Survivors of hematopoietic cell transplant (HCT) are at increased risk of skin cancer and screening for early detection is encouraged. New research published by Armenian et al in JNCCN—Journal of the National Comprehensive Cancer Network shows how a technology enabled, remotely delivered, cost-effective, and scalable education program targeting survivors and their primary care doctors can significantly improve screening.
“HCT survivors face a markedly elevated risk of skin cancer, yet screening rates remain low, especially after they transition out of specialty care. This study shows that practical, scalable solutions can close that gap and may be applicable to other long-term complications in cancer survivors,” said study first author Saro Armenian, DO, MPH, the Barron Hilton Chair in Pediatrics and Director of the Center for Survivorship and Outcomes, Hematologic Malignancies Research Institute at City of Hope.
HCT can be used to treat patients with leukemia, lymphoma, multiple myeloma, and other blood cancers, as well as other conditions like aplastic anemia and sickle cell disease. Survivors face nearly double the risk of cutaneous squamous cell carcinoma and other skin cancers, including basal cell carcinoma, melanoma, and Merkel cell carcinoma. Skin cancers often first appear 3 to 5 years after the transplant.
Intervention Details and Findings
City of Hope’s “patient activation and education” program split 720 transplant survivors randomly into two groups. Participants received educational materials through the mail, including information on their elevated skin cancer risk, instructions for performing a self-exam, and pictures of suspicious lesions for reference. All survivors also received regular text messages to reinforce the information. For approximately half of the group, researchers also sent the patients’ primary care doctors’ information on the link between HCT and skin cancer risk and guidance on performing full-body skin exams.
The percentage of patients completing self-exams and receiving annual skin checks from their doctors nearly tripled overall. Sending materials to physicians appeared to make the greatest impact. Although all patients participating in the study completed more self-exams, the portion of patients who also received an in-office skin check from their doctor was 40% higher among patients whose primary care physicians received educational materials compared to those whose physicians didn’t receive them.
“One notable finding was how effective patient education alone was in increasing self-examination, even without intensive intervention,” Dr. Armenian said. “At the same time, the added benefit of physician activation specifically for clinical exams reinforces how critical provider education remains.”
Patient activation programs exist in other areas of chronic disease and cancer survivorship, but they have rarely been applied in a coordinated way to both transplant survivors and the primary care physicians providing their care, he noted. This study employed a new approach that engages both transplant survivors and their doctors using a model that can easily be expanded to reach many people at high risk of cancer.
Dr. Armenian said his team’s new findings are being incorporated into how City of Hope provides follow-up care for patients.
“These results are informing how we think about survivorship care delivery, particularly the use of remote, low-intensity strategies to support patients as they transition to primary care,” he said. “The approach aligns well with efforts to scale risk-based, technology-enabled survivorship models across broader populations.”
DISCLOSURE: For full disclosures of the study authors, visit jnccn.org.
