Technology-Enabled Activation of Skin Cancer Screening for Hematopoietic Cell Transplantation Survivors and their Primary Care Providers

利用技术激活造血细胞移植幸存者及其初级保健提供者的皮肤癌筛查

• 批准号: 10375440
• 负责人: Saro Armenian
• 金额: $ 80.66万
• 依托单位: BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10375440
• 关键词: Address; Age; Cancer Burden; Cancer Detection; Cancer Survivor; Cancer Survivorship; Car Phone; Cardiovascular system; Caring; Cellular Phone; Clinical; Coupled; Dermatologic; Dermatologist; Dermatology; Detection; Diagnosis; E-learning; Early Diagnosis; Early treatment; Education; Educational process of instructing; Endocrine; Enrollment; Ensure; Exposure to; Face; Future; General Population; Health Promotion; Hematologic Neoplasms; Hematological Disease; Hematology; High-Risk Cancer; Individual; Knowledge; Late Effects; Lesion; Long-Term Care; Long-Term Survivors; Malignant Neoplasms; Measures; Medical; Morbidity - disease rate; Neoplasms; Oncology; Participant; Patients; Pattern; Physicians; Population; Prevention; Preventive care; Primary Care Physician; Primary Health Care; Provider; Quality of life; Radiation exposure; Randomized; Recurrence; Reporting; Research Priority; Risk; Risk Factors; Screening for Skin Cancer; Self-Examination; Skin; Skin Cancer; Skin Carcinoma; Survival Rate; Survivors; Technology; Testing; Therapeutic immunosuppression; Time; Transplant Recipients; Treatment-Related Cancer; United States National Institutes of Health; Whole-Body Irradiation; advanced disease; base; behavioral outcome; cancer diagnosis; care providers; clinically relevant; comparative effectiveness study; conditioning; cost; cost effective; digital; experience; follow-up; graft vs host disease; health related quality of life; hematopoietic cell transplantation; high risk; implementation science; improved; innovation; melanoma; mortality; multidisciplinary; primary care setting; programs; response; screening; skills; survivorship; transplant centers; transplant survivor

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.

摘要/摘要 造血细胞移植（HCT）是越来越多的血液学患者的治愈方法 疾病和恶性肿瘤。但是，与HCT相关的因素，例如用于调节的总体辐照， 移植物抗宿主病，并长期暴露于免疫抑制疗法，导致非常高的风险 随后的皮肤癌。与一般人群相比，HCT幸存者也更有可能发展 年轻时的皮肤癌在表现时患有晚期疾病，并经历了多次复发。 尽管负担很大，但不到20％的长期HCT幸存者报告正在检查皮肤癌，甚至 尽管他们的初级保健医师（PCP）在上一年看到了> 90％。在HCT幸存者中，皮肤癌 在他们的后续护理主要从肿瘤学到初级保健过渡的时候发展 设置，强调需要制定创新策略的必要性，即1）为HCT幸存者提供技能 进行有效的皮肤自我检查，并在令人担忧的病变时迅速采取行动 成立; 2）让PCP参与基于HCT风险的皮肤癌； 3）确保快速进入皮肤病学 考试。技术的进步，包括手机和远程镜检查的广泛可用性（远程 照片病变的专家评估）为改善早期检测和 治疗皮肤癌。我们提出了一项比较有效性研究，该研究将检查患者的影响 临床 有意义的行为结果。我们将在一个大型的HCT中心注册720个HCT幸存者， 1）确定单独或使用医师激活（PAE+Phys）对皮肤癌筛查和 12个月的预防实践； 2）在HCT幸存者的PCP中，确定A的影响 与提供可疑病变的印刷材料相比，远程示例镜检查的电子学习计划。 我们假设与PAE相比，随机分配给PAE+物理的患者将报告更高的透彻率 自我和提供者的皮肤检查，较短的时间转诊可疑病变以及改善的生活质量；比较的 要单独打印材料，随机分配给远程镜检查电子学习的医生将更加认识到 可疑病变和更合适的，更具成本效益的转诊模式。我们的多学科团队将：1） 建立PAE的功效，以及医师激活的相对益处； 2）告知皮肤癌的实践 使用易于适用于临床环境的创新移动策略进行筛选； 3）识别 适当提供以生存为重点的预防保​​健的促进者和障碍的长期HCT 幸存者。从当前研究获得的信息可用于制定管理策略以管理 在初级保健环境中HCT幸存者中的其他晚期影响（例如心血管，内分泌），并改善 在其他高危（例如辐射暴露）癌症幸存者种群中进行皮肤癌筛查。