Documentation of contraceptive and hpv vaccination counseling and use is low in youngadult survivors of pediatric cancer.

The rates of pregnancy in the young adult survivors of pediatric cancer (YASPC) population is not well known. However, patients are typically advised to avoid pregnancy during and soon after treatment, and to receive the human papilloma virus (HPV) vaccine series due to their immunocompromised state. Our objective was to examine the documentation of contraceptive and HPV vaccine counseling and use in the YASPC population. This is a retrospective chart review of patients with prior childhood cancer diagnosed at age 16-30 with > 1 office visit at a large urban medical center from 2018-2020. Patients without confirmed childhood cancer diagnosis were excluded. Demographics, cancer type, treatment type (surgery vs chemotherapy vs radiation vs multiple therapies) and documentation of contraceptive and HPV counseling and use were collected. Data were analyzed using ANOVA and chi-square (p<0.05 considered significant). The final sample (N=197) included 85 female and 112 male patients. Mean age was 19.35 (SD 2.72) and similar in males and females (M 19.39, F 19.32, p=0.87) 49 (24.9%) patients received contraception counseling (CC), and 34 (17.3%) started contraception before onset of treatment. Forms of birth control included condoms (N=18, 9.1%), combined hormonal methods (N=10, 5.1%), progestone only methods (N=4, 2.0%) and copper intra-uterine device (N=2, 1.0%). Documentation of CC and use did not depend on cancer type (p = 0.139, p=0.168). Similarly, CC and use was not associated with treatment type (p=0.43, p=0.07). However, there was an association between CC and patient sex (Female: N= 22, 25.9%, Male N= 12, 10.7%, p<0.01). Thirteen (6.6%) patients had documented HPV vaccine counseling, and 39 (19.8%) were vaccinated before onset of treatment. Treatment type was significantly associated with rate of HPV vaccination (p<0.01) with the rates of vaccination as follows: multiple treatment modalities (N=24, 12.2%), surgery (N=9, 4.6%), chemotherapy (N=3, 1.5%), radiation (N=2, 1%). In addition, HPV vaccination was significantly associated with patient sex (Female: N= 10, 11.7%, Male: N= 3, 2.7%, p < 0.02) While contraception and HPV counseling are recommended for all YASPC, less than a quarter of patients received contraception counseling and fewer received the HPV vaccine. Contraception counseling and use did not depend on the form of cancer or treatment type. HPV vaccination rates were not associated with cancer type but were associated with treatment type, with the highest rate of vaccination seen in patients who received multiple treatment modalities. Females were more likely than males to receive CC or HPV vaccination.