Advancing Survivors Knowledge (ASK Study) of Skin Cancer Surveillance After Childhood Cancer: A Randomized Controlled Trial in the Childhood Cancer Survivor Study

Abstract

Purpose: To improve skin cancer screening among survivors of childhood cancer treated with radiotherapy where skin cancers make up 58% of all subsequent neoplasms. Less than 30% of survivors currently complete recommended skin cancer screening.

Patients and methods: This randomized controlled comparative effectiveness trial evaluated patient and provider activation (PAE + MD) and patient and provider activation with teledermoscopy (PAE + MD + TD) compared with patient activation alone (PAE), which included print materials, text messaging, and a website on skin cancer risk factors and screening behaviors. Seven hundred twenty-eight participants from the Childhood Cancer Survivor Study (median age at baseline 44 years), age > 18 years, treated with radiotherapy as children, and without previous history of skin cancer were randomly assigned (1:1:1). Primary outcomes included receiving a physician skin examination at 12 months and conducting a skin self-examination at 18 months after intervention.

Results: Rates of physician skin examinations increased significantly from baseline to 12 months in all three intervention groups: PAE, 24%-39%, relative risk [RR], 1.65, 95% CI, 1.32 to 2.08; PAE + MD, 24% to 39%, RR, 1.56, 95% CI, 1.25 to 1.97; PAE + MD + TD, 24% to 46%, RR, 1.89, 95% CI, 1.51 to 2.37. The increase in rates did not differ between groups (P = .49). Similarly, rates of skin self-examinations increased significantly from baseline to 18 months in all three groups: PAE, 29% to 50%, RR, 1.75, 95% CI, 1.42 to 2.16; PAE + MD, 31% to 58%, RR, 1.85, 95% CI, 1.52 to 2.26; PAE + MD + TD, 29% to 58%, RR, 1.95, 95% CI, 1.59 to 2.40, but the increase in rates did not differ between groups (P = .43).

Conclusion: 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.

Trial registration: ClinicalTrials.gov NCT02046811.

FIG 1.

CONSORT diagram. All 728 participants were contacted for the 18-month follow-up, even if they did not complete the 12-month follow-up, hence the slightly increased follow-up rate at 18 months. HIPPA, Health Insurance Portability and Accountability Act; PAE, patient activation and education; PAE + MD, patient activation and education, with physician activation; PAE + MD + TD, patient activation and education, with physician activation, and teledermoscopy.

FIG 2.

Visual representation of within-arm changes throughout the study: (A) physician skin examination in the past 12 months, (B) skin self-examination in the past 2 months, and (C) body parts self-examined in the past 2 months. Arm 1 = PAE, arm 2 = PAE + MD, and arm 3 = PAE + MD + TD. PAE, patient activation and education; PAE + MD, patient activation and education, with physician activation; PAE + MD + TD, patient activation and education, with physician activation, and teledermoscopy.

FIG A1.

Final recruitment status for the ASK intervention trial. PCP, primary care physician.