Scalable education program protects transplant survivors from elevated skin cancer risk

Experts at City of Hope^®, one of the nation's largest and most advanced cancer research and treatment organizations, are shining a spotlight on the risk of skin cancer faced by hematopoietic cell transplant (HCT) survivors, as well as the need for early detection. New City of Hope research published in JNCCN-Journal of the National Comprehensive Cancer Network shows how a cost-effective, scalable education program targeting survivors and their 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."

Saro Armenian, D.O., M.P.H., study first author, the Barron Hilton Chair in Pediatrics and director of the Center for Survivorship and Outcomes, Hematologic Malignancies Research Institute, City of Hope

Hematopoietic cell transplant, also called bone marrow transplant or stem cell transplant, 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 squamous cell carcinoma and other skin cancers, including basal cell carcinoma, melanoma and Merkel cell carcinoma. Skin cancers often first appear three to five years after the transplant, which is why performing regular skin self-exams and getting annual skin checks is so important.

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, City of Hope 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 results were striking. 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 percent 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. The City of Hope study is 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. At City of Hope, survivorship is considered a core responsibility of cancer care and is a non-negotiable part of every patient's treatment timeline, ensuring patients continue to thrive after treatment ends. A national leader in survivorship research, City of Hope researchers are contributing to our understanding of why late effects occur, who is most at risk and how earlier intervention can protect long-term health.

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."