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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

COVID-19 vaccine hesitancy, acceptance and informational needs in an Australian cancer population: a cross-sectional survey

Brighid Scanlon A B * , David Wyld A B C , Paul Firman A C , Midori Nakagaki A C , Jo Durham D , Glen Kennedy B E , Paul Moran E , Michael Smith B E and Nicole Gavin A B C
+ Author Affiliations
- Author Affiliations

A Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Qld 4029, Australia.

B Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Qld 4059, Australia.

C University of Queensland, 11 Wyndham Street, Herston, Qld 4006, Australia.

D School of Public Health, Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Qld 4059, Australia.

E Cancer Care Services, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Qld 4029, Australia.


Australian Health Review 47(1) 110-118 https://doi.org/10.1071/AH22142
Submitted: 1 March 2022  Accepted: 28 October 2022   Published: 8 December 2022

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).

Abstract

Objective This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia.

Methods A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs.

Results COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation.

Conclusions There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts.

Keywords: cancer, communication, COVID-19, oncology, pandemic, vaccination, vaccine hesitancy.


References

[1]  Mak DB, Daly AM, Armstrong PK, Effler PV. Pandemic (H1N1) 2009 influenza vaccination coverage in Western Australia. Med J Aust 2010; 193 401–4.
Pandemic (H1N1) 2009 influenza vaccination coverage in Western Australia.Crossref | GoogleScholarGoogle Scholar |

[2]  Kuderer NM, Hill JA, Carpenter PA, Lyman GH. Challenges and Opportunities for COVID-19 Vaccines in Patients with Cancer. Cancer Invest 2021; 39 205–13.
Challenges and Opportunities for COVID-19 Vaccines in Patients with Cancer.Crossref | GoogleScholarGoogle Scholar |

[3]  Wang Q, Berger NA, Xu R. Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection. JAMA Oncol 2021; 7 220–7.
Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection.Crossref | GoogleScholarGoogle Scholar |

[4]  Medical Oncology Group of Australia. COVID-19 vaccination in patients with solid tumours. Medical Oncology Group of Australia; 2021. Available at https://www.moga.org.au/all-position-statements/covid-19-vaccination-in-patients-with-solid-tumours

[5]  Haematology Society of Australia and New Zealand. COVID-19 Vaccination in Haematology Patients: An Australia and New Zealand Consensus Position Statement. Haematology Society of Australia and New Zealand; 2021. Available at https://www.hsanz.org.au/news/10054698

[6]  Department of Health and Aged Care. ATAGI recommendations on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised. Australian Government Department of Health; 2021. Available at https://www.health.gov.au/resources/publications/atagi-recommendations-on-the-use-of-a-third-primary-dose-of-covid-19-vaccine-in-individuals-who-are-severely-immunocompromised

[7]  Department of Health and Aged Care. Expanded ATAGI recommendations on winter COVID-19 booster doses for people at increased risk of severe COVID19. Australian Government; 2022. Available at https://www.health.gov.au/news/expanded-atagi-recommendations-on-winter-covid-19-booster-doses-for-people-at-increased-risk-of-severe-covid-19#:~:text=On%2025%20March%202022%2C%20ATAGI,aged%2050%20years%20or%20above

[8]  Cancer Australia. COVID-19 information for people affected by cancer. Australian Government, Cancer Australia; 2022. Available at https://www.canceraustralia.gov.au/affected-cancer/information-about-cancer-and-covid-19/people-affected-cancer

[9]  Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020; 383 2603–15.
Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine.Crossref | GoogleScholarGoogle Scholar |

[10]  Hwang JK, Zhang T, Wang AZ, Li Z. COVID-19 vaccines for patients with cancer: benefits likely outweigh risks. J Hematol Oncol 2021; 14 38
COVID-19 vaccines for patients with cancer: benefits likely outweigh risks.Crossref | GoogleScholarGoogle Scholar |

[11]  Department of Health and Aged Care. COVID-19 Vaccines. Australian Department of Health; 2022. Available at https://www.tga.gov.au/international-covid-19-vaccines-recognised-australia [updated 16 May 2022].

[12]  Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine hesitancy: Causes, consequences, and a call to action. Vaccine 2015; 33 D66–71.
Vaccine hesitancy: Causes, consequences, and a call to action.Crossref | GoogleScholarGoogle Scholar |

[13]  Trent M, Seale H, Chughtai AA, Salmon D, MacIntyre CR. Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States, United Kingdom, and Australia. Vaccine 2022; 40 2498–505.
Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States, United Kingdom, and Australia.Crossref | GoogleScholarGoogle Scholar |

[14]  Edwards B, Biddle N, Gray M, Sollis K. COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population. PLoS One 2021; 16 e0248892
COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population.Crossref | GoogleScholarGoogle Scholar |

[15]  Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults. Ann Intern Med 2020; 173 964–73.
Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults.Crossref | GoogleScholarGoogle Scholar |

[16]  Hickler B, Guirguis S, Obregon R. Vaccine Special Issue on Vaccine Hesitancy. Vaccine 2015; 33 4155–6.
Vaccine Special Issue on Vaccine Hesitancy.Crossref | GoogleScholarGoogle Scholar |

[17]  MacIntyre CR, Veness B, Berger D, Hamad N, Bari N. Thrombosis with Thrombocytopenia Syndrome (TTS) following AstraZeneca ChAdOx1 nCoV-19 (AZD1222) COVID-19 vaccination – A risk–benefit analysis for people <60 years in Australia. Vaccine 2021; 39 4784–7.
Thrombosis with Thrombocytopenia Syndrome (TTS) following AstraZeneca ChAdOx1 nCoV-19 (AZD1222) COVID-19 vaccination – A risk–benefit analysis for people <60 years in Australia.Crossref | GoogleScholarGoogle Scholar |

[18]  ABC News. NSW woman’s fatal blood clotting likely linked to AstraZeneca COVID vaccine, Therapeutic Goods Administration says. Australian Broadcasting Corporation; 2021. Available at https://www.abc.net.au/news/2021-04-16/coronavirus-vaccine-linked-to-womans-blood-clotting/100075902

[19]  Australian Government, Department of Health. ATAGI statement on revised recommendations on the use of COVID-19 Vaccine AstraZeneca, 17 June 2021. Australian Government, Department of Health; 2021. Available at https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021

[20]  Bartholomew K. Queensland’s Pfizer stocks ‘running out’, Health Minister says supplies will be gone next week. Australian Broadcasting Corporation; 2021. Available at https://www.abc.net.au/news/2021-06-30/pfizer-stocks-running-out-by-next-week-in-queensland/100255146

[21]  Queensland Government. South East Queensland, Townsville, Magnetic and Palm Islands to enter lockdown. Queensland Government; 2021. Available at https://statements.qld.gov.au/statements/92535

[22]  Dawson A, Ekeroma A, Wilson D, Noovao-Hill A, Panisi L, Takala B, et al. How do Pacific Island countries add up on contraception, abortion and reproductive coercion? Guidance from the Guttmacher report on investing in sexual and reproductive health. Reprod Health 2021; 18 68
How do Pacific Island countries add up on contraception, abortion and reproductive coercion? Guidance from the Guttmacher report on investing in sexual and reproductive health.Crossref | GoogleScholarGoogle Scholar |

[23]  Purtell M, McKenna K. Queensland has four COVID clusters: three of them Delta variant. This is what we know so far. Australian Broadcasting Corporation; 2021. Available at https://www.abc.net.au/news/2021-07-01/queensland-coronavirus-clusters-three-delta-explainer/100255826

[24]  NSW Health. COVID-19 in NSW - up to 8pm 9 August 2021. New South Wales Health; 2021. Available at https://www.health.nsw.gov.au/Infectious/covid-19/Pages/stats-nsw.aspx

[25]  Metro North Hospital and Health Service. Metro North Hospital and Health Service Consultation Hub. 2021. Available at https://metronorth.citizenspace.com/

[26]  SAGE Working Group. Report of the SAGE Working Group on vaccine hesitancy. World Health Organization; 2014. Available at https://www.asset-scienceinsociety.eu/sites/default/files/sage_working_group_revised_report_vaccine_hesitancy.pdf

[27]  IBM. IBM SPSS Statistics. IBM; 2021. Available at https://www.ibm.com/products/spss-statistics

[28]  Griffiths EA, Segal BH. Immune responses to COVID-19 vaccines in patients with cancer: Promising results and a note of caution. Cancer Cell 2021; 39 1045–7.
Immune responses to COVID-19 vaccines in patients with cancer: Promising results and a note of caution.Crossref | GoogleScholarGoogle Scholar |

[29]  Han HJ, Nwagwu C, Anyim O, Ekweremadu C, Kim S. COVID-19 and cancer: From basic mechanisms to vaccine development using nanotechnology. Int Immunopharmacol 2021; 90 107247
COVID-19 and cancer: From basic mechanisms to vaccine development using nanotechnology.Crossref | GoogleScholarGoogle Scholar |

[30]  Chemaly RF, Vigil KJ, Saad M, Vilar-Compte D, Cornejo-Juarez P, Perez-Jimenez C, et al. A multicenter study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries: early therapy improves outcomes. Cancer 2012; 118 4627–33.
A multicenter study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries: early therapy improves outcomes.Crossref | GoogleScholarGoogle Scholar |

[31]  Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21 335–7.
Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.Crossref | GoogleScholarGoogle Scholar |

[32]  Bakouny Z, Hawley JE, Choueiri TK, Peters S, Rini BI, Warner JL, et al. COVID-19 and Cancer: Current Challenges and Perspectives. Cancer Cell 2020; 38 629–46.
COVID-19 and Cancer: Current Challenges and Perspectives.Crossref | GoogleScholarGoogle Scholar |

[33]  Ehmsen S, Jakobsen LH, Lendorf ME, Eefsen RL, Bentsen L, Knoop AS, et al. Severity and 1-month outcome of SARS-CoV-2 infection in patients with solid cancers: a Danish nationwide cohort study. Acta Oncol 2021; 60 859–65.
Severity and 1-month outcome of SARS-CoV-2 infection in patients with solid cancers: a Danish nationwide cohort study.Crossref | GoogleScholarGoogle Scholar |

[34]  Guan W-j, Liang W-h, Zhao Y, Liang H-r, Chen Z-s, Li Y-m, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020; 55 2000547
Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis.Crossref | GoogleScholarGoogle Scholar |

[35]  Douce DR, Holmes CE, Cushman M, MacLean CD, Ades S, Zakai NA. Risk factors for cancer-associated venous thromboembolism: The venous thromboembolism prevention in the ambulatory cancer clinic (VTE-PACC) study. J Thromb Haemost 2019; 17 2152–9.
Risk factors for cancer-associated venous thromboembolism: The venous thromboembolism prevention in the ambulatory cancer clinic (VTE-PACC) study.Crossref | GoogleScholarGoogle Scholar |

[36]  Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5 632–4.
Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy.Crossref | GoogleScholarGoogle Scholar |

[37]  Australian Government. COVID-19 vaccination decision guide for people receiving palliative care and/or end-of-life care. Australian Government; 2022. Available at https://www.health.gov.au/sites/default/files/documents/2022/07/covid-19-vaccination-shared-decision-making-guide-for-people-receiving-palliative-care-or-end-of-life-care.pdf

[38]  Leask J, Carlson SJ, Attwell K, Clark KK, Kaufman J, Hughes C, et al. Communicating with patients and the public about COVID-19 vaccine safety: recommendations from the Collaboration on Social Science and Immunisation. Med J Aust 2021; 215 9–12.e1.
Communicating with patients and the public about COVID-19 vaccine safety: recommendations from the Collaboration on Social Science and Immunisation.Crossref | GoogleScholarGoogle Scholar |

[39]  Broniatowski DA, Hilyard KM, Dredze M. Effective vaccine communication during the disneyland measles outbreak. Vaccine 2016; 34 3225–8.
Effective vaccine communication during the disneyland measles outbreak.Crossref | GoogleScholarGoogle Scholar |

[40]  Cartmell KB, Mzik CR, Sundstrom BL, Luque JS, White A, Young-Pierce J. HPV Vaccination Communication Messages, Messengers, and Messaging Strategies. J Cancer Educ 2019; 34 1014–23.
HPV Vaccination Communication Messages, Messengers, and Messaging Strategies.Crossref | GoogleScholarGoogle Scholar |

[41]  Davis CJ, Golding M, McKay R. Efficacy information influences intention to take COVID-19 vaccine. Br J Health Psychol 2022; 27 300–19.
Efficacy information influences intention to take COVID-19 vaccine.Crossref | GoogleScholarGoogle Scholar |

[42]  Petersen MB, Bor A, Jørgensen F, Lindholt MF. Transparent communication about negative features of COVID-19 vaccines decreases acceptance but increases trust. Proc Natl Acad Sci USA 2021; 118 e2024597118
Transparent communication about negative features of COVID-19 vaccines decreases acceptance but increases trust.Crossref | GoogleScholarGoogle Scholar |

[43]  Kerr JR, Freeman ALJ, Marteau TM, van der Linden S. Effect of Information about COVID-19 Vaccine Effectiveness and Side Effects on Behavioural Intentions: Two Online Experiments. Vaccines 2021; 9 379
Effect of Information about COVID-19 Vaccine Effectiveness and Side Effects on Behavioural Intentions: Two Online Experiments.Crossref | GoogleScholarGoogle Scholar |