COVID-19 Vaccination Refusal Among Cancer Survivors in the United States: A Scoping Review
TL;DR
Estimates of vaccination refusal in this population are not directly comparable and should be interpreted alongside the construct measured, and should be interpreted alongside the construct measured.
Abstract
Cancer survivors face an elevated risk of severe COVID-19 outcomes and were prioritized for vaccination, yet reported rates of vaccination refusal in this population vary widely. The objective of this scoping review was to map the available evidence on COVID-19 vaccination refusal among adult cancer survivors in the United States, to characterize the reported barriers and enablers, and to examine how differences in measurement account for variation in the reported estimates. PubMed, EBSCOhost, CINAHL, medRxiv, and Google Scholar were searched for studies published between 1 December 2020 and 30 April 2026 reporting primary data on COVID-19 vaccination refusal among U.S. adults with a current or previous cancer diagnosis. Findings were charted and summarized descriptively. Six sources comprising 3344 participants met the eligibility criteria. Reported refusal ranged from 7.3% to 39.0%, a more than fivefold difference, with a median of 14.7%. This variation corresponded closely to what each source measured: declination of an offered vaccine, likelihood of acceptance on a Likert scale, hesitancy assessed before vaccines were widely available, or observed non-receipt of any dose. Barriers included concerns about vaccine safety, efficacy, and interaction with cancer treatment, mistrust of science and government, and low perceived need; clinician recommendation was the most consistent enabler. Estimates of vaccination refusal in this population are not directly comparable and should be interpreted alongside the construct measured.