Introduction

Childhood cancer survivors (CCS) are at increased risk of HPV-related cancers and yet are under vaccinated as compared to peers without a history of cancer. Many CCS do not transition back to general pediatrics for preventive care, instead seeing only their oncologist. Prior to this study, few pediatric oncology settings provided HPV vaccines on site. We developed and implemented an intervention in pediatric oncology settings to increase HPV vaccination rates among CCS.

Methods

Five pediatric oncology programs that are part of the Texas Pediatric Minority Underserved NCORP participated in the program. At each site we conducted annual HPV vaccine education programs including best practices for making strong HPV vaccine recommendations. We also worked with each site to develop individualized plans for providing the HPV vaccine in their clinics during regularly scheduled visits with CCS who were aged 9-26 (upper age expanded to 45 after FDA/ACIP approval) and at least 6 months off active treatment. We assessed HPV vaccine initiation (at least one dose) and completion (three doses) at baseline and annually and compared these rates to Texas and U.S. vaccination rates.

Results

At baseline in 2018, the overall rate of HPV vaccine initiation for CCS across the five participating sites was 30% and completion rate was 15%, which was significantly lower than 2018 NIS-Teen rates for both Texas (60% initiation, 44% completion) and U.S. (68% initiation, 51% completion).

As of August 2022, HPV vaccine rates among CCS who had been seen at the five participating sites since baseline had increased to 88% overall at initiation (including 91% of female CCS, 86% of male CCS) and 53% overall at completion (including 56% of female CCS, 50% of male CCS). This represents a 261% increase in HPV vaccine completion among CCS since baseline. These CCS rates exceeded the rate of completion in Texas (52% overall, 55% female, 48% male) and neared the 62% completion in the U.S (64% female, 60% male) using 2021 NIS-Teen data.

Conclusion

Recommending HPV vaccine to CCS and offering the vaccine on-site at oncology clinics is a feasible and effective way of increasing HPV vaccines among this vulnerable group. Future work should expand this to other oncology settings and make HPV vaccination, a form of cancer prevention, a standard of care for CCS.