Abstract
People with cancer have reported concerns regarding the possible interactions between COVID-19 vaccines, cancer and anti-cancer treatments. Vaccine hesitancy has been observed within this vulnerable population, but the attitudes and beliefs behind this behavior remain poorly understood. Online survey was conducted across nine health services in Australia from June to October 2021. Vaccination status, participant demographics and cancer history were collected. Attitudes and beliefs to COVID-19 vaccination was assessed through validated measures including the Oxford Hesitancy Scale (OHS), Oxford Vaccine Confidence and Complacency Scale (OCCS) and Disease Influenced Vaccine Acceptance Scale-Six (DIVAS-6). Statistical analysis included logistic, linear and multivariate regression. There were 2691 evaluable responses; 80% had received a COVID-19 vaccine (available for five months at the time of the study). Demographics associated with higher uptake included increasing age, male gender, English as a first language and metropolitan locality. Cancer-related factors associated with lower vaccine uptake were diagnosis within the last 6 months and head and neck cancer type. Higher OHS and DIVAS-6 scores, indicating greater concern and hesitancy, were observed in unvaccinated participants. DIVAS-6 measured the influence of cancer on concern for COVID-19 infection, ‘disease complacency’, and the extent cancer influenced vaccine attitude, ‘vaccine vulnerability’. Lower disease complacency and higher vaccine vulnerability was observed in participants with female gender, lung cancer, current anti-cancer treatment and metastatic disease. Higher disease complacency and lower vaccine vulnerability was observed in those with geniturinary cancers. Their doctor’s recommendation regarding the vaccine was considered important by 79%. Cancer-related and vaccine-related concerns can act as motivators or barriers to vaccination. DIVAS-6 is a simple clinical assessment tool which can be used by clinicians to identify specific concerns held by patients in order to direct tailored communication. This is essential to maximize vaccine uptake in this medically vulnerable population with ongoing need for additional booster doses.
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