Childhood Cancer Survivors Have Low Rates of HPV Vaccination

Survivors of childhood cancer are less likely than the general population to receive the human papillomavirus (HPV) vaccine, according to a study.

“This study shows that an effective, affordable, and widely available tool for cancer prevention is being underutilized by survivors of childhood cancer,” said study author James L. Klosky, PhD, of St. Jude Children’s Research Hospital in Memphis, in a press release from the American Society of Clinical Oncology (ASCO).

Current recommendations call for HPV vaccination for boys and girls age 9 to 26. The new study assessed vaccination rates along with sociodemographic and clinical characteristics of 982 cancer survivors, age 9 to 26 years, and compared those with a matched group from the National Immunization Survey-Teen and the National Health Interview Survey. Results were published in the Journal of Clinical Oncology.

Patients had a mean age of 16.3 years, and had been off of cancer therapy for a mean of 2.7 years. The most common cancers were leukemias and lymphomas, representing 59% of the cohort.

HPV vaccine initiation rates were significantly lower in the cancer survivors compared with the general population, at 23.8% vs 40.5%, respectively (P < .001). Survivors of childhood cancer were more likely to be HPV vaccine–naive vs the general population, with an odds ratio (OR) of 1.72 (95% CI, 1.41–2.09; P < .001).

The difference was most striking among adolescent survivors age 13 to 17 years. In these patients, the vaccine initiation rate was 22.0%, compared with 42.5% in the general population (P < .001). Young adult survivors (age 18 to 26 years) had similarly low rates of vaccine initiation to the general population, at 25.3% compared with 24.2%.

Several factors emerged as predictors for the failure to initiate HPV vaccination. The lack of a provider’s recommendation was among the strongest of these, with an OR of 10.8 (95% CI, 6.5–18.0; P < .001). The survivors’ belief that their insurance did not cover HPV vaccination was also a strong predictor, with an OR of 6.6 (95% CI, 3.9–11.0; P < .001). Male sex, endorsement of vaccine-related barriers, and younger age were also significant predictors.

“As clinicians, we need to initiate more conversations about HPV vaccination, especially with childhood cancer survivors because they stand to benefit even more than their peers,” Klosky said.

Merry-Jennifer Markham, MD, an expert in cancer survivorship with ASCO, noted that though young cancer survivors are now living long lives following treatment, their health remains vulnerable. “It’s concerning that the majority of survivors are not taking full advantage of HPV vaccination, which is widely available and can help them stay cancer-free,” she said. “Oncologists and primary care physicians are trusted resources for young survivors, and while barriers to HPV vaccination certainly exist, this study suggests that starting a conversation can help break down at least one.”