Suboptimal uptake of human papillomavirus (HPV) vaccine in survivors of childhood and adolescent and young adult (AYA) cancer
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To estimate the population-based incidence of HPV vaccination after childhood cancer.
Pediatric and young adult cancer survivors identified in the institutional Comprehensive Cancer Center registry were linked to the North Carolina Immunization Registry (NCIR). Initiation and completion of any HPV vaccine was evaluated in survivors born between 1984 and 2002 with an NCIR record by December 2014. Descriptive statistics and Kaplan-Meier estimates of cumulative incidence were stratified by sex and age at eligibility for vaccine. Cox proportional hazards were conducted and stratified by sex.
Among 879 (n = 428 female; n = 451 male) study-eligible cancer survivors without prior HPV vaccination (n = 501 < 18 years, n = 378 ≥ 18 years at the time of eligibility), the cumulative incidence of HPV vaccine initiation following cancer therapy was 48.1% among females at 8.2 years and 29.2% among males at 5.0 years after vaccine eligibility among those < 18 years, and 6.2% among females at 8.1 years and 2.0% among males at 4.2 years after vaccine eligibility among those ≥ 18 years. Among those who initiated vaccination, 53% of females and 43% of males completed a 3-dose series. Younger age at cancer diagnosis (≤ 10 and 11–14 years vs. ≥ 15 years) and shorter interval from diagnosis to vaccine eligibility were more likely to initiate vaccination in models adjusted for age at eligibility, race/ethnicity, cancer type, relapse, and transplant.
Despite the benefit of a cancer prevention strategy, cancer survivors are sub-optimally vaccinated against HPV.
Implications for Cancer Survivors
Immunization registries can help oncologists and primary care providers identify gaps in vaccination and target HPV vaccine delivery in survivors.
KeywordsHuman papilloma virus (HPV) vaccine Childhood cancer Adolescent and young adult (AYA) cancer survivor Vaccine-preventable disease Immunization registry
The authors would like to thank the Department of Emory Department of Pediatrics Grant and Manuscript Support Core.
Wake Forest Vaccine Center grant (Castellino); Biostatistics and Bioinformatics Shared Resource, Wake Forest Comprehensive Cancer Center , and NCI Cancer Center Support Grant (P30 CA012197).
Compliance with ethical standards
Conflict of interest
Dr. Castellino receives research funding from Bristol Meyers Squibb for an observational study not relevant to this work. Dr. Poehling received research funding for observational studies from the National Institutes of Health and MedImmune for an observational study not relevant to this work. The remaining authors declare they have no conflict of interest.
Compliance of ethical approval
All procedures performed in the study were in accordance with the ethical standards and approval of the Wake Forest School of Medicine institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The IRB determined that the retrospective nature of this study using publicly available databases did not require individual informed consent.
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