In a study reported in the Journal of Clinical Oncology, York et al found that perceived lack of insurance coverage for human papillomavirus (HPV) vaccine, male sex, and decreased parent-survivor communication regarding HPV vaccination were among the factors associated with an increased likelihood that health-care providers did not recommend HPV vaccination in young survivors of childhood cancers.
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As stated by the investigators, “Young cancer survivors are at increased risk for morbidities related to infection with HPV, yet their HPV vaccine initiation rates remain low.”
Study Details
The study was a post hoc analysis of data from a cross-sectional survey of young cancer survivors aged 9 to 26 years who were off cancer therapy for 1 to 5 years. The study period was from 2012 to 2015, and the report examined survey data from patients at five National Cancer Institute–designated comprehensive cancer centers to determine the prevalence and predictors of HPV vaccine noninitiation (the HPV Vaccine in Childhood Cancer Survivors Study).
Parents completed the survey for survivors aged 9 to 17 years.
Key Findings
Among 955 survivors completing the survey, 54% were male, 66% were non-Hispanic white, 36% had leukemia, and 96% reported having health insurance coverage. At the time of the survey, the average age of patients was 16.3 years, and they had been off therapy for an average of 32.8 months.
Overall, lack of provider HPV vaccine recommendation was reported by 73% of participants.
On multivariate analysis including relevant patient-level sociodemographic, clinical, and vaccine-related variables, patient-level factors significantly associated with reported lack of provider recommendation for the entire cohort included a survivor-perceived lack of insurance coverage for the vaccine (odds ratio [OR] = 4.0, P < .001), male sex (OR = 2.8, P < .001), and decreased parent-survivor communication regarding HPV vaccination as measured on a 4-point scale (OR = 1.7 per unit decrease in score, P < .001).
In a sex-stratified analysis, significant factors were perceived lack of insurance coverage among female survivors (OR = 3.4, P < .001) and perceived lack of insurance coverage (OR = 5.5, P < .001) and decreased parent-survivor communication (OR per unit decrease in score = 1.9, P < .001) among male survivors.
Age-stratified analysis consisted of two age categories: 9 to 17 years and 18 to 26 years. Among survivors aged 9 to 17 years, significant factors were perceived lack of insurance coverage (OR = 4.9, P < .001), black race (OR = 3.1, P < .001), male sex (OR = 2.4, P < .001), and decreased parent-survivor communication (OR per unit decrease in score = 2.0, P < .001). Among survivors aged 18 to 26 years, significant factors were male sex (OR = 4.0, P < .001) and perceived lack of insurance coverage (OR = 3.2, P < .001).
The investigators concluded, “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.”
Wendy Landier, PhD, of the Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, University of Alabama at Birmingham, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute, Merck Sharp & Dohme Corp., and American Lebanese Syrian Associated Charities. For full disclosures of the study authors, visit ascopubs.org.
