The gynecologic oncologist as the HPV champion: missed opportunities for cancer prevention

Abstract

Objectives: The Human Papillomavirus (HPV) vaccine is FDA approved up to age 45 and emerging evidence suggests it may prevent recurrent infections. This has important implications for patients commonly seen by gynecologic oncologists. Our objective was to describe factors that influence HPV vaccine recommendation amongst gynecologic oncologists and identify barriers and missed opportunities for vaccination. Methods: A pilot-tested online survey was electronically sent to all members of the Society of Gynecologic Oncology in the U.S. Questions evaluated the following domains: demographics, practice patterns, barriers and knowledge regarding the HPV vaccine. We defined HPV vaccine champions as providers who both recommended and either administered, stocked or prescribed the vaccine in the outpatient setting, and surveyed their practice patterns to identify possible missed opportunities for vaccination. Descriptive statistics were used to calculate the rate of HPV vaccine recommendation, explore barriers to vaccination and identify practice patterns. Univariate logistic regression was used to identify factors associated with vaccine recommendation. Results: A total of 183 gynecologic oncology providers completed the survey, representing 10% of invitations sent. Most were ≤ 45 years old (65%, n=99), practicing in urban (57%, n=105) and academic settings (67%, n=122). Eighty-one percent (n=147) had completed training, and of these, 68% (n=101) had been in practice for > 5 years. Ten percent (n=18/174) of respondents had not recommended the HPV vaccine in the past 12 months. Vaccine recommendation was associated with better HPV vaccine knowledge (Odds Ratio (OR) 1.7, 95% Confidence Interval (CI) 1.0-2.9), being a non-trainee (OR 3.8, CI 1.3-11.2) and practicing in the South (OR 10.8, CI 1.3-90.7). Among all providers, the most commonly reported barriers to vaccinating were that the patient's cancer diagnosis took precedence (88%, n=146/165), the cost to the clinic (48%, n=79/165), uncertainty about insurance coverage (43%, n=71/165) and that the vaccine history was not asked (48%, n=79/165). Forty eight percent (n=87) met criteria as HPV vaccine champions. Of those, 96% (n=78/81) at least sometimes offer the HPV vaccine at a visit for vulvar or cervical dysplasia. Eighty-three percent (n=67/81) offer it to patients with an HPV-related cancer diagnosis. In contrast, only 35% (n=29/82) were likely to offer it in a consultation for BRCA management and 28% (n=23/82) were likely to offer it at a surgical consultation for fibroids (Figure). Download : Download high-res image (89KB) Download : Download full-size image Conclusions: Gynecologic oncologists have a unique opportunity to educate and increase vaccination rates in eligible women. There are significant barriers to HPV vaccine administration in the gynecologic oncology office, and we identify examples of missed opportunities to vaccinate in non-HPV related clinical scenarios.