Human Papillomavirus (HPV) Vaccination Among Survivors of Childhood Cancer

Effective vaccination is now available to prevent human papillomavirus (HPV), the most
common sexually transmitted infection and the cause of cervical cancer, the second most
common cancer among women worldwide. HPV vaccine uptake is particularly important for
females surviving childhood cancer, many of whom are at high risk for HPV complications due
to the direct and indirect effects of cancer treatment. Thus, Version 3.0 of the Children's
Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and
Young Adult Cancer has recently recommended HPV vaccination for all eligible females
surviving childhood cancer. Because this vaccine was only FDA approved in 2006, little is
known about the complexity of vaccination uptake among those surviving cancer, and how the
factors influencing vaccination decision-making differ among families with and without a
history of pediatric cancer.

The purpose of this exploratory study is to estimate the prevalence of HPV vaccination and
to assess predictors of HPV vaccination (and intent) among 9-26 year old females who have
survived childhood cancer, while making comparisons to healthy acquaintance controls. In a
cross-sectional design, those surviving childhood cancer (and acquaintance controls) will be
asked to complete a questionnaire which queries sociodemographic, medical, and psychological
variables which may relate to HPV vaccination or intent. Current vaccination rates will be
examined and factors which associate with HPV vaccination (and intent) will be identified.
Findings of the present study will inform recruitment strategies for future studies
examining the immunogenicity, safety, tolerability, and behavioral outcomes of HPV
vaccination among females surviving childhood cancer. More immediately, this work will
further our understanding of familial decision-making regarding HPV vaccination among female
survivors of childhood cancer and will determine whether vaccination recruitment models
developed for healthy adolescents and young adults generalize to the pediatric cancer
population.

Inclusion Criteria- Mothers of ACT patients

1. Active females patients (aged 18-26 years) or mothers/female primary caregivers of
minor female patients (aged 9-17 years) in the After Completion of Therapy (ACT)
clinic at St. Jude Children's Research Hospital (SJCRH).

2. Proficient in reading and writing English.

3. Cognitively intact such that the study questionnaire can be understood and completed.

4. Participant is willing and able to provide informed consent according to
institutional guidelines.

Inclusion criteria for acquaintance control participants:

An acquaintance control sample will be comprised of a community sample of adult women
(aged 18-26 years) and mothers with daughters in the 9-17 year age range who are
acquainted with the ACT patient's family.The primary feature distinguishing the
acquaintance controls from the SJCRH sample is the presence/nonpresence of personal (for
controls aged 18-26) or daughter's (for maternal controls) cancer history.

The following represents the inclusion criteria for acquaintance control participants:

1. Females (aged 18-26 years) or mothers/female primary caregivers (with daughters aged
9-17 years) referred for study participation by adult survivors or maternal
participants from the ACT clinic

2. Proficient in reading and writing English

3. Cognitively intact such that the study questionnaire can be understood and completed.

4. Participant is willing and able to provide informed consent according to
institutional guidelines.

According to institutional and NIH policy, the study will approach and consent research
participants regardless of ethnic background.Institutional experience confirms broad
representation in this regard.

Exclusion Criteria for acquaintance control group

*Personal history of cancer (for controls aged 18-26 years) or history of having a child
diagnosed with cancer (for maternal controls with daughters aged 9-17 years)

A supplemental community control sample (meeting the inclusion and exclusion criteria
outlined above) will also be utilized via the subject pool in the Department of Psychology
at The University of Memphis.