To describe knowledge about human papillomavirus (HPV), HPV-related care behavior, and advocacy intent (e.g., vaccine recommendation and willingness to become an advocate for vaccination) and to investigate associations between knowledge, HPV-related care behavior, and advocacy intent among HPV-related cancer survivors.
A cross-sectional online survey was offered through Qualtrics to HPV-related cancer survivors who were either volunteers at a cancer center or patients of survivorship clinics.
A total of 200 survivors responded. Only 33.2% of respondents reported knowing their cancer was HPV-related and 56.8% reported HPV vaccine is safe. Participants who knew that their cancer was caused by HPV were more likely to have vaccinated their children (p < .001). Also, participants who knew that the vaccine is safe were more willing to recommend the vaccine (p < .001), to be a peer mentor for others with HPV-related cancers (43.2% vs. 14.0%, p < .001), and to act as an advocate for increasing vaccination rates (44.1% vs. 24.4%, p = 0.01). Finally, survivors who were aware of the vaccine’s effectiveness in decreasing precancerous lesions were more likely to recommend the vaccine (45.7% vs. 12.0%, p = .002).
Raising survivor awareness of the link between HPV and cancer and HPV vaccine safety may increase their willingness to serve as powerful opinion leaders and peer mentors to promote HPV vaccination. Providers may take the simple step of informing patients that their cancer is HPV-related and HPV vaccine is safe to increase the number of informed and empowered survivors.
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Prevention, C.f.D.C.a. (2017) Cancers associated with human papillomavirus, United States—2010–2014. Atlanta, GA
Viens LJ, Henley SJ, Watson M, Markowitz LE, Thomas CC, Thompson TD, Razzaghi H, Saraiya M (2016) Human papillomavirus-associated cancers - United States, 2008-2012. MMWR Morb Mortal Wkly Rep 65(26):661–666
Reagan-Steiner S, Yankey D, Jeyarajah J, Elam-Evans LD, Curtis CR, MacNeil J, Markowitz LE, Singleton JA (2016) National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2015. MMWR Morb Mortal Wkly Rep 65(33):850–858
Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S (2014) Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 168(1):76–82
McGlone MS, Stephens KK, Rodriguez SA, Fernandez ME (2017) Persuasive texts for prompting action: agency assignment in HPV vaccination reminders. Vaccine 35(34):4295–4297
Kornides ML, Garrell JM, Gilkey MB (2017) Content of web-based continuing medical education about HPV vaccination. Vaccine 35(35 Pt B):4510–4514
Hanson KE, Koch B, Bonner K, McRee AL, Basta NE (2018) National trends in parental human papillomavirus vaccination intentions and reasons for hesitancy, 2010-2015. Clin Infect Dis 67(7):1018–1026
Thompson EL, Rosen BL, Vamos CA, Kadono M, Daley EM (2017) Human papillomavirus vaccination: what are the reasons for nonvaccination among U.S. adolescents? J Adolesc Health 61(3):288–293
Rogers EM (2002) Diffusion of preventive innovations. Addict Behav 27(6):989–993
Rosen B, Goodson P (2013) A recommendation to use the diffusion of innovations theory to understand school nurses' role in HPV vaccine uptake. Int Q Community Health Educ 34(1):37–49
Green LW, Ottoson JM, García C, Hiatt RA (2009) Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health 30:151–174
McQueen A, Kreuter MW (2010) Women’s cognitive and affective reactions to breast cancer survivor stories: a structural equation analysis. Patient Educ Couns 81(Suppl):S15–S21
Perez M et al (2014) A novel intervention using interactive technology and personal narratives to reduce cancer disparities: African American breast cancer survivor stories. J Cancer Surviv 8(1):21–30
Dillard AJ, Main JL (2013) Using a health message with a testimonial to motivate colon cancer screening: associations with perceived identification and vividness. Health Educ Behav 40(6):673–682
Vijaykumar S, Wray RJ, Jupka K, Clarke R, Shahid M (2013) Prostate cancer survivors as community health educators: implications for informed decision making and cancer communication. J Cancer Educ 28(4):623–628
Yi M, Park EY (2012) Effects of breast health education conducted by trained breast cancer survivors. J Adv Nurs 68(5):1100–1110
Ladd IG et al (2018) Cervical cancer patients' willingness and ability to serve as health care educators to advocate for human papillomavirus vaccine uptake. J Cancer Educ
Simon S (2017) Head and neck cancer survivor advocates for HPV vaccination. In: The American Cancer Society
Carter J (2017) Cervical cancer survivor: why I support the HPV vaccine. The University of Texas MD Anderson Cancer Center, Houston, TX
Ryan L (2015) Why I vaccinate my sons against HPV. The University of Texas MD Anderson Cancer Center, Houston, TX
Javaid M, Ashrawi D, Landgren R, Stevens L, Bello R, Foxhall L, Mims M, Ramondetta L (2017) Human papillomavirus vaccine uptake in Texas pediatric care settings: a statewide survey of healthcare professionals. J Community Health 42(1):58–65
Benjamini Y, Drai D, Elmer G, Kafkafi N, Golani I (2001) Controlling the false discovery rate in behavior genetics research. Behav Brain Res 125(1–2):279–284
Elizabeth J, Clark P (1996) MSW, Enpowering the cancer survivor, E.L. Stovall, Editor
Mirrielees JA, Breckheimer KR, White TA, Denure DA, Schroeder MM, Gaines ME, Wilke LG, Tevaarwerk AJ (2017) Breast cancer survivor advocacy at a university hospital: development of a peer support program with evaluation by patients, advocates, and clinicians. J Cancer Educ 32(1):97–104
Haylock PJ (2015) Cancer survivorship advocacy. Semin Oncol Nurs 31(1):79–85
Fitch M, McAndrew A, Turner F, Ross E, Pison I (2011) Survivors teaching students: increasing awareness about ovarian cancer. Can Oncol Nurs J 21(1):16–26
Waller J, Marlow LA, Wardle J (2007) The association between knowledge of HPV and feelings of stigma, shame and anxiety. Sex Transm Infect 83(2):155–159
Liederbach E, Kyrillos A, Wang CH, Liu JC, Sturgis EM, Bhayani MK (2017) The national landscape of human papillomavirus-associated oropharynx squamous cell carcinoma. Int J Cancer 140(3):504–512
Warner EL, Ding Q, Pappas LM, Henry K, Kepka D (2017) White, affluent, educated parents are least likely to choose HPV vaccination for their children: a cross-sectional study of the National Immunization Study - teen. BMC Pediatr 17(1):200
Arbyn M et al (2018) Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 5:CD009069
Yu Y, Xu M, Sun J, Li R, Li M, Wang J, Zhang D, Xu A (2016) Human papillomavirus infection and vaccination: awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China. PLoS One 11(1):e0146741
Inglehart RC, Taberna M, Pickard RKL, Hoff M, Fakhry C, Ozer E, Katz M, Gillison ML (2016) HPV knowledge gaps and information seeking by oral cancer patients. Oral Oncol 63:23–29
Kaufman J et al (2018) Face-to-face interventions for informing or educating parents about early childhood vaccination. Cochrane Database Syst Rev 5:CD010038
Center, T.U.o.T.M.A.C. (2018) Squamous cell carcinoma survivor on the importance of the HPV vaccine
Center, T.U.o.T.M.A.C. (2018) Squamous cell carcinoma survivor shares her story
Center, T.U.o.T.M.A.C. (2018) Cervical cancer patient wishes the HPV vaccine had been available to her
Editorial assistance was provided by MD Anderson Cancer Center’s Department of Scientific Publications.
Dr. Ramondetta acknowledges full control of all primary data and will allow journal to review upon request.
This study was supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant (NCI Grant P30 CA016672) and through generous philanthropic contributions, including a contribution from the Lyda Hill Foundation to The University of Texas MD Anderson Cancer Centers Moon Shots Program. This work is also supported in part by a faculty fellowship from the University of Texas MD Anderson Cancer Center Duncan Family Institute for Cancer Prevention and Risk Assessment.
The study was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center.
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The authors declare that they have no conflict of interest.
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Zeena Shelal and Dalnim Cho are co first authors
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Shelal, Z., Cho, D., Urbauer, D.L. et al. Knowledge matters and empowers: HPV vaccine advocacy among HPV-related cancer survivors. Support Care Cancer (2019). https://doi.org/10.1007/s00520-019-05035-1
- Human papillomavirus (HPV)
- Oropharyngeal cancer
- Cervical cancer