Human Papillomavirus Vaccination in Adult Survivors of Childhood, Adolescent, and Young Adult Cancers: A Missed Opportunity

Introduction Studies assessing human papillomavirus (HPV) vaccination uptake in survivors of childhood, adolescent, and young adult (CAYA) cancers are sparse. We examined HPV vaccine uptake between survivors of CAYA cancer aged 18-35 and 18-35-year-old respondents without a cancer diagnosis in the United States. Methods We used the 2017-2018 National Health Interview Survey, a national, annual cross-sectional national dataset that monitors health-related information on the non-institutionalized civilian population in the United States. Outcome variables included: 1) self-reported initiation of the HPV vaccine, defined as having received ≥1 dose, and 2) self-reported completion of the HPV vaccine, defined as having received ≥3 doses. The exposure variable was cancer survivorship, dichotomized as CAYA cancer survivors (those diagnosed with cancer during childhood, adolescence, or young adulthood) versus non-cancer survivors (no cancer diagnosis). -Weighted multivariable logistic regression models estimated the association between cancer survivorship and HPV vaccine initiation and completion, adjusting for socioeconomic covariates and factors related to healthcare access. Results A total of 2677 respondents were included in the study, of which 177 (5.3%) were CAYA cancer survivors. Overall, 28.0% of the study cohort initiated and 17.1% completed the HPV vaccine series. When stratified by cancer survivorship, initiation of the HPV vaccine (27.1%) and completion of the vaccine series (20.3%) among CAYA cancer survivors were comparable to respondents without cancer diagnosis (initiation: 28.1%, completion: 16.9%). After we controlled for covariates, cancer survivorship had neither a significant association with initiation of HPV vaccine (aOR=1.12; 95% CI, 0.71-1.79; P=0.6242) nor completion of HPV vaccine (aOR=1.37; 95% CI, 0.84-2.22; P=0.2055). Conclusions There was low HPV vaccination initiation and completion among both cohorts. CAYA may benefit the most from HPV vaccination, given that they are at a higher risk of developing secondary HPV-related cancer.