Sexual behaviors and human papillomavirus vaccine non-initiation among young adult cancer survivors

Journal of Cancer Survivorship (2021)Cite this article

Abstract

Background

Young adult cancer survivors are at risk for subsequent human papillomavirus (HPV)-related malignancies. High-risk sexual behavior increases risk for HPV acquisition; HPV vaccination protects against infection. We aimed to determine the prevalence of sexual behaviors, factors related to high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among survivors.

Methods

Survivors at comprehensive cancer centers, aged 18–26 years and 1–5 years post-treatment, reported sexual behaviors and HPV vaccine initiation (i.e., ≥ 1 dose). Multivariable logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with high-risk sexual behaviors (age at first intercourse < 16 years, ≥ 3 lifetime sexual partners, or condom use ≤ 50% of the time) and to explore the relationship between sexual behaviors and vaccine non-initiation.

Results

Of the 312 participants (48.1% female, median age at cancer diagnosis 17.2 years and at survey 20.9 years), sexual intercourse was reported by 63.1%. Of those reporting intercourse, 74.6% reported high-risk sexual behavior. Factors related to high-risk sexual behavior included currently dating/partnered (OR = 4.39, 95%CI 2.5–7.7, P < 0.001) and perceived susceptibility to HPV (OR = 1.76, 95%CI 1.3-2.5, P < 0.001). Most survivors (75.3%) reported HPV vaccine non-initiation; sexual behaviors were not associated with vaccine non-initiation (P = 0.4).

Conclusions

Many survivors participate in high-risk sexual behaviors, yet HPV vaccine initiation rates are low. Factors related to high-risk sexual behaviors can inform interventions to reduce risk for HPV acquisition among survivors.

Implications for Cancer Survivors

Cancer survivors participate in sexual behaviors that increase risk for HPV acquisition and would benefit from vaccination.

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Funding

This work was supported by the National Cancer Institute (R01CA166559—MPIs-Landier & Klosky) and supported in part by the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MISP #40083; PI-Landier), and the American Lebanese Syrian Associated Charities (ALSAC) support of the Consortium for Pediatric Intervention Research. Dr. Cherven received support from the Robert Wood Johnson Future of Nursing Scholars (RWJF 72509) program and the American Cancer Society Doctoral Scholarship in Cancer Nursing (17-078-01-SCN). The opinions expressed in this paper are those of the authors and do not necessarily represent those of the study sponsors.

Author information

Affiliations

  1. University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA

    Brooke Cherven, Karen Heaton, Gwendolyn Childs & Wendy Landier

  2. Emory University School of Medicine and The Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Brooke Cherven, James L. Klosky & Karen Wasilewski-Masker

  3. St. Jude Children’s Research Hospital, Memphis, TN, USA

    James L. Klosky, Jessica S. Flynn, Leslie L. Robison & Melissa M. Hudson

  4. University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship/School of Medicine, 1600 7th Ave S., Lowder 500, Birmingham, AL, USA

    Yanjun Chen, Jocelyn M. York, Smita Bhatia & Wendy Landier

  5. Vanderbilt University, Nashville, USA

    James A. Connelly

  6. City of Hope, Duarte, CA, USA

    F. Lennie Wong

Authors
  1. Brooke Cherven
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  2. James L. Klosky
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  3. Yanjun Chen
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  4. Jocelyn M. York
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  7. Jessica S. Flynn
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  10. Leslie L. Robison
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  14. Wendy Landier
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Contributions

Conception and Design: Brooke Cherven, James L. Klosky, Karen Heaton, Gwendolyn Childs, Smita Bhatia, Wendy Landier.

Financial Support: James L. Klosky, Wendy Landier, Brooke Cherven

Administrative Support: James L. Klosky, Smita Bhatia, Leslie L. Robison, Wendy Landier

Provision of Study Materials or Patients: James L. Klosky, Jocelyn M. York, Jessica S. Flynn, James A. Connelly, Karen Wasilewski-Masker, Leslie L. Robison, Melissa M. Hudson, Smita Bhatia, Wendy Landier

Collection and Assembly of Data: James L. Klosky, Jocelyn M. York, Jessica S. Flynn, James A. Connelly, Karen Wasilewski-Masker, Wendy Landier

Data Analysis and Interpretation: Brooke Cherven, James L. Klosky, Yanjun Chen, Karen Heaton, Gwendolyn Childs, F. Lennie Wong, Smita Bhatia, Wendy Landier

Manuscript Writing: All authors

Final Approval of Manuscript: All authors

Accountable for All Aspects of the Work: All authors

Corresponding author

Correspondence to Wendy Landier.

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Ethics approval

The study was approved by the Institutional Review Board at the study coordinating center (University of Alabama at Birmingham) and at each participating site (City of Hope, St. Jude Children’s Research Hospital, University of Michigan, and Emory University/Children’s Healthcare of Atlanta). The study was performed in line with the principles of the Declaration of Helsinki. Young adult participants provided written informed consent in their preferred language.

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The authors declare no competing interests.

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Cherven, B., Klosky, J.L., Chen, Y. et al. Sexual behaviors and human papillomavirus vaccine non-initiation among young adult cancer survivors. J Cancer Surviv (2021). https://doi.org/10.1007/s11764-021-01000-2

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Keywords

  • Cancer survivor
  • Human papillomavirus
  • HPV vaccine
  • Sexual behavior