Technology-enabled activation of skin cancer screening for hematopoietic cell transplantation survivors and their primary care providers (TEACH)

Saro H Armenian, Lanie Lindenfeld, Aleksi Iukuridze, Meagan Echevarria, Samantha Bebel, Catherine Coleman, Ryotaro Nakamura, Farah Abdullah, Badri Modi, Kevin C Oeffinger, Karen M Emmons, Ashfaq A Marghoob, Alan C Geller, Saro H Armenian, Lanie Lindenfeld, Aleksi Iukuridze, Meagan Echevarria, Samantha Bebel, Catherine Coleman, Ryotaro Nakamura, Farah Abdullah, Badri Modi, Kevin C Oeffinger, Karen M Emmons, Ashfaq A Marghoob, Alan C Geller

Abstract

Background: 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 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/design: 720 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.

Discussion: When 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 registration: ClinicalTrials.gov, NCT04358276 . Registered 24 April 2020.

Keywords: Dermoscopy; Early detection; Hematopoietic cell transplantation; Patient activation; Skin cancer; Skin self-examination; Survivors.

Conflict of interest statement

There is no competing interest to declare on the part of any named author.

Figures

Fig. 1
Fig. 1
DermLite Dermatoscope. DermLite (www.dermlite.com) works with virtually any smartphone and tablet
Fig. 2
Fig. 2
Study Schema for different arms. PAE: Patient Activation/Education (educational materials and text messages). PAE + Phys: Patient Activation/Education (educational materials and text messages) + physician activation/educational materials targeted to identified primary care providers (PCPs). PAE + Phys+TD: Phys: Patient Activation/Education (print materials and text messages) + physician activation/education + teledermoscopy (PCPs receive a dermatoscope to upload images of suspicious skin lesions to the remote study dermatologist)

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