination among all young cancer survivors.
年轻癌症幸存者感染人乳头瘤病毒（HPV）相关疾病的风险增加，但他们的 HPV 疫苗接种率仍然很低。患者/家长报告称，医疗服务提供者未建议接种 HPV 疫苗，这与疫苗接种未启动密切相关。我们旨在确定与年轻癌症幸存者报告的医疗服务提供者未建议接种 HPV 疫苗相关的患者层面因素。
9-26 岁的癌症幸存者和治疗后 1-5 年的幸存者完成了一项横断面调查（9-17 岁的幸存者由家长完成）。在多变量逻辑回归模型中，将与患者相关的社会人口统计学、临床和疫苗相关变量纳入其中，将缺乏医疗服务提供者 HPV 疫苗推荐作为感兴趣的结局。
在 955 名幸存者中，54%为男性，66%为非西班牙裔白人，36%患有白血病。在参与调查时，幸存者的平均年龄（±标准差）为 16.3 ± 4.7 岁，治疗后 32.8 ± 14.7 个月。报告称缺乏提供者 HPV 疫苗推荐的幸存者占 73%（95%CI，70%-75%）。对于整个队列，与缺乏报告的提供者推荐相关的患者层面因素包括感知到 HPV 疫苗的保险覆盖不足（比值比 [OR]，4.0；95%CI，2.7 至 5.9；<0.001）、男性（OR，2.8；95%CI，1.9 至 4.0；<0.001）和父母与幸存者之间关于 HPV 疫苗接种的沟通减少（OR，评分每降低 1 单位，增加 1.7；95%CI，1.3 至 2.2；<0.001）。在按性别和年龄分层的模型中，感知到的保险不足（所有模型）和男性（按年龄分层的模型）也与缺乏报告的提供者推荐显著相关。
我们确定了一些特征，这些特征可以描述那些报告未收到医疗服务提供者 HPV 疫苗推荐的幸存者。需要进一步研究制定干预措施，以促进所有年轻癌症幸存者有效获得 HPV 疫苗接种建议。
