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.
