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Capstone Case Study Part I

Cervical cancer

Capstone Case Study

Cervical cancer is becoming a major health concern among adolescent girls, particularly due to the increasing prevalence of Human Papillomavirus (HPV) infections. The Centers for Disease Control and Prevention (CDC) states that there are 13,000 new cervical cancer cases reported annually in the United States, of which about 4,000 of the women diagnosed with cervical cancer die (Senkomago et al., 2017). When diagnosed in the early stages, cervical cancer patients have a 92% chance of survival (Kessler, 2017). However, when cancer has spread to the lymph nodes and other body organs and tissues, the chance of survival reduces to 58% (Kessler, 2017). The major cause of cervical cancer is long-lasting and consistent HPV infection, as 10% of the women who contract the infection on their cervix are at risk of developing cervical cancer (Kessler, 2017). Human Papillomavirus (HPV) vaccine in adolescent girls is very important because it reduces the risk of cervical cancer, especially when the girls or women are vaccinated before they are exposed to the HPV virus.

The Centers for Disease Control and Prevention recommends that adolescent girls should receive the HPV vaccine as early as nine years before they become sexually active and exposed to the HPV virus (Senkomago et al., 2017). CDC recommends that adolescent girls aged between eleven and twelve years should be given the HPV vaccine, but it is important to note that early HPV vaccination does not mean adolescents can or should participate in risky sexual behaviors since the vaccine does not provide the green light to participate in reckless sexual behaviors (Leung et al., 2019). The vaccine should be administered before a person is infected with the virus since the virus infection renders the vaccine ineffective if administered after HPV infection. Additionally, young people respond to vaccines better compared to older people. 

PICOT Question

The PICOT question that would be used to guide the research is: in adolescent patients with HPV, how does being vaccinated compare to not being vaccinated reduce the incidence of cervical cancer within fifteen weeks? The population of the study is adolescent patients with HPV as they are at risk of HPV infection and developing cervical cancer. The intervention is vaccination against HPV, which is appropriate as it is supported by evidence from research. The comparison group is not being unvaccinated, which will be compared with the intervention group to determine whether the intervention is effective or not. The outcome is the reduction of the incidence of cervical cancer, which is expected to be achieved when the intervention is applied, while the timeline of the study is 15 weeks.

The Vulnerable Population

HPV infection possesses a great risk to the adolescent girls' population and is a big cause of morbidity and mortality in infected patients (Senkomago et al., 2017). The infection is associated with sexual activity and the adolescent population is vulnerable to this virus because it is at this stage when many people become sexually active. This virus is dangerous to this population as any genital contact can result in viral infection. However, research shows that condoms offer some protection against disease progression and infection (Dempsey et al., 2018). Most sexually active adolescents are at risk of contracting HPV 16 and 18 strains, which cause about 70% of all cervical cancers globally, and HPV 6 and 11, which cause genital warts (Liu, 2022). Most HPV infections are cleared by the body's immune system but there is also a high risk of precancer lesions in adolescent women, which when left untreated, can progress to invasive cervical cancer (Liu, 2022). 

When the adolescent body cannot get rid of HPV infection caused by oncogenic HPV strains, the infection turns the normal cells into precancerous cells (abnormal cells), which later develop into cancer (Liu et al., 2022). The risk of cervical cancer is high after HPV infection because there are 13 strains of HPV that lead to cervical cancer (Sakamoto et al., 2018). Other risk factors for cervical cancer include Human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), family history of HPV, previous cancer diagnosis, contraceptive pills, and smoking tobacco (Leung et al., 2019). Cervical cancer mostly affects women between the ages of 21 and 65 years and it is the fourth most common cancer in women, which makes it necessary for vulnerable groups to have constant and frequent screening (Kessler, 2017). Screening can ensure that the cancer is detected early and effectively managed or prevent HPV from progressing into cervical cancer at the precancerous stage (Kessler, 2017). 

Literature Review

According to Acampora et al. (2020), vaccinating adolescents with the HVP vaccine is a strategic way of preventing not only cervical cancer but also other cancers and diseases related to HPV infection. Vaccinating adolescents between the age of nine and fifteen is an effective prevention strategy that reduces the burden of HPV virus infection. Acampora et al. (2020) focused on establishing effective ways to increase vaccination among adolescents with most strategies having a positive influence on HPV vaccination coverage in this population. According to this scholarly article, having effective strategies that increase vaccination coverage in the adolescent population has a positive outcome as more adolescents are vaccinated and the risk of cervical cancer is significantly reduced (Acampora et al., 2020).  

According to Braverman (2019), HPV is one of the most common sexually transmitted infections and one of the major risk factors for cervical cancer. Vaccinating adolescents with the three safe effective and licensed HPV vaccines decreases the virus prevalence and helps prevent cervical cancer (Braverman, 2019). The researchers established that when administered at the early stages of adolescence, the HPV vaccine has proved to be effective in adolescent girls. At this early stage, adolescent girls only need two doses of the HPV vaccine (Braverman, 2019). However, once they reach the age of fifteen years, they require three doses of the HPV vaccine and it is not effective as it is when administered between nine and fifteen years old (Braverman, 2019). The researchers indicated that the current efforts aimed at increasing the vaccination rate in this population through strong and consistent recommendations from physicians. These recommendations are interventions to reduce missed vaccination opportunities within fifteen weeks because of a constant reminder of its significance in reducing cervical cancer.  

Oliveira and Niccolai (2021) argue that HPV is effective in reducing cervical cancer risk in adolescents by almost 90% when offered between ages eleven and thirteen years. According to the authors, the HPV vaccine prevents particular strains of the HPV virus, therefore, reducing cervical cancer rates in women because it reduces the number of individuals who develop cancer later in life. The vaccination prevents persistent cervical precancer and other precursors to cancer (Oliveira & Niccolai, 2021). However, the authors point out that there is a lack of sufficient evidence to show whether the vaccine prevents cervical cancer by treating precancerous lesions in the cervix or by preventing the lesions from progressing to cancer. 

Research conducted by Lei et al. (2021) on HPV vaccination and the risk of invasive cervical cancer indicated that the risk of cervical cancer in unvaccinated women increases at the age of twenty-two years. The research was conducted in Sweden where 1,672,983 Swedish women and girls aged ten and thirty years were studied. The results of the study showed that unvaccinated women were at risk of getting cervical cancer compared to their vaccinated counterparts. Of 100,000 unvaccinated women, there were 94 cases of cervical cancer while there were only 47 cases of cervical cancer among 100,000 vaccinated women (Lei et al., 2021). According to the authors, the quadrivalent HPV vaccine administered during the clinical trials reduced the risk of invasive cervical cancer in the population.

The HPV vaccination benefits the vaccinated and those that are not vaccinated. When a person is vaccinated, they are unable to transmit the HPV to their sexual partners. When vaccinated in the adolescent stage, HPV vaccination has proven to be 90% effective and protects the vaccinated adolescent patient from cervical cancer (Bednarczyk et al., 2019). According to Bednarczyk et al. (2019), when administered on time, sexually inactive adolescents are protected from strains of this virus since the vaccine does not protect the vaccinated people against the HPV infection they acquired before being vaccinated therefore the emphasis on vaccination in early stages of adolescence. 

The availability and increase of HPV vaccine coverage have reduced the number of women and girls with cervical cancer in the United States (Bednarczyk et al., 2019). There has been a significant decline in the number of girls and women aged fifteen and twenty years who develop cancer since the majority of the women in this age group have received the HPV vaccination (Bednarczyk et al., 2019). According to Mix et al. (2021), timely vaccination saves the lives of women aged 15 and 21 years, a group rarely screened for cervical cancer. When administered at the right age, the HPV vaccine and constant cervical cancer screening reduce the rate of invasive cervical cancer in adolescent women. Since 2006 when the vaccine was made available, the vaccine has reduced squamous cell carcinomas (SCCs) which when left untreated causes 75% of cervical cancers (Mix et al., 2021) 

Strengths and Weakness of the Sources

Acampora et al. (2020) provided detailed information to support HPV vaccination effectiveness when administered at the early adolescent stage. On the other hand, Mix et al. (2021) provide sufficient evidence to show that within fifteen weeks of vaccination, adolescent girls and women who participate in sexual activity are at low risk of getting infected with HPV. However, the article does not give conclusive information on how the HPV vaccine prevents cervical cancers caused by adenocarcinomas (ACs).

Lei et al. (2020) conducted thorough research and the findings are supported by evidence from demographic and health registers ranging from 2006 through 2017. The research also focuses on a large sample of girls and women reducing the risk of response bias. However, the research has some weaknesses as it focuses on women of various ages (10-30 years) instead of adolescent women alone and the data does not show the effectiveness of the vaccine within fifteen weeks. The strength of Braverman's (2019) research is that it gives information on the accurate doses required in adolescents' vaccination depending on the age and when the first dose should be administered. However, the research fails to demonstrate how clinicians' recommendations increase HPV vaccine coverage among adolescent patients.

Oliveira and Niccola (2020) explain how the HPV vaccine prevents cervical cancer and provide statistics to support that the vaccine is effective when administered between the ages of nine to fifteen years or before an adolescent becomes sexually active. Bednarczyk et al. (2019) explain how the vaccine benefits those who are vaccinated and those that are not vaccinated. However, this article does not have any figures to support how it is beneficial to vaccinate adolescent patients compared to those who are not vaccinated.

Proposal

The intervention will involve the vaccination of adolescent girls with an HPV infection who will be recruited from four major hospitals in the city. The project leader will engage the facilities’ management to get information about patients who have been diagnosed with cervical cancer and seek permission to contact them to be included in the study through a letter. After confirmation from the management, the project leader will send consent forms to the patients to inform them about the purpose of the project and seek their consent to be involved in the study. The patients who will agree to the request will be enrolled in the study. The participants will be screened for HPV and cervical cancer, and also asked about their vaccination status. The researchers will analyze the data collected and compare the number of patients that were vaccinated against HPV and developed cervical cancer against those who were unvaccinated and had cervical cancer.

The resources that will be necessary include human resources to help the project leader during the project, finances to facilitate the movement of personnel and meet any costs that would arise during the study such as printing and internet expenses, and compensation of participants to motivate them to participate in the study. The other resources would include a facility from which the screening would be done and computers. The individuals involved in the study will include the project leader, two individuals recruited to assist the project leader, and nurses to conduct the screening. Nurses are important in an advanced role of they understand the needs of patients and have the clinical practice and educational competence to provide a range of preventive and primary care services (Kim et al., 2021). The proposed intervention will be conducted for a period of 15 weeks.

References

Acampora, A., Grossi, A., Barbara, A., Colamesta, V., Causio, F. A., Calabrò, G. E., ... & de Waure, C. (2020). Increasing HPV vaccination uptake among adolescents: A systematic review.  International journal of environmental research and public health,  17(21), 7997. https://doi.org/10.3390/ijerph17217997

Bednarczyk, R. A., Ellingson, M. K., & Omer, S. B. (2019). Human papillomavirus vaccination before 13 and 15 years of age: analysis of national immunization survey teen data.  The Journal of infectious diseases,  220(5), 730-734. https://doi.org/10.1093/infdis/jiy682

Braverman, P. K. (2019). HPV Vaccine in adolescents.  Pediatric Annals,  48(2), e71-e77. https://doi.org/10.3928/19382359-20190118-02

Dempsey, A. F., Pyrznawoski, J., Lockhart, S., Barnard, J., Campagna, E. J., Garrett, K., ... & O’Leary, S. T. (2018). Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: a cluster randomized clinical trial.  JAMA pediatrics,  172(5), e180016-e180016. https://doi.org/10.1001/jamapediatrics.2018.0016.

Kessler, T. A. (2017, May). Cervical cancer: prevention and early detection. In  Seminars in oncology nursing (Vol. 33, No. 2, pp. 172-183). https://doi.org/10.1158/1055-9965.EPI-20-0846

Lei, J., Ploner, A., Elfström, K. M., Wang, J., Roth, A., Fang, F., ... & Sparén, P. (2020). HPV vaccination and the risk of invasive cervical cancer.  New England Journal of Medicine,  383(14), 1340-1348. https://doi.org/10.1056/NEJMoa1917338

Leung, S. O. A., Akinwunmi, B., Elias, K. M., & Feldman, S. (2019). Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review.  Vaccine: X,  3, 100037.

Liu, H. (2022). Research progress of HPV vaccine for preventing damage from HPV infection. Highlights in Science, Engineering and Technology, 8, 604-610. https://doi.org/10.54097/hset.v8i.1221

Mix, J. M., Van Dyne, E. A., Saraiya, M., Hallowell, B. D., & Thomas, C. C. (2021). Assessing Impact of HPV Vaccination on Cervical Cancer Incidence among Women Aged 15–29 Years in the United States, 1999–2017: An Ecologic StudyCervical Cancer Incidence in Women 15–29 Years.  Cancer Epidemiology, Biomarkers & Prevention,  30(1), 30-37. https://doi.org/10.1158/1055-9965.EPI-20-0846

Oliveira, C. R., & Niccolai, L. M. (2021). Monitoring HPV vaccine impact on cervical disease: Status and future directions for the era of cervical cancer elimination.  Preventive Medicine,  144, 106363. https://doi.org/10.3928/19382359-20190118-02

Sakamoto, J., Kamiura, S., Okayama, K., Okodo, M., Shibata, T., Osaka, Y., ... & Sasagawa, T. (2018). Single type infection of human papillomavirus as a cause for high-grade cervical intraepithelial neoplasia and invasive cancer in Japan. Papillomavirus Research, 6, 46-51. https://doi.org/10.1016/j.pvr.2018.10.001

Senkomago, V., Duran, D., Loharikar, A., Hyde, T. B., Markowitz, L. E., Unger, E. R., & Saraiya, M. (2017). CDC activities for improving implementation of human papillomavirus vaccination, cervical cancer screening, and surveillance worldwide.  Emerging Infectious Diseases,  23(Suppl 1), S101. https://doi.org/10.3928/19382359-20190118-02