Early COVID-19 Vaccine Initiation and Completion Among Cancer Survivors and Barriers to Vaccine Completion: Implications for Future COVID-19 Vaccination Uptake Rates

Abstract

Purpose

Cancer survivors are considered by public health officials as a high-risk group in the United States for severe complications from COVID-19. We aimed to characterize patterns of early uptake of the COVID-19 vaccine among cancer survivors and to determine modifiable barriers to vaccine completion that can be addressed to ensure future booster adherence.

Methods

Cross-sectional data of vaccine uptake by summer 2021 was extracted from adult cancer survivors enrolled in the “All of Us” research program. Vaccine completion was determined based on receiving at least two doses. We assessed sociodemographic factors, socioeconomic barriers (education, income, health insurance status, housing, and employment status), and COVID-19 vaccine uptake by Summer 2021, employing multivariable ordinal logistic regression for those who were unvaccinated, had initiated vaccine uptake, and had completed COVID-19 vaccination.

Results

Of the 514 cancer survivors in the sample, 73.7% were fully vaccinated by summer 2021. Those who received no vaccine doses showed higher proportions of SES barriers, medical distrust, and perceived lack of need barriers. Race (non-Hispanic White vs. other) was not statistically significantly associated with vaccine uptake (OR (95% CI) = 0.94 (0.51, 1.70)), while for every additional SES barrier, there was a 40% decrease (OR (95% CI) = 0.60 (0.48, 0.75)) in the odds of receiving more COVID-19 vaccine doses. Higher medical distrust and perceived lack of need were associated with 56% (OR = 0.44, 95% CI: 0.32–0.59) and 39% (OR = 0.61, 95% CI: 0.43–0.87) lower odds, respectively.

Conclusion

Racial/ethnic disparities in vaccine uptake may be explained by SES barriers. Addressing SES disparities and fostering medical trust may enhance future COVID-19 vaccination uptake rates for this high-risk group.