Technology-Enabled Activation of Skin Cancer Screening for Hematopoietic Cell Transplantation Survivors and their Primary Care Providers

利用技术激活造血细胞移植幸存者及其初级保健提供者的皮肤癌筛查

• 批准号: 10595099
• 负责人: Saro Armenian
• 金额: $ 79.82万
• 依托单位: BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595099
• 关键词: Address; Age; Cancer Burden; Cancer Detection; Cancer Survivor; Cancer Survivorship; Cardiovascular system; Caring; Cellular Phone; Clinical; Coupled; Dermatologic; Dermatologist; Dermatology; Detection; Diagnosis; E-learning; Early Diagnosis; Early treatment; Education; Educational process of instructing; Endocrine; Enrollment; Ensure; Exposure to; Face; Future; General Population; Health Promotion; Hematologic Neoplasms; Hematological Disease; Hematology; High-Risk Cancer; Individual; Knowledge; Late Effects; Lesion; Long-Term Care; Long-Term Survivors; Malignant Neoplasms; Measures; Medical; Morbidity - disease rate; Neoplasms; Oncology; Participant; Patients; Pattern; Physicians; Population; Preventive care; Primary Care; Primary Care Physician; Printing; Provider; Quality of life; Radiation exposure; Randomized; Recurrence; Reporting; Research Priority; Risk; Risk Factors; Screening for Skin Cancer; Self-Examination; Skin; Skin Cancer; Skin Carcinoma; Survival Rate; Survivors; Technology; Testing; Therapeutic immunosuppression; Time; Transplant Recipients; Treatment-Related Cancer; United States National Institutes of Health; Whole-Body Irradiation; advanced disease; behavioral outcome; cancer diagnosis; clinically relevant; comparative effectiveness study; conditioning; cost; cost effective; digital; experience; follow-up; graft vs host disease; health related quality of life; hematopoietic cell transplantation; high risk; implementation science; improved; innovation; melanoma; mortality; multidisciplinary; prevention practice; primary care provider; primary care setting; programs; response; screening; skills; survivorship; transplant centers; transplant survivor

SUMMARY/ABSTRACT Hematopoietic 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 subsequent skin cancers. Compared with the general population, HCT survivors are also more likely to develop skin cancers at a younger age, have advanced disease at presentation, and experience multiple recurrences. Despite this high burden, less than 20% of long-term HCT survivors report being examined for skin cancer, even though >90% were seen by their primary care physician (PCPs) in the prior year. In HCT survivors, skin cancers develop at a time when their follow-up care has largely transitioned from oncology care to the primary care setting, emphasizing the need to develop innovative strategies that 1) provide HCT survivors with the skills to conduct effective skin self-examinations, and prompt action from their providers when worrisome lesions are found; 2) engage PCPs in HCT risk-based screening for skin cancer; and 3) ensure rapid access to dermatologic exams. Advances in technology, including widespread availability of cell phones and teledermoscopy (remote expert assessment of a photographed lesion) offer promising opportunities to improve early detection and treatment of skin cancer. We propose a comparative effectiveness study that will examine the impact of patient activation and education (PAE), alone or in combination with physician-tailored strategies, on clinically meaningful behavioral outcomes. We will enroll 720 HCT survivors at a large, diverse HCT center to: 1) Determine the impact of PAE alone or with physician activation (PAE+Phys) on skin cancer screening and prevention practices at 12 months; and 2) Among PCPs of HCT survivors, determine the impact of a teledermoscopy e-learning program compared with provision of print materials for identifying suspect lesions. We hypothesize that compared to PAE, patients randomized to PAE+Phys will report higher rates of thorough self- and provider skin exam, shorter time to referral of suspicious lesions, and improved quality of life; compared to print materials alone, physicians randomized to teledermoscopy e-learning will have greater recognition of suspect lesions and more appropriate, cost-effective referral patterns. Our multi-disciplinary team will: 1) establish the efficacy of PAE, and the relative benefit of physician activation; 2) inform the practice of skin cancer screening using innovative mobile strategies that are readily applicable in the clinical setting; and 3) identify facilitators of and barriers to appropriate delivery of survivorship-focused preventive care for long-term HCT survivors. Information obtained from the current study can be used to develop strategies for management of other late effects (e.g. cardiovascular, endocrine) in HCT survivors in the primary care setting, and to improve skin cancer screening in other high-risk (e.g. radiation-exposed) cancer survivor populations.

摘要/摘要 造血细胞移植（HCT）是越来越多血液病患者的一种治疗选择 疾病和恶性肿瘤。然而，HCT 相关因素，例如用于调理的全身照射， 移植物抗宿主病和长期接受免疫抑制治疗会导致非常高的风险 随后的皮肤癌。与一般人群相比，HCT 幸存者也更有可能发生 皮肤癌发病年龄较轻，就诊时已处于晚期，并且会多次复发。 尽管负担如此沉重，但只有不到 20% 的长期 HCT 幸存者报告接受了皮肤癌检查，即使 尽管超过 90% 的人是在上一年去看初级保健医生 (PCP) 的。在 HCT 幸存者中，皮肤癌 在他们的后续护理基本上从肿瘤护理过渡到初级护理的时候发展 背景，强调需要制定创新战略，1）为 HCT 幸存者提供以下技能： 进行有效的皮肤自我检查，并在出现令人担忧的病变时立即采取行动 成立; 2) 让 PCP 参与基于 HCT 风险的皮肤癌筛查； 3) 确保快速获得皮肤科治疗 考试。技术进步，包括手机和远程皮肤镜检查（远程 对拍摄的病变进行专家评估）为改善早期发现和治疗提供了有希望的机会 治疗皮肤癌。我们提出了一项比较有效性研究，该研究将检验患者的影响 激活和教育（PAE），单独或与医生定制的策略相结合，在临床上 有意义的行为结果。我们将在一个大型、多元化的 HCT 中心招募 720 名 HCT 幸存者，以便： 1) 确定 PAE 单独使用或与医生激活 (PAE+Phys) 对皮肤癌筛查的影响 12个月时的预防措施； 2) 在 HCT 幸存者的 PCP 中，确定 远程皮肤镜电子学习计划与提供印刷材料进行比较，以识别可疑病变。 我们假设与 PAE 相比，随机接受 PAE+Phys 的患者将报告更高的彻底治疗率 自我和提供者皮肤检查，缩短转诊可疑病变的时间，并提高生活质量；比较的 仅打印材料，随机参加远程皮肤镜电子学习的医生将获得更大的认可 可疑病变和更合适、更具成本效益的转诊模式。我们的多学科团队将：1) 确定 PAE 的功效以及医生激活的相对益处； 2）告知皮肤癌的实践 使用易于应用于临床环境的创新移动策略进行筛查； 3) 识别 适当提供以幸存者为中心的长期 HCT 预防性护理的促进因素和障碍 幸存者。从当前研究中获得的信息可用于制定管理策略 初级保健机构中 HCT 幸存者的其他后期影响（例如心血管、内分泌），并改善 对其他高风险（例如暴露于辐射的）癌症幸存者人群进行皮肤癌筛查。