Childhood Cancer Survivors Benefit From HPV Vaccine

Fran Lowry

November 08, 2018

ORLANDO, Florida — Survivors of childhood cancer are more likely to express intent to get vaccinated for the human papillomavirus (HPV) if a physician recommends it, and intent is a strong predictor of vaccine initiation, new research shows.

Brooke Cherven

"We know that less than 25% of childhood cancer survivors aged 13 to 26 report getting vaccinated against HPV, although they are at higher risk of developing HPV-related cancers because of their previous cancer therapy," said Brooke Cherven, RN, from the University of Alabama at Birmingham.

The vaccine is approved by the US Food and Drug Administration for males and females 9 to 26 years of age. Cancer survivors can miss their window for vaccination when they are undergoing cancer treatment, "so it's important to make sure they get a recommendation for the vaccine, even if they are not at that standard recommended preadolescent age," she explained.

A partnership between oncology and primary care providers can help "ensure that patients get a recommendation for the HPV vaccine," she said here at the American Academy of Pediatrics 2018 National Conference.

To identify predictors of HPV vaccine intent and subsequent initiation among survivors of childhood cancers, Cherven and her team surveyed 135 patients 1 to 5 years after they were treated at a pediatric cancer center in Georgia.

All respondents were 9 to 26 years of age (mean, 15.3 years), 58% had had leukemia or lymphoma, and mean time from completion of cancer therapy was 3.0 years.

At the time of the survey, 23.7% reported that they had started the HPV vaccine.

The researchers identified another 20.7% of respondents who initiated the vaccine during the subsequent 3.5-year follow-up period using the Georgia Registry for Immunization Transactions, which records all immunizations administered in the state.

However, the remaining 55.6% of respondents remained unvaccinated 3.5 years after being surveyed.

Respondents who received a recommendation for the HPV vaccination from their provider were five times more likely to express their intention to get vaccinated than respondents who received no such recommendation (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.4 - 18.4; P = .01).

Other factors associated with vaccine intent were a positive attitude toward vaccines (OR, 4.7; 95% CI, 2.0 - 11.2; P < .01) and the perceived severity of HPV infection (OR, 3.5; 95% CI, 1.25 - 9.9; P = .02).

Survey respondents who reported their intention to get vaccinated were more likely to do so during the 3.5-year follow-up period than those who did not report intent (47% vs 17%; OR, 3.9; 95% CI, 1.2 - 12.5; P = .02).

"I was very encouraged by this result because it intuitively makes sense that if someone says, 'yes, I am intending to get the vaccine,' they would go ahead and get it at some point," said Cherven.

However, more than half the respondents did not initiate HPV vaccination and remain at risk for HPV infection and subsequent cancers, she added.

HPV-Related Cancers

These findings reinforce the need for healthcare providers, working in the oncology or primary care setting, "to talk to our patients about the vaccine and its importance in terms of their future health," she said.

Cora Breuner

"This is a wonderful study," said Cora Breuner, MD, from Seattle Children's Hospital.

It is likely that subspecialists who are taking care of childhood cancer survivors "aren't spending enough time on preventive care because there is no time," she told Medscape Medical News.

As a provider, "you want to stay on top of recurrences, you want to stay on top of remission, you want to stay on top of blood counts, and so on," she pointed out, adding that she understands that preventive care, such as HPV vaccination, "wouldn't be the first thing" providers would think about.

"However, it is the most important thing to think about because these kids are very vulnerable. Their immune systems have been completely tanked with the treatment they've been through," said Breuner.

Some people mistakenly believe that young survivors of childhood cancers won't be sexually active, but "these kids are very interested in being like their peers, developing relationships and becoming sexually active," she explained. In fact, "some may even engage in high-risk behavior, in terms of sex without condoms, because it's just not a conversation they've had with their providers."

To be honest, "many oncologists and other subspecialists are very uncomfortable talking to teenagers about this," she added.

The purpose of the HPV vaccine is to prevent cervical, oropharyngeal, and anorectal cancers, said Breuner. "I think that if these kids realized that they could get a vaccine to prevent cancer coming back in another form, they would rush to it."

A possible solution would be to incorporate HPV vaccination into protocols for the treatment of childhood cancers, she suggested.

Patients who undergo kidney transplantation receive appropriate vaccinations. "It's not an option for them; they cannot refuse," she explained.

"We could do something similar regarding the HPV vaccine. And there may be other vaccines that these kids are behind on besides HPV," she pointed out.

The study was funded by the National Cancer Institute and Merck. Cherven and Breuner have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2018. Presented November 5, 2018.

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