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

点击翻译按钮获取中文摘要

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.