South Texas Young Adult Cancer Survivors: Voices on HPV Vaccination
Introduction
Adolescent and young adult (AYA) cancer survivors have a 70% increased risk of developing a secondary HPV-related cancer compared to their peers. Yet, despite this risk, HPV vaccination in AYA cancer survivors remains low compared to the general population (23.8% vs. 40.5%). Confusion persists for patients and providers around patient eligibility for vaccination and when to vaccinate. The South Texas AYA population is of particular interest given the majority Hispanic/Latino ethnicity and disparities in this region regarding access to cancer care, cancer screening, and survival outcomes. In this study, we sought to identify patient-level attitudes, beliefs, and behaviors related to HPV vaccination among South Texas AYA cancer survivors through the development and dissemination of a dual language “AYA HPV landscape survey.”
Methods
An electronic REDCap survey was developed to obtain baseline patient-reported information about HPV vaccination among AYA survivors seen January-April 2023 at Mays Cancer Center, a “Hispanic-serving” NCI-designated cancer center. Eligible participants included those ages 18-45 years previously treated for any cancer with an email address on file. The Multi-Language Management System in REDCap allowed patients to choose English or Spanish versions of the survey which included 23 multiple choice questions with branching logic to guide response-adapted query. Survey content was developed across three topic areas: participant demographics; social determinants of health that can impact HPV vaccine access; and HPV-focused questions about risks, education, and motivation about the virus and vaccine.
Results
The survey was distributed via email to 333 participants and 45 surveys were completed (13.5% response rate). Most respondents were females (82.2%) ages 19-45 with a high school education or higher (88.9%). Half identified as Hispanic/Latino (53.3%). Carcinoma was the most common prior cancer type (66.7%) and half were still receiving cancer treatment (51.1%). The majority of participants had no prior HPV vaccine (73.3%), mostly due to no PCP recommendation or uncertainty about eligibility (60.6%). The remaining respondents were HPV-vaccinated females ages 20-45 with health insurance and a PCP (26.7%). Among them, 83.3% received their HPV vaccine series before their cancer diagnosis. Some respondents were aware that the HPV vaccine prevents six cancer types (20%), and only 4.4% received an HPV vaccine recommendation by their PCP or oncologist. A minority of participants believe they are at an increased risk of acquiring an HPV-related cancer (17.7%), with 62.5% of these attributing their increased risk to their previous cancer diagnosis.
Conclusion
HPV recommendation and vaccination is an underutilized survivorship care guideline in the AYA cancer survivor population. Most young adult survivors were HPV unvaccinated (73.3%) and few (<20%) felt they had increased risk for an HPV-driven cancer, providing strong rationale for patient education about HPV-related cancers and AYA cancer survivors’ risk. Few respondents were recommended the HPV vaccine by their PCP or oncologist, highlighting needs for provider-targeted interventions to improve vaccination rates. Results of this survey will be used to guide next-step implementation studies targeting improved provider recommendation, AYA survivor education, and uptake of HPV vaccination.