Abstract
BackgroundHematopoietic cell transplantation (HCT) is a curative option for a growing number of patients with hematologic diseases and malignancies. However, HCT-related factors, such as total body irradiation used for conditioning, graft-versus-host disease, and prolonged exposure to immunosuppressive therapy, result in very high risk for melanoma and non-melanoma skin cancer (NMSC). In fact, skin cancer is the most common subsequent neoplasm in HCT survivors, tending to develop at a time when survivors’ follow-up care has largely transitioned to the primary care setting. The goal of this study is to increase skin cancer screening rates among HCT survivors through patient-directed activation alone or in combination with physician-directed activation. The proposed intervention will identify facilitators of and barriers to risk-based screening in this population and help reduce the burden of cancer-related morbidity after HCT.Methods/design720 HCT survivors will be enrolled in this 12-month randomized controlled trial. This study uses a comparative effectiveness design comparing (1) patient activation and education (PAE, N = 360) including text messaging and print materials to encourage and motivate skin examinations; (2) PAE plus primary care physician activation (PAE + Phys, N = 360) adding print materials for the physician on the HCT survivors’ increased risk of skin cancer and importance of conducting a full-body skin exam. Patients on the PAE + Phys arm will be further randomized 1:1 to the teledermoscopy (PAE + Phys+TD) adding physician receipt of a portable dermatoscope to upload images of suspect lesions for review by the study dermatologist and an online course with descriptions of dermoscopic images for skin cancers.DiscussionWhen completed, this study will provide much-needed information regarding strategies to improve skin cancer detection in other high-risk (e.g. radiation-exposed) cancer survivor populations, and to facilitate screening and management of other late effects (e.g. cardiovascular, endocrine) in HCT survivors.Trial registrationClinicalTrials.gov, NCT04358276. Registered 24 April 2020.
Highlights
Hematopoietic cell transplantation (HCT) is a curative option for a growing number of patients with hematologic diseases and malignancies
We have shown that TD can improve the sensitivity and specificity of skin cancer detection by Primary care physician (PCP), and can identify smaller-diameter basal cell carcinoma (BCC), most of which can be treated by PCPs using shave biopsy or the topical agent imiquimod, rather than the invasive surgical procedures required to treat larger lesions by a dermatologist [52]
In HCT survivors, skin cancers develop at a time when their follow-up has largely transitioned to the primary care setting [12], emphasizing the need to develop innovative strategies that educate survivors and PCPs alike to improve skin cancer self-examination and clinical screening rates
Summary
Hematopoietic cell transplantation (HCT) is a curative option for a growing number of patients with hematologic diseases and malignancies. HCT-related factors, such as total body irradiation used for conditioning, graft-versus-host disease, and prolonged exposure to immunosuppressive therapy, result in very high risk for melanoma and non-melanoma skin cancer (NMSC). The proposed intervention will identify facilitators of and barriers to risk-based screening in this population and help reduce the burden of cancer-related morbidity after HCT. Melanoma/skin cancer in the general population Skin cancer, including melanoma and non-melanoma (NMSC), is diagnosed in 1 in 5 Americans during their lifetime and is the most common cause of cancer in the United States (U.S) [1]. The U.S Preventive Services Task Force (USPSTF) recently concluded that there was insufficient evidence to recommend screening for skin cancer in the general population, due to concern about potential harms, including the psychological stress of screening [4]. The USPSTF emphasized that future research on skin cancer screening should focus on evaluating the effectiveness of targeted screening in people considered to be at higher risk for skin cancer, while measuring the possible benefits and harms of screening by both at-risk individuals and their providers [4]
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