Knowledge matters and empowers: HPV vaccine advocacy among HPV-related cancer survivors



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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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.

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Correspondence to Lois M. Ramondetta.

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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 28, 2407–2413 (2020).

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  • Human papillomavirus (HPV)
  • Vaccine
  • Oropharyngeal cancer
  • Cervical cancer
  • Survivors
  • Advocacy