P2.133: Improve Advocacy for Pediatric Cancer Survivors and Empower Primary Care Providers Through Revaccination Education

Background: The incidence of childhood cancer has been increasing since the 1970’s. Research groups such as the Children’s Oncology Group (COG), have made great progress in the treatment of childhood cancer, reflected with decreased mortality and increased remission rates leading to an increased number of childhood cancer survivors living in the United States. They are a vulnerable population who are at increased risk for relapsed disease, secondary malignancies, and therapy-related late effects. One additional unique aspect of survivorship care includes revaccination against vaccine preventable infections. Chemotherapy used for the treatment of malignancies cause quantitative loss of B-cells leading to reduced production of antibodies leading to inadequate seroprotection against vaccine preventable diseases. Some studies have shown that up to 93% of patients will have at least one inadequate antibody level at 6 months after completion of cancer treatment.

Project Description: After hearing first-hand accounts of revaccination experiences from survivors and their families, several barriers emerged, notably a lack of knowledge regarding the need to repeat routine childhood vaccinations. The vision of this project was to advocate for childhood cancer survivors by empowering primary care providers (PCPs) through education about revaccination. The education was done primarily through a series of presentations to PCPs. Pre and post presentation surveys were performed with each presentation to measure audience comfort level with information about revaccination. Success of the project was measured by number of presentations given with a goal of 3 presentations and providers feeling more comfortable with revaccination of survivors at the conclusion of the presentations.

Discussion: A presentation was given to pediatric and medicine-pediatric resident trainees at an academic center, all of whom have general pediatrics clinics. Pre and post surveys were completed voluntarily by 19 residents who attended the presentation. Survey results showed overall improvement in comfort level of PCPs after the presentation with 89% of survey respondents reported feeling “comfortable” or "very comfortable" compared to only 15% of respondents prior to the presentation. The project plans to include several more scheduled presentations on revaccination including to general pediatric faculty at an academic center and private pediatric offices in rural Missouri.

Conclusion: While the project is still active with more presentations scheduled, it has shown improved comfort levels for providers regarding revaccination for pediatric cancer survivors. Future work with this project could include expanding this education beyond practices in Mid-Missouri and the immediate surrounding area to other parts of the state of Missouri and beyond. This would be helpful for PCPs as children's hospitals often have a large catchment area with patients traveling several hours for specialty care while receiving their primary care at local pediatric and family medicine offices.