New strategies for the prevention of cervical cancer with HPV vaccines | Top Vip News

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The human papillomavirus (HPV) vaccine has been shown to significantly reduce the incidence of cervical cancer by almost 90%.1; However, it is estimated that only 60% of adult women have been vaccinated against HPV.2 NYU Langone researchers, including Dr. Catherine Herrman, investigated whether offering HPV vaccines at the time of abortion care could increase vaccination rates among women of reproductive age.

The quality improvement initiative was conducted at a clinic that provides abortion services. The researchers provided staff with additional training about HPV and the vaccine. They also created a new system to talk to patients about the vaccine and get them vaccinated. This system included prompts for doctors to talk to patients about the vaccine, making it easier for patients to receive the vaccine during their clinic visit and reminding them to return for any additional shots they needed.

Before the new system was implemented, about 24% of women who could have received the HPV vaccine received counseling and about 7% began the vaccine series. After the new system was implemented, these figures increased to 69% and 34%, respectively.3

The researchers also found that the majority of women who received the vaccine were Hispanic or Latina and spoke Spanish as their first language.

The study shows that administering HPV vaccines in clinics that offer abortion services is a viable method to vaccinate more patients against HPV, thereby reducing cervical cancer risks for patients as they age.

In an interview with Targeted OncologyM.T.Herrman, a second-year fellow at NYU Langone, discussed the findings and implications of the study she presented at the 2024 Society of Gynecologic Oncology (SGO) Annual Meeting on women’s health.

Targeted Oncology: What was the rationale for the study you presented at SGO?
Herman: Despite a wealth of data on the effectiveness of the HPV vaccine in preventing cervical cancer, vaccination rates in the United States remain quite low. Unfortunately, both HPV and cervical cancer disproportionately affect women who belong to groups that have been marginalized. To improve vaccine acceptance and help resolve these disparities, we felt a creative solution was needed, which is why we thought about abortion care. It is common; 1 in 4 women have abortions during their reproductive years, and this may help capture women earlier in their reproductive years, when the vaccine is most likely to be beneficial.

What was the methodology for your analysis?

[We did a] quality improvement study. Before starting our workflow, we did a retrospective chart review of the 6 months prior to implementation of the study workflow, just to capture our baseline vaccination and counseling rates. We then implemented the workflow over 31 weeks that incorporated 4 different principles. The first was the standardization of advice. To do this, we incorporated a standardized note template that everyone could use. We also provide in-person education to providers and then provide them with a brochure on frequently asked patient questions to assist with their counseling. Then we also work with our [post anesthesia care unit] and clinical nursing teams to help expedite same-day vaccinations for patients undergoing a medical or surgical abortion. We also had a tracking workflow that consisted of a tracking list built into the [electronic medical record]. The nurse administering the current vaccine scheduled patients for their follow-up vaccine. We also send reminder text messages or phone calls depending on the patient’s preferences.

Can you comment on your findings?

Before implementing the workflow, we had 265 patients who were eligible for vaccination in the 6 months prior to the study. Only 20.3% of these patients received advice about the HPV vaccine. Of the eligible patients, only 6.8% actually started the series. After implementing this study, we had 300 patients who were eligible. During the 31 weeks that we had the study running, the counseling rate increased to 68.7%. Of the patients who received counseling, 63% accepted it. Among patients who accepted it, 78.5% received at least 1 dose. Our overall rate of eligible patients who subsequently received at least 1 dose of the vaccine increased from 6.8% to 34%.

During the study period, our data on completing the vaccine series [are not] completely mature yet. We are still waiting for several [patients] to determine whether they have completed it or not. But 41.4% of the 99 patients who were due to receive a subsequent dose returned to receive at least 1 additional dose and we had 13 patients who completed the series.

Were there any subgroups of patients for whom this initiative seemed particularly effective?

We didn’t do any kind of subgroup analysis, but I will say that our cohort was quite diverse. Naturally, we had a breakdown of what some people might consider subgroups in other studies. Our median age was 30 years. The most common language among vaccinated patients was Spanish; that was 66% of the patients. We had self-identified ethnicity data on 50 of the patients. The most common was Ecuadorian, with 41%. We also had Mexicans with 12% and Dominicans with 8%. We had a very diverse group of patients.

What are the implications of these findings for patients and doctors?

I think the conclusion we can draw from this is that it is feasible and effective to implement an HPV vaccine workflow in an abortion clinic. I think it speaks to the fact that abortion care is a great opportunity to address vaccination gaps in patients of reproductive age. We know from the population that we implement this because it can be effective among patients who have very few resources and those patients who are at higher risk for cervical cancer disparities. I think it is a call to action for referral centers that still perform abortions. States that have implemented abortion bans tend to be those that also have the lowest HPV vaccination rates. Because patients come from those states for abortions, we now have the opportunity to address two disparities at once. I think it’s something we need to take into account as suppliers.

REFERENCES:
1. A large study confirms that the HPV vaccine prevents cervical cancer. Press release. National Cancer Institute. October 14, 2020. Accessed March 29, 2024. https://tinyurl.com/yr7c5unj
2. Vaccination against HPV. National Cancer Institute. Updated March 2024. Accessed March 29, 2024. https://tinyurl.com/u2hjd9ks
3. Herrman C, Lipkin P, Hunter A, et al. Gardasil at the time of the abortion visit: a quality improvement initiative. Presented at: Society of Gynecologic Oncology 2024 Annual Meeting on Women’s Health. March 15-18, 2024. San Diego, CA.

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