Concerns related to the interactions between COVID-19 vaccination and cancer/cancer treatment were barriers to complete primary vaccination series among Chinese cancer patients: A multicentre cross-sectional survey

Figures & data

Figure 1. (a) The COVID − 19 situation in China during the study period. (b) The COVID − 19 situation in four conveniently selected Chinese cities during the study period.

Figure 2. Flowchart of recruitment procedures.

Table 1. Background characteristics of the participants (n = 893).

	n	%
Sociodemographic characteristics
Age group, years
18–45	124	13.9
46–60	366	41.0
61–75	343	38.4
>75	60	6.7
Gender
Male	486	54.4
Female	407	45.6
Ethnicity
Han majority	743	83.2
Other ethnic minorities	150	16.8
Education level
Junior high or below	599	67.1
Senior high or equivalent	166	18.6
College and above	128	14.3
Relationship status
Single/divorced/widowed	77	8.6
Married	816	91.4
Employment status
Full-time	180	20.2
Part-time/self-employed/unemployed/retired/students	713	79.8
Cancer related characteristics
Type of cancer
Lung cancer	214	24.0
Gastric cancer	104	11.6
Liver cancer	23	2.6
Breast cancer	85	9.5
Colorectal cancer	145	16.2
Thyroid cancer	3	0.3
Esophageal cancer	41	4.6
Ovarian cancer	74	8.3
Other cancers	204	22.8
Metastatic cancers
No	835	93.5
Yes	58	6.5
Current treatment for cancer
Not yet started treatment	27	3.0
Chemotherapy only	616	69.0
Radiotherapy only	115	12.9
Immunotherapy only	23	2.6
Chemotherapy and radiotherapy	52	5.8
Immunotherapy and chemotherapy/radiotherapy	29	3.2
Treatment completed	31	3.5
Presence of other chronic diseases, yes
Diabetes mellitus	43	4.8
Hypertension and/or hyperlipidemia	108	12.1
Chronic cardiovascular diseases	28	3.1
Chronic respiratory diseases	5	0.6
Chronic liver and/or kidney diseases	11	1.2
Other chronic diseases	21	2.4
Any of above	166	18.6

Figure 3. Adverse effects after vaccination.

Table 2. COVID-19 vaccination uptake, perceptions and media influences related to COVID-19 vaccination (n = 893).

	n	%
COVID-19 vaccination uptake
Number of doses received by the participants
0	326	36.5
1	42	4.7
2	263	29.5
3	262	29.3
Completion of primary vaccination series
No	368	41.2
Yes	525	58.8
Perceptions related to COVID-19 vaccination
Perceived susceptibility to COVID-19
As compared to people without cancers, is your risk of COVID-19 higher or lower?
Much lower than people without cancers	12	1.3
Somewhat lower than people without cancers	49	5.5
Similar to people without cancers	435	48.7
Somewhat higher than people without cancers	313	35.1
Much higher than people without cancers	84	9.4
How high is your risk of contracting the Omicron variant of COVID-19
Low	172	19.3
Moderate	257	28.8
High	213	23.9
Uncertain	251	28.1
Perceived severity of COVID-19 infection
As compared to people without cancers, is your chance of having consequences higher or lower if contracting COVID-19 infection?
Much lower than people without cancers	22	2.5
Somewhat lower than people without cancers	36	4.0
Similar to people without cancers	428	47.9
Somewhat higher than people without cancers	68	7.6
Much higher than people without cancers	339	38.0
Your chance of having severe consequence if contracting COVID-19
Low	41	4.6
Moderate	190	21.3
High	407	45.6
Uncertain	255	28.6
Perceived barriers to receive COVID-19 vaccination, agree/strongly agree
The protection offered by the COVID-19 vaccination is weaker among people with cancers	356	39.9
Cancer therapy could decrease the protection of COVID-19 vaccination	309	34.6
The side effects of COVID-19 vaccination are more severe among people with cancers	386	43.2
The duration of protection of COVID-19 vaccination is shorter among people with cancers	308	34.5
COVID-19 vaccination could negatively affect the control of cancers	380	42.6
Perceived Barrier Scale^a, mean (SD)	16.5	(4.6)
Cue to action related to COVID-19 vaccination, agree/strongly agree
Doctors would suggest you to receive COVID-19 vaccination	195	21.8
Your family members would suggest you to receive COVID-19 vaccination	243	27.2
Cue to Action Scale^b, mean (SD)	5.5	(2.5)
Perceived self-efficacy to receive COVID-19 vaccination, agree/strongly agree
You are confident to receive COVID-19 vaccination if you want to	316	35.4
Item score, mean (SD)	3.1	(1.2)
Media influences related to COVID-19 and COVID-19 vaccination
Frequency of exposure to the following contents on TV, radio, newspaper and internet
Infectivity of the Omicron variant of COVID-19
Almost never	84	9.4
Seldom	82	9.2
Sometimes	336	37.6
Always	391	43.8
Item score, mean (SD)	3.2	(0.9)
Risk of having severe consequences or death is relatively low following infection of the Omicron variant of COVID-19
Almost never	104	11.6
Seldom	188	21.1
Sometimes	428	47.9
Always	173	19.4
Item score, mean (SD)	2.7	(0.9)
COVID-19 pandemic is not under control after COVID-19 vaccination rollout
Almost never	100	11.2
Seldom	322	36.1
Sometimes	347	38.9
Always	124	13.9
Item score, mean (SD)	2.6	(0.9)
Some people contract COVID-19 after completion of their primary vaccine series
Almost never	100	11.2
Seldom	238	26.7
Sometimes	375	42.0
Always	180	20.2
Item score, mean (SD)	2.7	(0.9)
Frequency of thoughtful consideration about veracity of COVID-19-specific information
Almost never	133	14.9
Seldom	257	28.8
Sometimes	347	38.9
Always	156	17.5
Item score, mean (SD)	2.6	(0.9)

^aPerceived Barrier Scale, 5 items, Cronbach’s alpha: 0.92, one factor was identified by exploratory factor analysis, explaining 76.7% of total variance.

^bCue to Action Scale, 2 items, Cronbach’s alpha: 0.89, one factor was identified by exploratory factor analysis, explaining 89.9% of total variance.

Table 3. Associations between background characteristics and completion of primary COVID − 19 vaccination series among cancer patients (n = 893).

	Completion of primary COVID-19 vaccination series (n/N, %)	OR (95%CI)	P values
Age group, years
18–45	87/124, 70.2%	1.0
46–60	219/366, 59.8%	0.63 (0.41, 0.98)	.04
61–75	194/343, 56.6%	0.55 (0.36, 0.86)	.01
>75	25/60, 41.7%	0.30 (0.16, 0.58)	<.001
Gender
Male	293/486, 60.3%	1.0
Female	232/407, 57.0%	0.87 (0.67, 1.14)	.32
Ethnicity
Han majority	426/743, 57.3%	1.0
Other ethnic minorities	99/150, 66.0%	1.44 (1.00, 2.09)	.05
Education level
Junior high or below	338/599, 56.4%	1.0
Senior high or equivalent	102/166, 61.4%	1.23 (0.87, 1.75)	.25
College and above	85/128, 66.4%	1.53 (1.02, 2.28)	.04
Relationship status
Single/divorced/widowed	39/77, 50.6%	1.0
Married	486/816, 59.6%	1.44 (0.90, 2.29)	.13
Employment status
Full-time	138/180, 76.7%	1.0
Part-time/self-employed/unemployed/retired/students	387/713, 54.3%	0.36 (0.25, 0.53)	<.001
Type of cancer
Lung cancer	109/214, 50.9%	1.0
Gastric cancer	66/104, 63.5%	1.67 (1.04, 2.71)	.04
Liver cancer	15/23, 65.2%	1.81 (0.74, 4.44)	.20
Breast cancer	30/85, 35.3%	0.53 (0.31, 0.88)	.02
Colorectal cancer	97/145. 66.9%	1.95 (1.26, 3.02)	.003
Thyroid cancer	0/3, 0%	N.A.	N.A.
Esophageal cancer	26/41, 63.4%	1.67 (0.84, 3.33)	.15
Ovarian cancer	43/74, 58.1%	1.34 (0.78, 2.28)	.29
Other cancers	139/204, 68.1%	2.06 (1.38, 3.07)	<.001
Metastatic cancers
No	490/835, 58.7%	1.0
Yes	35/58, 60.3%	1.07 (0.62, 1.85)	.80
Current treatment for cancer
Not yet started treatment	17/27, 63.0%	1.0
Chemotherapy only	338/616, 54.9%	0.72 (0.32, 1.59)	.41
Radiotherapy only	89/115, 77.4%	2.01 (0.82, 4.93)	.13
Immunotherapy only	12/23, 52.2%	0.64 (0.21, 1.99)	.44
Chemotherapy and radiotherapy	34/52, 65.4%	1.11 (0.42, 2.92)	.83
Immunotherapy and chemotherapy/radiotherapy	15/29, 51.7%	0.63 (0.22, 1.83)	.40
Treatment completed	20/31, 64.5%	1.07 (0.37, 3.13)	.90
Presence of any other chronic diseases
No	412/727, 56.7%	1.0
Yes	113/166, 68.1%	1.63 (1.14, 2.33)	.01

OR: crude odds ratios.

CI: confidence interval.

Table 4. Factors associated with and completion of primary COVID-19 vaccination series among cancer patients (n = 893).

	Completion of primary COVID-19 vaccination series (n/N, %)	OR (95%CI)	P values	AOR (95%CI)	P values
Perceptions related to COVID-19 vaccination
As compared to people without cancers, is your risk of COVID-19 higher or lower?
Much/somewhat lower than people without cancers	43/61, 70.5%	1.0		1.0
Similar to people without cancers	263/435, 60.5%	0.64 (0.36, 1.15)	.13	0.58 (0.30, 1.09)	.09
Much/somewhat higher than people without cancers	219/397, 55.2%	0.52 (0.29, 0.92)	.03	0.46 (0.24, 0.88)	.02
How high is your risk of contracting the Omicron variant of COVID-19
Low/moderate/uncertain	408/680, 60.0%	1.0		1.0
High	117/213, 54.9%	0.81 (0.60, 1.11)	.19	0.86 (0.61, 1.20)	.36
As compared to people without cancers, is your chance of having consequences higher or lower if contracting COVID-19 infection?
Much/somewhat lower than people without cancers	37/58, 63.8%	1.0		1.0
Similar to people without cancers	262/428, 61.2%	0.90 (0.51, 1.58)	.71	0.73 (0.39, 1.37)	.33
Much/somewhat higher than people without cancers	226/407, 55.5%	0.71 (0.40, 1.25)	.24	0.58 (0.31, 1.08)	.09
Your chance of having severe consequence if contracting COVID-19
Low/moderate/uncertain	309/486, 63.6%	1.0		1.0
High	216/407, 53.1%	0.65 (0.50, 0.85)	.002	0.68 (0.51, 0.91)	.01
Perceived Barrier Scale	N.A.	0.96 (0.93, 0.99)	.01	0.97 (0.94, 0.99)	.04
Cue to Action Scale	N.A.	1.34 (1.25, 1.42)	<.001	1.32 (1.23, 1.41)	<.001
Perceived self-efficacy to receive COVID-19 vaccination	N.A.	1.46 (1.31, 1.64)	<.001	1.48 (1.31, 1.67)	<.001
Media influences related to COVID-19 and COVID-19 vaccination
Frequency of exposure to the following contents on TV, radio, newspaper and internet
Infectivity of the Omicron variant of COVID-19	N.A.	0.81 (0.70, 0.94)	.01	0.86 (0.73, 1.01)	.07
Risk of having severe consequences or death is relatively low following infection of the Omicron variant of COVID-19	N.A.	0.95 (0.81, 1.10)	.45	1.01 (0.85, 1.19)	.92
COVID-19 pandemic is not under control after COVID-19 vaccination rollout	N.A.	1.02 (0.87, 1.19)	.81	1.12 (0.94, 1.32)	.21
Some people contract COVID-19 after completion of their primary vaccine series	N.A.	0.92 (0.79, 1.06)	.25	1.00 (0.85, 1.18)	.98
Frequency of thoughtful consideration about veracity of COVID-19-specific information	N.A.	1.07 (0.93, 1.23)	.36	1.11 (0.95, 1.30)	.20

N.A.: not applicable.

OR: crude odds ratios.

AOR: adjusted odds ratios, odds ratios adjusted for significant background characteristics listed in Table 3.

CI: confidence interval.

Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available as they contain sensitive personal behaviors but are available from the corresponding author on reasonable request.