Interventions to Improve Skin Cancer Surveillance in Childhood Cancer Survivors Who Received Radiotherapy

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In a study (Advancing Survivors Knowledge; ASK) reported in the Journal of Clinical Oncology, Geller et al found that three patient- and patient/physician-based interventions to improve skin cancer surveillance among childhood cancer survivors treated with radiotherapy resulted in increased rates of physician skin examinations and patient self-examinations.

As stated by the investigators, skin cancers constitute 58% of all subsequent neoplasms in survivors treated with radiotherapy, and less than 30% of survivors currently complete recommended skin cancer screening.

Study Details

In the study, 728 patients from the Childhood Cancer Survivor Study (median age = 44 years) were randomly assigned to interventions consisting of patient activation/education alone (n = 241), patient and physician activation/education (n = 245), and patient and physician activation/education plus teledermoscopy (n = 242). Elements of patient and physician activation/education included educational print materials, text messaging, and a website on skin cancer risk factors and screening behaviors. The intervention period was 12 months. Primary outcomes included receiving a physician skin examination at 12 months and conducting a skin self-examination at 18 months after the start of the intervention.

Key Findings

Rates of physician skin examinations increased significantly from baseline to 12 months in the patient-alone group (from 23.8% to 39.1%; relative risk [RR] = 1.65, 95% confidence interval [CI] = 1.32–2.08), the patient plus physician group (from 23.9% to 38.5%; RR = 1.56, 95% CI = 1.25–1.97), and the patient/physician plus teledermoscopy group (from 24.1% to 45.6%; RR = 1.89, 95% CI = 1.51–2.37). No significant differences in the increase in these rates were observed among groups (overall P = .49).

Rates of skin self-examinations increased significantly from baseline to 18 months in the patient-alone group (from 28.8% to 49.5%; RR = 1.75, 95% CI = 1.42–2.16), the patient/physician group (from 31.0% to 57.6%; RR = 1.85, 95% CI = 1.52–2.26), and the patient/physician plus teledermoscopy group (from 29.4% to 58.4%; RR = 1.95, 95% CI = 1.59–2.40). No significant differences in the increase in these rates were observed among groups (overall P = .43).

The investigators concluded, “Although skin cancer screening rates increased more than 1.5-fold in each of the intervention groups, there were no differences between groups. Any of these interventions, if implemented, could improve skin cancer prevention behaviors among childhood cancer survivors.”

Alan C. Geller, RN, MPH, of the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute and American Lebanese-Syrian Associated Charities. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.