Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Cancer. 2023 Feb 15;129(4):614-623. doi: 10.1002/cncr.34521. Epub 2022 Dec 19.
Cancer survivors are at risk for developing subsequent human papillomavirus (HPV)-related malignancies. HPV vaccination rates among survivors remain low, and the reasons for refusal of the vaccine are unclear in this population.
The authors conducted a secondary analysis of data from an open-label clinical trial evaluating the immunogenicity and safety of the HPV vaccine among vaccine-naive cancer survivors who were 9-26 years old and 1-5 years from the completion of their cancer treatment. Survivors/parents who declined trial participation were asked their reasons for declining. Refusal reasons were categorized, and multivariable logistic regression models were developed to identify associations between survivor characteristics and primary refusal reasons.
Among the 301 survivors who refused participation in the clinical trial, 215 (71.4%) refused for reasons related to the HPV vaccine. Reasons for vaccine-related refusal included safety concerns, vaccine hesitancy/disinterest, external influences, vaccine-related information deficits, and health beliefs/family decisional processes. Compared with males, females were more likely to refuse for reasons related to health beliefs/family decisional processes (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.12-3.93; p = .022) and were less likely to do so because of external influences (OR, 0.43; 95% CI, 0.19-0.92; p = .035). Survivors approached about participation during the latter years of the trial were more likely to refuse because of safety concerns (OR, 3.33; 95% CI, 1.55-7.69; p = .003).
Cancer survivors refused participation in an open-label trial evaluating the immunogenicity and safety of the HPV vaccine primarily because of vaccine-related concerns that were unrelated to the research study. Many of these concerns are potentially addressable by health care providers using evidence-based messages tailored to the cancer survivor population.
癌症幸存者有发展后续人乳头瘤病毒（HPV）相关恶性肿瘤的风险。幸存者中的 HPV 疫苗接种率仍然很低，并且不清楚在这一人群中拒绝接种疫苗的原因。
作者对一项开放性临床试验的数据进行了二次分析，该试验评估了 HPV 疫苗在 9-26 岁且癌症治疗完成后 1-5 年的 HPV 疫苗初免癌症幸存者中的免疫原性和安全性。拒绝参加试验的幸存者/父母被问及拒绝的原因。将拒绝原因进行分类，并建立多变量逻辑回归模型，以确定幸存者特征与主要拒绝原因之间的关联。
在 301 名拒绝参加临床试验的幸存者中，有 215 名（71.4%）因与 HPV 疫苗相关的原因拒绝参加。疫苗相关拒绝的原因包括安全性担忧、疫苗犹豫/不感兴趣、外部影响、疫苗相关信息不足以及健康信念/家庭决策过程。与男性相比，女性更有可能因健康信念/家庭决策过程方面的原因而拒绝（比值比[OR]，2.08；95%置信区间[CI]，1.12-3.93；p =.022），而不太可能因外部影响而拒绝（OR，0.43；95% CI，0.19-0.92；p =.035）。在试验后期被邀请参加的幸存者更有可能因为安全性问题而拒绝（OR，3.33；95% CI，1.55-7.69；p =.003）。
癌症幸存者拒绝参加一项评估 HPV 疫苗免疫原性和安全性的开放性试验，主要是因为与疫苗相关的担忧与研究无关。许多此类担忧可以通过医疗保健提供者使用针对癌症幸存者人群的循证信息来解决。
