— But education and shared decision-making can convince some patients to get vaccinated
Contributing Writer, MedPage Today
September 5, 2023
Most respondents to a survey conducted at an academic medical center were not informed of the relationship between human papillomavirus (HPV) and throat cancer by their healthcare providers, a study showed.
Among 271 respondents who visited an otolaryngology clinic, only 23.3% understood the relationship between HPV infection and throat cancer and a mere 7.4% said they knew that throat cancer is the most common HPV-associated cancer type, reported Daniel Faden, MD, of Boston Medical Center and Mass Eye and Ear, and colleagues.
Most respondents also said their doctors had never told them that the HPV vaccine protects against throat cancer, the authors noted in JAMA Otolaryngology – Head & Neck Surgery.
Most healthcare practitioners discuss the vaccine solely in the context of cervical cancer, said Faden and co-authors, pointing out that HPV vaccination rates could be increased by counseling both men and women about the link between HPV and throat cancer, rather than only focusing on the cervical cancer connection.
However, physicians and other providers “may not feel comfortable or well informed enough to discuss the relationship between HPV and OPSCC [oropharyngeal squamous cell carcinoma],” they wrote. “Healthcare practitioners, who typically recommend vaccines, do not routinely talk to their patients about the relationship between HPV and OPSCC in part due to lack of knowledge and comfort surrounding the topic.”
Of 156 respondents who were not vaccinated, 12.2% of men and 5.3% of women received point-of-care vaccination after discussing the link with an otolaryngologist during their visit. Of those who declined vaccination, the reasons for refusal were no time to stay for vaccination, attempting to get pregnant, and wanting to do more research. Four people gave no reason.
In the overall analysis, 78.6% of participants had heard of HPV and 84% had heard of the HPV vaccine; 61.3% knew that HPV is spread through sexual contact, and 46.6% knew that HPV can cause cancer. About 63% incorrectly said that cervical cancer is the most prevalent HPV-associated cancer.
Women were more likely than men to be vaccinated (OR 6.5, 95% CI 3.0-13.9), more aware that HPV causes cancer (OR 3.7, 95% CI 1.9-7.1), and more likely to have heard about HPV and HPV vaccination from their healthcare provider (OR 2.6, 95% CI 1.2-5.7).
“This may be partially due to the efforts by the American College of Obstetrics and Gynecology, whose guidelines recommend that all patients receiving care are offered the HPV vaccine,” Faden and team noted. Despite this understanding, vaccinated women were as ignorant as unvaccinated men about the relationship between HPV and throat cancer (OR 1.7, 95% CI 0.9-3.2).
White patients were more likely to be vaccinated compared with other racial or ethnic groups (OR 2.6, 95% CI 1.3-5.3), and were more likely to know that HPV causes cancer (OR 3.3, 95% CI 1.7-6.4), and to have a positive opinion about the vaccine (OR 2.9, 95% CI 1.4-6.1). However, white patients were no more likely to be aware of the HPV/throat cancer connection versus other groups.
College education increased the odds of knowing that HPV causes cancer in general and throat cancer specifically.
White, college-educated women were most likely to be fully vaccinated, and non-white men without a college education were least likely to be vaccinated, and also the least likely to be interested in getting a vaccine. Among the unvaccinated patients who were interested in the vaccine, the most cited reason for not being vaccinated was that their doctor had not recommended it (24%).
After adjusting for race and ethnicity, gender, educational level, and age, participants were significantly less likely to be vaccinated if a doctor didn’t recommend it (OR 0.1, 95% CI 0.01-0.7), and were more likely to have a positive outlook on the HPV vaccine if they were told about it from a healthcare worker (OR 2.6, 95% CI 1.1-6.3). They were more likely to be vaccinated if they had been educated about the vaccine (OR 3.8, 95% CI 1.0-14.5), if they knew that HPV causes cancer (OR 4.1, 95% CI 1.8-9.5) and if they were aware of the HPV/throat cancer link (OR 3.7, 95% CI 1.8-7.6).
“Our findings, supported by other research, point to the necessity of interventions that illustrate to adults how HPV vaccines can protect against developing cancer, especially OPSCC,” Faden and colleagues wrote. “Doing so may palliate the vaccination gap between genders and increase overall coverage.”
“Future research should focus on the development of an educational intervention that can be deployed without provider support to efficiently improve vaccination knowledge gaps and optimize patient and HCP [healthcare practitioner] comfort,” they added.
For this study, the researchers included patients ages 18 to 45 who sought routine outpatient care at the otolaryngology clinic at Boston Medical Center from September 2020 to May 2021. They were surveyed using the HPV-Associated Head and Neck Cancer Epidemiology, Awareness and Demographics survey.
Three questions assess demographics, five assess the patient’s knowledge about HPV and the HPV vaccine, and three ask about the patient’s HPV vaccination status. Other questions ask about the person’s willingness to get the vaccine; if the patient declined, follow-up questions identify the reasons for this. If the patient was willing, the vaccine was administered.
The survey was distributed to 405 patients, 288 responded, and the final dataset included 271 surveys. Median age was 29, 58.3% were women, 39.8% were white, 24.7% were Asian, 22.1% were Black, and 50.8% had a college degree.
Of these participants, 26.6% were fully vaccinated against HPV, 8.9% had an incomplete vaccine series, and 57.6% were unvaccinated. Of the 72 fully vaccinated patients, 60 were women and 12 were men.
The findings of this study were limited to a study population from a single otolaryngology clinic in an urban, academic medical center, and may not be fully generalizable to the U.S. population, Faden and team noted.
Faden reported receiving personal fees from Merck, Neotic, Focus, Bristol Myers Squibb, Chrystalis Biomedical Advisors, and Guidepoint, nonfinancial support from BostonGene and Predicine, and grants from Calico outside the study. A co-author reported receiving grants from the American Head and Neck Cancer Society during the conduct of the study.
JAMA Otolaryngology – Head & Neck Surgery
Source Reference: Bloom JC, et al “Deciphering knowledge and opinions of human papillomavirus and human papillomavirus vaccination for facilitation of point-of-care vaccination in adults” JAMA Otolaryngol Head Neck Surg 2023; DOI: 10.1001/jamaoto.2023.2073.