Human papillomavirus (HPV) is known to cause most cervical, anal, and oropharyngeal cancers, and a large proportion of vaginal, vulvar, and penile malignancies. Every year nearly 39,000 new cases of HPV-related cancers are diagnosed in the United States alone. This incidence persists nearly a decade following the launch of the HPV vaccine in 2006, and in fact is rising with continued poor HPV vaccine uptake. In 2016, only 43% of females and 32% of males completed the 3-dose series and rates in Texas are even lower where HPV-related malignancies are highest among the state's predominately Hispanic population. Thus, HPV vaccine initiatives targeting in Texas are critical, beginning with ...

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Human papillomavirus (HPV) is known to cause most cervical, anal, and oropharyngeal cancers, and a large proportion of vaginal, vulvar, and penile malignancies. Every year nearly 39,000 new cases of HPV-related cancers are diagnosed in the United States alone. This incidence persists nearly a decade following the launch of the HPV vaccine in 2006, and in fact is rising with continued poor HPV vaccine uptake. In 2016, only 43% of females and 32% of males completed the 3-dose series and rates in Texas are even lower where HPV-related malignancies are highest among the state's predominately Hispanic population. Thus, HPV vaccine initiatives targeting in Texas are critical, beginning with those at greatest risk. Childhood cancer survivors (CCS) represent a particularly high-risk population. Compared to the U.S. general population, CCS experience significantly higher rates of HPV-related malignancies (40% more in females and 150% more in males). Despite these increased risks, CCS have very low HPV vaccination rates. Many CCS do not transition back to a general pediatrician for preventive care, instead seeing only their oncologist. Because oncologists do not routinely provide vaccines for their patients, CCS may not be offered the HPV vaccine despite their increased risk for future HPV-related malignancies. In our initial CPRIT-funded project, only 23% of age-eligible CCS had initiated the vaccine series at baseline, and a mere 8% had completed the HPV vaccine series, meaning that approximately 11 of every 12 CCS were unprotected from HPV-related cancers. Overall Project Strategy: For this project, we have partnered with 10 pediatric oncology centers across the state of Texas, including our five continuation sites from the previously-funded project (University of Texas Health Science Center San Antonio, Methodist Children's Hospital (San Antonio), Dell Children's Hospital (Austin), Driscoll Children's Hospital (Corpus Christi), and Texas Tech University Health Sciences Center El Paso) and five geographically and institutionally diverse expansion sites (Children's Hospital of San Antonio, MD Anderson Cancer Center (Houston), Texas Tech University Health Sciences Center Amarillo, Texas Oncology (Midland), and UT Southwestern (Dallas and Plano)). The catchment areas across these 10 sites encompasses 225 counties and together they serve over 3,004 CCS who will be age-eligible for the HPV vaccine during the project period. Our overall project goal is to increase HPV vaccination rates among eligible CCS who are actively followed within one of the 10 participating sites. We propose to accomplish this goal by: 1) delivering an evidence-based HPV provider and staff continuing education program focused on the unique risks and needs of childhood cancer survivors; 2) implementing practice-level changes to build an HPV vaccine-friendly culture and allowing for the monitoring of HPV vaccine eligibility status among childhood cancer survivors at five pediatric oncology sites across the state of Texas; and 3) offering on-site delivery of the HPV vaccine to eligible childhood cancer survivors at each participating clinic. Specific Goals: 1. At all participating sites, deliver an evidence-based provider and staff continuing education program to approximately 250 oncology providers and staff, targeting the unique needs of childhood cancer survivors to increase HPV vaccine recommendation practices. 2. Increase HPV vaccine initiation among 3,004 male and female childhood cancer survivors aged 9-45 who are at least 6 months off active treatment. 3. Increase HPV vaccine completion 3,004 among male and female childhood cancer survivors aged 9- 45 are at least 6 months off active treatment. Innovation: Despite the increased vulnerability of CCS to secondary HPV-related cancers, this population has largely been neglected in the research, education, and large-scale HPV vaccine initiatives. With the rising incidence of HPV-related cancers in Texas, low uptake of HPV vaccination in this region, and increased susceptibility of CCS to HPV-related disease, targeting this population within the oncology follow-up setting is both novel and risk-directed. Significance and Impact: Our program focuses both on a specific area of interest for CPRIT (HPV vaccination), and on a priority population, with childhood cancer survivors treated across sites mostly comprising a Hispanic ethnic minority and having low HPV vaccine rates with high risk of second HPV-related cancers. Additionally, because of Dr. Grimes' leadership within the Children's Oncology Group, this program is well placed to inform future survivorship care guidelines and for dissemination across oncology centers nationwide.

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