A total of 294 lung cancer patients who had undergone surgery and met our inclusion criteria participated in the survey. Thirteen participants were excluded due to taking < 60 s (may have been answering without reading the questions to complete the survey quickly). A total of 281 participants were included in the final analysis. Among the participants, 152 (54.1%) were female, 93.6% were of Han ethnicity, and most participants (88.3%) had married. Of these patients, 135 (48.0%) were in pathologic stage I, 36.3% in stage II, 10.3% in stage III, and 5.3% in stage IV. Terminal education level high school or below was reported by 38.4% of respondents; 39.5% said a saidgh school education, and 19.6% had a partial college education. Regarding personal experience during the COVID-19 pandemic, 78.6% of lung cancer patients had taken the COVID-19 test, and no one had been diagnosed with COVID-19. Table 1 summarizes the characteristics distributions of participants by different population groups.
Table 1
Patient characteristics of vaccine-hesitant and vaccine-accepting COVID-19 vaccination
| | COVID-19 vaccine acceptance group (n = 164) | COVID-19 vaccine hesitant group (n = 117) | P value |
Gender | | | | |
Male | | 73 (44.5%) | 56 (47.9%) | 0.628 |
Female | | 91 (55.9%) | 61 (52.1%) |
Age (years) | | | | |
<40 | | 11 (6.1%) | 26 (22.2%) | < 0.001 |
40 ~ 60 | | 109 (66.5%) | 33 (28.2%) |
>60 | | 44 (26.8%) | 58 (49.6%) |
Marital status | | | | |
Unmarried | | 10 (6.7%) | 8 (6.8%) | 0.963 |
Married | | 145 (88.4%) | 103 (88.0%) |
Others | | 9 (5.9%) | 6 (5.1%) |
Ethnic group | | | | |
Han | | 151 (92.1%) | 112 (87.2%) | 0.225 |
Minority | | 13 (7.9%) | 5 (12.8%) |
Educational level | | | | |
Less than high school degree | | 43 (26.2%) | 65 (55.6%) | < 0.001 |
High school | | 72 (43.9%) | 29 (24.8%) |
Some college | | 37 (22.6%) | 18 (15.4%) |
College degree or more | | 12 (7.3%) | 5 (4.3%) |
BMI(kg/m2,mean ± SD) | | 24.1 ± 4.3 | 23.3 ± 3.8 | 0.483 |
Smoking history | | | | |
Yes | | 69 (42.1%) | 47 (40.2%) | 0.806 |
No | | 95 (57.9%) | 70 (59.8%) |
Hypertension | | | | |
Yes | | 34 (20.7%) | 23 (19.7%) | 0.881 |
No | | 130 (79.3%) | 94(80.3%) |
Diabetes | | | | |
Yes | | 29 (17.7%) | 14 (12.0%) | 0.240 |
No | | 135 (82.3%) | 103 (88.0%) |
Pathologic cancer stage | | | | |
Stage I | | 84 (51.2%) | 51 (43.6%) | 0.366 |
Stage II | | 57 (34.8%) | 45 (38.5%) |
Stage III | | 17 (10.4%) | 12 (10.3%) |
Stage IV | | 6 (3.7%) | 9 (5.3%) |
Duration of cancer (year) | | | | |
<1 | | 42 (25.6%) | 66 (56.4%) | < 0.001 |
1 ~ 3 | | 72 (43.9%) | 29 (24.8%) |
4 ~ 5 | | 39 (23.8%) | 15 (12.8%) |
>5 | | 11 (6.7%) | 7 (6.0%) |
Self-perceived feel | | | | |
Good | | 73 (44.5%) | 24 (20.5%) | < 0.001 |
General | | 69 (42.1%) | 66 (56.4%) |
Bad | | 22 (13.4%) | 27 (23.1%) |
Recent treatments | | | | |
Targeted Therapy | | 69 (42.1%) | 59 (50.4%) | 0.001 |
Immunotherapy | | 4 (2.4%) | 9 (7.7%) |
Chemotherapy | | 8 (4.9%) | 12 (10.3%) |
Radiotherapy | | 2 (1.2%) | 5 (4.3%) |
Postoperative pain | | | | |
Yes | | 33 (20.1%) | 47 (41.2%) | < 0.001 |
No | | 131 (78.9%) | 70 (59.8%) |
Ever tested for COVID-19 | | | | |
Yes | | 125 (76.2%) | 96 (82.2%) | 0.301 |
No | | 39 (23.8%) | 21 (17.9%) |
As shown in Table 1, the willingness to take COVID-19 vaccination was 164 (58.4%), whereas 117 (41.6%) expressed their hesitancy. Vaccine hesitancy was higher in patients with men aged ≥ 60 years, lower educational level, short duration of cancer (< 3 years), lower self-report health condition, recent lung cancer-related treatments, and postoperative pain (P all < 0.001).
As shown in Table 2, We survey attitudes and opinions about COVID-19 infection and vaccination. Patients who knew about the severity of COVID-19 illness, perillnesse likelihood of COVID-19 infection in disease, and agreed that the vaccine would protect them from COVID-19 infection were less hesitant (P all < 0.001). Ever hesitated or refused to get a vaccination or influenza vaccine were more likely to be hesitant (P all < 0.05). Patients’ concerns about the COVID vaccine worsening the prognosis of lung cancer were associated with hesitancy, and those worried about the COVID vaccine interfering with cancer treatments were more likely to be hesitant (P all < 0.001). Doctors who are recommending getting the COVID-19 vaccine were associated less likely to hesitate (P = 0.023). Patients who had doubts about the source of information and received COVID-19 vaccine negative information were associated with more likely to have COVID-19 vaccine hesitancy (P all < 0.001).
Table 2
Attitudes and Opinions for vaccine-hesitant and vaccine-accepting COVID-19 vaccination
| COVID-19 vaccine acceptance group(n = 164) | COVID-19 vaccine hesitant group(n = 117) | P value |
Knowledge about COVID-19 vaccine a | 2.31 ± 0.21 | 1.71 ± 0.18 | < 0.001 |
Perceived likelihood of COVID-19 infection in the future b | 3.08 ± 0.90 | 2.34 ± 0.77 | < 0.001 |
Perceived severity of COVID-19 infection a | 3.21 ± 1.20 | 2.61 ± 0.80 | < 0.001 |
Have you ever hesitated or refused to get vaccination c | 2.10 ± 0.29 | 3.31 ± 0.64 | < 0.001 |
Are you agree with vaccines can protect you from diseases d | 3.07 ± 1.01 | 2.94 ± 0.51 | 0.004 |
Are you will get all vaccines that National Immunization Program or government recommended a | 3.14 ± 0.61 | 2.21 ± 0.87 | < 0.001 |
Have you ever hesitated or refused to get Influenza Vaccine a | 2.75 ± 0.88 | 3.01 ± 0.52 | 0.010 |
Are you need open information about COVID-19 vaccine development, efficacy and safety a | 3.75 ± 0.92 | 3.67 ± 0.97 | 0.078 |
Are you have doubts about the source of information about the COVID-19 vaccine c | 2.51 ± 0.54 | 2.89 ± 0.78 | 0.002 |
Are you ever get negative information about getting the COVID-19 vaccine c | 2.53 ± 0.94 | 3.09 ± 0.68 | < 0.001 |
Do you worried about vaccine adverse reactions c | 2.66 ± 0.70 | 3.21 ± 0.49 | < 0.001 |
Do you worried about the COVID vaccine worsens the prognosis of cancer c | 2.59 ± 0.97 | 3.01 ± 0.74 | < 0.001 |
Do you worried about the COVID vaccine interferes with cancer treatments c | 2.27 ± 0.58 | 2.74 ± 0.82 | < 0.001 |
Are your family members or friends advice will affect your intention of getting COVID-19 vaccine c | 3.00 ± 0.77 | 3.15 ± 0.66 | 0.050 |
Are you will get COVID-19 vaccine if doctors recommend? a | 3.62 ± 0.32 | 3.14 ± 0.40 | 0.023 |
a :4-point response scale ranging from ‘‘not at all” to ‘‘very” (possible range = 1–4). b: 4-point response scale ranging from ‘‘no chance” to ‘‘high chance” (possible range = 1–4). c: 4-point response scale ranging from ‘‘not at all” to ‘‘a lot” (possible range = 1–4). d: 4-point response scale ranging from ‘‘strongly disagree” to ‘‘strongly agree” (possible range = 1–4). |
A lower score on the items “perceived likelihood of getting a COVID-19 infection in the future”, “perceived severity of COVID-19 infection”, and “agree with vaccines can protect you from diseases.” were associated with more likely to have COVID-19 vaccine hesitancy. A higher score on the items “ever hesitated or refused to get a vaccination,” “Are you ever hesitated or refused to get Influenza Vaccine,” “Do you worried about vaccine adverse reactions,” and “Do you think the COVID vaccine worsens the prognosis of cancer,” ‘“Are you ever get COVID-19 vaccine negative information”, “Are you have doubts about the source of the COVID-19 vaccine information” were associated with more likely to have COVID-19 vaccine hesitancy.
In multivariable regression analysis, age over 60 years old, low educational level, duration of cancer (< 1 year), subjective health status, current cancer treatments use, presence of postoperative pain, and report of the items “ever hesitated or refused to get a vaccination,” “get negative information about getting the COVID-19 vaccine”, “worried about vaccine adverse reactions,” and “worried about the COVID vaccine interferes with cancer treatments” were independently associated with hesitant of the COVID-19 vaccine (Table 3).
Table 3
Multivariate logistic regression correlates of COVID-19 vaccine hesitancy
| OR | (95% CI) | P value |
Age (> 60 years) | 0.71 | 0.50–0.92 | 0.01 |
Less than a high school degree | 0.96 | 0.79–1.17 | < 0.001 |
Duration of cancer (< 1 year) | 4.01 | 3.11–4.64 | < 0.001 |
Targeted Therapy | 2.97 | 2.01–3.17 | 0.01 |
Self-perceived feel bad | 2.51 | 1.81–2.90 | 0.01 |
Postoperative pain | 1.43 | 1.21–1.71 | < 0.001 |
Have you ever hesitated or refused to get vaccination c | 3.28 | 3.01–3.64 | < 0.001 |
Are you ever get negative information about getting the COVID-19 vaccine c | 0.88 | 0.67–1.01 | < 0.001 |
Do you worried about vaccine adverse reactions c | 0.54 | 0.34–0.77 | 0.02 |
Do you think the COVID vaccine interferes with cancer treatments | 1.91 | 1.01–2.75 | < 0.001 |
c: 4-point response scale ranging from ‘‘not at all” to ‘‘a lot” (possible range = 1–4). |
The reasons provided for the hesitant COVID-19 vaccine are presented in Fig. 1. Of the ten reasons for vaccine hesitancy to assess potential reasons underlying patients’ decisions, a 4-point response scale ranged from ‘‘Very important” to ‘‘Do not Know.” These included: “Concerns about COVID-19 vaccine safety” (83% agreement), “Mistrust in COVID-19 vaccine efficacy” (57% agreement), “Do not understand how vaccines work” (55% agreement), “Lack of information about COVID-19 vaccine” (77% agreement), “Thinking oneself condition is not yet stable” (79% agreement), “Do not trust pharmaceutical companies” (41% agreement), “Concerns about vaccine adverse reactions” (86% agreement), “Had a bad reaction to a vaccine in the past” (31% agreement), “Do not think the vaccine will protect me” (15% agreement), “Do not trust the experts” (19% agreement), “Being afraid of needles/injection” (46% agreement).