为什么年轻癌症患者拒绝人乳头瘤病毒疫苗

IF 503.1 1区 医学 Q1 ONCOLOGY CA: A Cancer Journal for Clinicians Pub Date : 2023-05-04 DOI:10.3322/caac.21781
Mike Fillon
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引用次数: 0

摘要

尽管他们患宫颈癌、口咽癌和其他人类乳头瘤病毒(HPV)相关癌症的风险较高,而且有强有力和一致的证据表明HPV疫苗的安全性和有效性,但许多年轻的癌症幸存者拒绝接种这种疫苗。在《癌症》杂志上发表的一项新研究中,来自埃默里大学医学院和Aflac癌症研究所的研究人员。血液疾病中心(均位于佐治亚州亚特兰大)、伯明翰阿拉巴马大学和圣裘德儿童研究医院(田纳西州孟菲斯)调查了许多年轻幸存者拒绝这种疫苗的原因(doi:10.1002/cncr.34521)。资深研究作者Wendy Landier博士,伯明翰阿拉巴马大学Marnix E. Heersink医学院儿科血液学/肿瘤学教授和癌症预后和幸存者研究所副主任,说这是第一个系统地描述一大群年轻癌症幸存者(或他们的父母)拒绝接种HPV疫苗的原因的研究。未接种HPV疫苗的儿童、青少年和年轻成人癌症幸存者被邀请参加2013年1月12日至2018年10月5日进行的一项开放标签临床试验,该试验评估了疫苗的免疫原性和四价HPV疫苗的安全性。根据兰迪尔博士的说法,“我们系统地实时记录了那些拒绝参与研究的人的拒绝原因。”两名研究人员独立审查了这些拒绝接种疫苗的原因,并为拒绝接种疫苗的主要和次要原因制定了编码清单。四名研究人员随后提出了拒绝理由的最后几类。研究了这些不同原因与参与者特征(包括性别、种族/民族、癌症诊断和年龄)之间的关系,以帮助指导临床医生更好地遵守疫苗指南。在755名有资格参加疫苗安全性和有效性研究的幸存者中,301名(39.9%)拒绝参加。在拒绝接种的人中,86名幸存者或其父母(28.6%)表示原因与HPV疫苗无关。例如,一些人说他们只是对参加任何研究不感兴趣或不舒服,或者担心与研究相关的抽血所需的针头,或者他们提到“后勤问题”。215名因疫苗相关原因拒绝参加临床试验的幸存者或其父母成为本研究的重点。约75%(75.3%)为非西班牙裔白人,53.0%为男性,54.9%患有白血病或淋巴瘤。幸存者年龄9.0 ~ 26.9岁;他们第一次参加研究的平均年龄是14.2岁。幸存者在接受研究前已完成癌症治疗1-5年(中位数,2.8年)。
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Why young patients with cancer refuse the human papillomavirus vaccine

Despite their elevated risk for developing cervical, oropharyngeal, and other human papillomavirus (HPV)–related cancers and the strong and consistent evidence for the HPV vaccine’s safety and efficacy, many young cancer survivors reject this vaccine. In a new study appearing in Cancer, researchers from Emory University School of Medicine and the Aflac Cancer & Blood Disorders Center (both in Atlanta, Georgia), the University of Alabama at Birmingham, and St. Jude Children’s Research Hospital (Memphis, Tennessee) investigate the reasons that many young survivors are rejecting this vaccine (doi:10.1002/cncr.34521).

Senior study author Wendy Landier, PhD, a professor in the Division of Pediatric Hematology/Oncology and deputy director of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, says that this is the first study to systematically characterize reasons for HPV vaccine refusal by a large group of young cancer survivors (or their parents).

HPV vaccine–naive childhood, adolescent, and young adult cancer survivors were invited to participate in an open-label clinical trial conducted from January 12, 2013, and October 5, 2018, that evaluated the immunogenicity of the vaccine and safety of a quadrivalent HPV vaccine. According to Dr Landier, “We methodically recorded study refusal reasons in real time for those declining participation.”

Two researchers independently reviewed these reasons for refusal and developed coding lists for primary and secondary reasons for declining the vaccine. Four of the study researchers then developed the final categories of reasons for refusal. Associations of these various reasons with participant characteristics, including sex, race/ethnicity, cancer diagnosis, and age, were examined to help guide clinicians in improving adherence with vaccine guidelines.

Of the 755 survivors eligible to participate in the study of vaccine safety and efficacy, 301 (39.9%) declined to participate. Among those who declined, 86 survivors or their parents (28.6%) cited reasons unrelated to the HPV vaccine. For example,

some said that they simply were not interested or were uncomfortable with taking part in any research study or had concerns about the needle sticks required for study-related blood draws, or they mentioned “logistical concerns.”

The 215 survivors or their parents who refused clinical trial participation for vaccine-related reasons became the focus of this study. Approximately 75% (75.3%) were non-Hispanic White, 53.0% were male, and 54.9% had had leukemia or lymphoma. The ages of the survivors ranged from 9.0 to 26.9 years; the median age at which they were first offered study participation was 14.2 years. The survivors had completed cancer therapy 1–5 years (median, 2.8 years) before they were offered the study.

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来源期刊
CiteScore
873.20
自引率
0.10%
发文量
51
审稿时长
1 months
期刊介绍: CA: A Cancer Journal for Clinicians" has been published by the American Cancer Society since 1950, making it one of the oldest peer-reviewed journals in oncology. It maintains the highest impact factor among all ISI-ranked journals. The journal effectively reaches a broad and diverse audience of health professionals, offering a unique platform to disseminate information on cancer prevention, early detection, various treatment modalities, palliative care, advocacy matters, quality-of-life topics, and more. As the premier journal of the American Cancer Society, it publishes mission-driven content that significantly influences patient care.
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