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A survey of pediatric oncologists revealed barriers to vaccine uptake among pediatric immunocompromised patients, including oncologist familiarity with and adherence to vaccine guidelines, parents’ perception of need for vaccines, and institutional support for vaccination. These results were published in BMC Health Services Research.
A team of researchers conducted an online survey of pediatric oncologists from a variety of geographic locations across the United States to learn more about their vaccination practices for immunocompromised patients. The one-time survey was conducted from March to October 2018. Their effort was part of a larger project on vaccination after pediatric cancer.
The 32-item survey asked participants about which vaccines they provided in their clinic, their vaccine recommendation strategies for pediatric cancer patients and bone marrow transplant patients both during and after treatment. The survey also asked about respondents’ knowledge of common vaccine guidelines for immunocompromised patients and potential barriers to vaccination within their clinics.
A total of 111 pediatric oncologists at 9 institutions in 8 states responded to the survey. Among the respondents, 82.9% were White, 54.1% were female, and 12.6% specialized in bone marrow transplant.
Regarding vaccine administration, 90.1% reported that their clinics can and do vaccinate patients, but only 63.1% reported that their clinic kept vaccines in stock.
Less than two-thirds of respondents (62.2%) reported familiarity with the guidelines for immunization of immunocompromised patients from the Advisory Committee on Immunization Practices (ACIP), and a little more than half (52.3%) were familiar with the guidelines from the Infectious Disease Society of America (IDSA).
However, 88.3% reported that the only vaccine they recommend to cancer patients during treatment is the influenza vaccine. Only 7.2% reported that they recommend other vaccines during treatment.
The majority of respondents (62.7%) reported they recommend restarting age-appropriate vaccines for their patients 6 to 12 months after the end of chemotherapy. A smaller percentage of respondents (23.4%) recommended restarting vaccines 3 to 6 months after completing treatment.
The survey also revealed common barriers to providing vaccines, including not having previous vaccine records for patients (56.8%) and lack of time to determine which vaccines patients need (32.4%). Other barriers were time for discussing, ordering, and administering vaccines.
Oncologists also reported encountering family barriers, including the patient’s family did not believe in vaccinations, parents’ fear of side effects, concerns about child’s immune system after cancer, and feeling unsure of the need for vaccines.
More than 84% of respondents believed that primary care providers should play a “critical role” in caring for childhood cancer survivors. However, less than half (42.3%) of respondents provide recommendations to see a primary care provider for vaccines after treatment.
“Following the end of treatment, pediatric oncologists should prioritize discussions with their patients and families regarding the importance of vaccinations and provide clear guidance to primary care providers on their recommendations,” the researchers wrote.
They recommend institutional guidance, as well as clinical guidelines, on vaccine practices. Vaccination remains an essential and safe practice for most pediatric cancer survivors, childhood and adolescent cancer survivors should receive vaccinations to reduce their risk of vaccine-preventable diseases.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
van Thiel Berghuijs KM, Kaddas HK, Warner EL, et al. Vaccination practices of pediatric oncologists from eight states. BMC Health Serv Res. Published online November 7, 2023. doi:10.1186/s12913-023-10160-z
