Purpose Cancer survivors are at high risk for human papillomavirus (HPV)-related morbidities; we estimated the prevalence of HPV vaccine initiation in cancer survivors versus the US population and examined predictors of noninitiation. Methods Participants included 982 cancer survivors (9 to 26 years of age; 1 to 5 years postcompletion of therapy); we assessed HPV vaccine initiation, sociodemographic and clinical characteristics, and vaccine-specific health beliefs; age-, sex-, and year-matched US population comparisons were from the National Immunization Survey-Teen and the National Health Interview Survey (2012-2015). Results The mean age at the time of the study was 16.3 ± 4.7 years; the mean time off therapy was 2.7 ± 1.2 years; participants were 55% male and 66% non-Hispanic white; 59% had leukemia/lymphoma. Vaccine initiation rates were significantly lower in cancer survivors versus the general population (23.8%; 95% CI, 20.6% to 27.0% v 40.5%; 95% CI, 40.2% to 40.7%; P < .001); survivors were more likely to be HPV vaccine-naïve than general population peers (odds ratio [OR], 1.72; 95% CI, 1.41 to 2.09; P < .001). Initiation in adolescent survivors (ages 13 to 17 years) was 22.0% (95% CI, 17.3% to 26.7%), significantly lower than population peers (42.5%; 95% CI, 42.2% to 42.8%; P < .001). Initiation in young adult survivors and peers (ages 18 to 26 years) was comparably low (25.3%; 95% CI, 20.9% to 29.7% v 24.2%; 95% CI, 23.6% to 24.9%). Predictors of noninitiation included lack of provider recommendation (OR, 10.8; 95% CI, 6.5 to 18.0; P < .001), survivors' perceived lack of insurance coverage for HPV vaccine (OR, 6.6; 95% CI, 3.9 to 11.0; P < .001), male sex (OR, 2.9; 95% CI, 1.7 to 4.8; P < .001), endorsement of vaccine-related barriers (OR, 2.7; 95% CI, 1.6 to 4.6; P < .001), and younger age (9 to 12 years; OR, 3.7; 95% CI, 1.8-7.6; P < .001; comparison, 13 to 17 years). Conclusion HPV vaccine initiation rates in cancer survivors are low. Lack of provider recommendation and barriers to vaccine receipt should be targeted in vaccine promotion efforts.

中文翻译：

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年轻癌症幸存者的人乳头瘤病毒疫苗接种率

目的 癌症幸存者罹患人乳头瘤病毒 (HPV) 相关疾病的风险较高；我们评估了癌症幸存者与美国人群中 HPV 疫苗接种的流行率，并检查了不接种疫苗的预测因素。方法 参与者包括 982 名癌症幸存者（9 至 26 岁；治疗完成后 1 至 5 年）；我们评估了 HPV 疫苗的接种、社会人口学和临床特征以及针对疫苗的健康信念；年龄、性别和年份匹配的美国人口比较来自国家青少年免疫调查和国家健康访谈调查（2012-2015）。结果 研究时的平均年龄为 16.3 ± 4.7 岁；平均停药时间为 2.7 ± 1.2 年；参与者中 55% 为男性，66% 为非西班牙裔白人；59% 患有白血病/淋巴瘤。与一般人群相比，癌症幸存者的疫苗接种率显着较低（23.8%；95% CI，20.6% 至 27.0% vs 40.5%；95% CI，40.2% 至 40.7%；P < .001）；与普通人群相比，幸存者更有可能未接种 HPV 疫苗（比值比 [OR]，1.72；95% CI，1.41 至 2.09；P < .001）。青少年幸存者（13 至 17 岁）的起始率为 22.0%（95% CI，17.3% 至 26.7%），显着低于同龄人（42.5%；95% CI，42.2% 至 42.8%；P < .001） 。年轻成年幸存者和同龄人（18 至 26 岁）的起始程度相对较低（25.3%；95% CI，20.9% 至 29.7% vs 24.2%；95% CI，23.6% 至 24.9%）。不开始接种的预测因素包括缺乏提供者推荐（OR，10.8；95% CI，6.5 至 18.0；P < .001）、幸存者认为缺乏 HPV 疫苗保险覆盖（OR，6.6；95% CI，3.9 至 11.0； P < .001）、男性（OR，2.9；95% CI，1.7 至 4.8；P < .001）、疫苗相关障碍的认可（OR，2.7；95% CI，1.6 至 4.6；P < .001 ）和年龄较小（9 至 12 岁；OR，3.7；95% CI，1.8-7.6；P < .001；比较，13 至 17 岁）。结论 癌症幸存者的 HPV 疫苗接种率较低。缺乏提供者推荐和疫苗接种障碍应成为疫苗推广工作的目标。