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Leung T, Eysenbach G, Peterson S, Heckman C, Kashy D, Berger A, Studts C, Negrón R, Buller D, Paddock L, Gallo J, Kulik A, Frederick S, Pesanelli M, Domider M, Grosso M. Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e39640. [PMID: 36692933 PMCID: PMC9906316 DOI: 10.2196/39640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors. OBJECTIVE We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. METHODS Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors' SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating. RESULTS This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates. CONCLUSIONS The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention's delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others. TRIAL REGISTRATION ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39640.
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Affiliation(s)
| | | | - Susan Peterson
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, The University of Texas, San Antonio, TX, United States
| | - Carolyn Heckman
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Deborah Kashy
- College of Social Science, Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Adam Berger
- Division of Surgical Oncology, Department of Surgery, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Christina Studts
- Pediatrics - General Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rosalyn Negrón
- College of Liberal Arts, University of Massachusetts Boston, Boston, MA, United States
| | | | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Joseph Gallo
- Hackensack Meridian Jersey Shore Medical Center, Hackensack Meridian Health, Neptune City, NJ, United States
| | - Alexandria Kulik
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Sara Frederick
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Morgan Pesanelli
- School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Mara Domider
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Marissa Grosso
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Niu Z, Heckman CJ. Digital Educational Strategies to Teach Skin Self-examination to Individuals at Risk for Skin Cancer. JOURNAL OF HEALTH COMMUNICATION 2022; 27:790-800. [PMID: 36625227 DOI: 10.1080/10810730.2022.2157910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Skin cancer is the most common cancer in the United States, and early detection of melanoma may lead to diagnosis of thinner and more treatable cancers, resulting in improved survival rates. This study examined the effects of message interactivity (high vs. low) and imagery (cartoon, real human character, or customized imagery preference) on accuracy of identifying abnormal skin lesions (ASL) and skin self-examination (SSE) intention. This study employed a 3 (cartoon character vs. real person vs. customization) x 2 (high interactivity vs. low interactivity) between-subjects online experimental design. Participants at risk for skin cancer were randomly assigned to one of the six conditions and completed a survey after reviewing the educational materials. Univariate analyses were conducted to detect group differences on the accuracy of identifying ASL and intention to conduct SSE in the next 3 months. Among 321 participants who completed the study, the mean age was 36.61 years, 56.7% were females, 76.1% had a college or higher degree, and over 60% self-identified as non-Hispanic White. Individuals in the high interactivity and customization group (compared to the low interactivity and cartoon group) were more likely to accurately identify ASL. Individuals in the high interactivity and customization or low interactivity and real person imagery groups (compared to the low interactivity and cartoon group) reported higher intention to conduct SSE in the next 3 months. These results suggest that customization and interactivity may be beneficial for educational programs or intervention design to improve both melanoma identification and SSE intention.
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Affiliation(s)
- Zhaomeng Niu
- Department of Health Informatics, Rutgers School of Health Professions, Piscataway, New Jersey, United States
| | - Carolyn J Heckman
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
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Merten JW, Hamadi HY, King JL. Cancer Risk Perceptions Among People Who Check Their Skin for Skin Cancer: Results from the 2017 U.S. Health Information National Trends Survey (HINTS). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:770-778. [PMID: 32968953 DOI: 10.1007/s13187-020-01880-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
When detected early, melanoma is highly treatable and rarely fatal. Self-skin checks can identify changes in moles that could be an indicator of melanoma. Cancer risk perceptions may influence the uptake of important preventive health behaviors such as self-skin checks. The purpose of this study is to examine cancer risk perception factors associated with those who have checked their skin for signs of skin cancer using the 2017 HINTS data. Retrospective cross-sectional analysis of a nationally representative sample of U.S. adults using the Health Information National Trends Survey (HINTS). Logistic regressions were performed to identify associations between having checked skin for signs of skin cancer, risk perceptions, and demographic variables. White women over the age of 45 with a college degree and annual incomes greater than $75,000 were more likely to check their skin for signs of skin cancer. More than a third reported they would rather not know if they had cancer and more than 60% had some level of worry about having cancer. Those with a personal or family history of cancer were more likely to check. HINTS is a cross-sectional survey which provides only a glimpse of behavioral predictors. Self-skin checks are simple and cost-effective to detect melanoma early and improve outcomes. Fear and worry about cancer were significant factors in the likelihood of checking skin for signs of skin cancer. Population-based strategies could be developed to reduce concerns about early detection.
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Affiliation(s)
- Julie Williams Merten
- Department of Public Health, Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA.
| | - Hanadi Y Hamadi
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Jessica L King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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Content Analysis of Skin Cancer Screenings on Pinterest: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052507. [PMID: 35270198 PMCID: PMC8909577 DOI: 10.3390/ijerph19052507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
Skin cancer rates are rising in the United States, yet screening rates remain low. Meanwhile, social media has evolved to become a primary source of health information, with 40% of daily users of Pinterest reporting the platform as a “go-to” source. The objective of this research paper is to examine how skin cancer screenings were portrayed on Pinterest. Using the search terms “skin cancer screening” and “skin cancer exam”, researchers sampled every fifth pin to collect 274 relevant pins. Two researchers coded the pins, and interrater agreement was established at 94%. The results showed that twenty-two percent of the sample depicted skin cancer screening in a negative way, yet 41.5% noted that early detection leads to better outcomes. The pins were geared toward younger, white women with minimal depiction of people of color. Few pins included comprehensive information about skin cancer risk factors, importance of routine self-screenings, or what to expect with a medical provider. Fifty-eight percent of pins included links to personal blogs. In conclusion, social media has become a powerful source of health information, yet much of the posted information is incomplete. These findings present public health experts with an opportunity to disseminate more comprehensive skin cancer screening information on social media.
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D’Ecclesiis O, Caini S, Martinoli C, Raimondi S, Gaiaschi C, Tosti G, Queirolo P, Veneri C, Saieva C, Gandini S, Chiocca S. Gender-Dependent Specificities in Cutaneous Melanoma Predisposition, Risk Factors, Somatic Mutations, Prognostic and Predictive Factors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7945. [PMID: 34360236 PMCID: PMC8345480 DOI: 10.3390/ijerph18157945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Over the last decades, the incidence of melanoma has been steadily growing, with 4.2% of the population worldwide affected by cutaneous melanoma (CM) in 2020 and with a higher incidence and mortality in men than in women. We investigated both the risk factors for CM development and the prognostic and predictive factors for survival, stratifying for both sex and gender. METHODS We conducted a systematic review of studies indexed in PUB-MED, EMBASE, and Scopus until 4 February 2021. We included reviews, meta-analyses, and pooled analyses investigating differences between women and men in CM risk factors and in prognostic and predictive factors for CM survival. DATA SYNTHESIS Twenty-four studies were included, and relevant data extracted. Of these, 13 studies concerned potential risk factors, six concerned predictive factors, and five addressed prognostic factors of melanoma. DISCUSSION The systematic review revealed no significant differences in genetic predisposition to CM between males and females, while there appear to be several gender disparities regarding CM risk factors, partly attributable to different lifestyles and behavioral habits between men and women. There is currently no clear evidence of whether the mutational landscapes of CM differ by sex/gender. Prognosis is justified by a complex combination of phenotypes and immune functions, while reported differences between genders in predicting the effectiveness of new treatments are inconsistent. Overall, the results emerging from the literature reveal the importance of considering the sex/gender variable in all studies and pave the way for including it towards precision medicine. CONCLUSIONS Men and women differ genetically, biologically, and by social construct. Our systematic review shows that, although fundamental, the variable sex/gender is not among the ones collected and analyzed.
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Affiliation(s)
- Oriana D’Ecclesiis
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy; (S.C.); (C.S.)
| | - Chiara Martinoli
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Sara Raimondi
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Camilla Gaiaschi
- GENDERS Center, Department of Social and Political Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (C.G.); (C.V.)
- Faculty of Social and Political Sciences, Institute of Social Sciences, University of Lausanne, 1015 Lausanne, Switzerland
| | - Giulio Tosti
- Division of Melanoma Surgery, Sarcoma and Rare Tumors, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (G.T.); (P.Q.)
| | - Paola Queirolo
- Division of Melanoma Surgery, Sarcoma and Rare Tumors, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (G.T.); (P.Q.)
| | - Camilla Veneri
- GENDERS Center, Department of Social and Political Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (C.G.); (C.V.)
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy; (S.C.); (C.S.)
| | - Sara Gandini
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
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Bhurosy T, Heckman CJ, Riley M. Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review. Transl Behav Med 2020; 10:1120-1133. [PMID: 33044529 DOI: 10.1093/tbm/ibaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).
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Affiliation(s)
- Trishnee Bhurosy
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Mary Riley
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Núñez-González S, Bedoya E, Simancas-Racines D, Gault C. Spatial clusters and temporal trends of malignant melanoma mortality in Ecuador. SAGE Open Med 2020; 8:2050312120918285. [PMID: 32435484 PMCID: PMC7222651 DOI: 10.1177/2050312120918285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/05/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of this study is two fold. First, it describes the temporal trends of malignant melanoma mortality from 2000 to 2016 in Ecuador. Second, it analyzes the spatial clusters of high mortality rates due to malignant melanoma in the country, from 2011 to 2016. METHODS This is an ecological study; we included all death certificates of malignant melanoma from the National Institute of Statistics and Census database in Ecuador from 2000 to 2016. We calculated crude mortality rates and age-standardized mortality rates, all rates are expressed as deaths per 100,000 population. In order to assess the trend of malignant melanoma rates, we obtained average annual percent changes through Joinpoint regression analysis. Spatial scan statistics were used to identify high-risk clusters and the spatial autocorrelation was evaluated through a global Moran index. RESULTS In Ecuador, between 2000 and 2016, malignant melanoma caused a total of 958 deaths. Crude mortality rates increased significantly (annual percent change = 4.8%; 95% confidence interval: 2.6-7.0), the age-standardized mortality rate also increased (annual percent change: 2.9%; 95% confidence interval: 0.5-5.4). The most likely cluster included 19 cantons and the second most likely cluster included 10 cantons, located in the Highlands region. The Global Moran I index for the study period shows a positive spatial autocorrelation (0.32; p = 0.001). CONCLUSION Mortality due to malignant melanoma in Ecuador significantly increased over the 17-year study period; the spatial analysis and spatial autocorrelation indicates the presence of high-risk occurrence clusters in the Highlands region of the country.
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Affiliation(s)
- Solange Núñez-González
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Estefania Bedoya
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Christopher Gault
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
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Tew M, Clarke P, Thursky K, Dalziel K. Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients. PHARMACOECONOMICS 2019; 37:931-941. [PMID: 30864067 DOI: 10.1007/s40273-019-00790-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The inclusion of future medical costs in cost-effectiveness analyses remains a controversial issue. The impact of capturing future medical costs is likely to be particularly important in patients with cancer where costly lifelong medical care is necessary. The lack of clear, definitive pharmacoeconomic guidelines can limit comparability and has implications for decision making. OBJECTIVE The aim of this study was to demonstrate the impact of incorporating future medical costs through an applied example using original data from a clinical study evaluating the cost effectiveness of a sepsis intervention in cancer patients. METHODS A decision analytic model was used to capture quality-adjusted life-years (QALYs) and lifetime costs of cancer patients from an Australian healthcare system perspective over a lifetime horizon. The evaluation considered three scenarios: (1) intervention-related costs (no future medical cost), (2) lifetime cancer costs and (3) all future healthcare costs. Inputs to the model included patient-level data from the clinical study, relative risk of death due to sepsis, cancer mortality and future medical costs sourced from published literature. All costs are expressed in 2017 Australian dollars and discounted at 5%. To further assess the impact of future costs on cancer heterogeneity, variation in survival and lifetime costs between cancer types and the implications for cost-effectiveness analysis were explored. RESULTS The inclusion of future medical costs increased incremental cost-effectiveness ratios (ICERs) resulting in a shift from the intervention being a dominant strategy (cheaper and more effective) to an ICER of $7526/QALY. Across different cancer types, longer life expectancies did not necessarily result in greater lifetime healthcare costs. Incremental costs differed across cancers depending on the respective costs of managing cancer and survivorship, thus resulting in variations in ICERs. CONCLUSIONS There is scope for including costs beyond intervention costs in economic evaluations. The inclusion of future medical costs can result in markedly different cost-effectiveness results, leading to higher ICERs in a cancer population, with possible implications for funding decisions.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia.
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Karin Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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Coups EJ, Manne SL, Pagoto SL, Criswell KR, Goydos JS. Facebook Intervention for Young-Onset Melanoma Patients and Their Family Members: Pilot and Feasibility Study. JMIR DERMATOLOGY 2018. [DOI: 10.2196/derma.9734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marek AJ, Chu EY, Ming ME, Khan ZA, Kovarik CL. Piloting the Use of Smartphones, Reminders, and Accountability Partners to Promote Skin Self-Examinations in Patients with Total Body Photography: A Randomized Controlled Trial. Am J Clin Dermatol 2018; 19:779-785. [PMID: 30062632 DOI: 10.1007/s40257-018-0372-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of a mobile application (app) in patients already using total body photography (TBP) to increase skin self-examination (SSE) rates and pilot the effectiveness of examination reminders and accountability partners. DESIGN Randomized controlled trial with computer generated randomization table to allocate interventions. SETTING University of Pennsylvania pigmented lesion clinic. PARTICIPANTS 69 patients aged 18 years or older with an iPhone/iPad, who were already in possession of TBP photographs. INTERVENTION A mobile app loaded with digital TBP photos for all participants, and either (1) the mobile app only, (2) skin examination reminders, (3) an accountability partner, or (4) reminders and an accountability partner. MAIN OUTCOME MEASURE Change in SSE rates as assessed by enrollment and end-of-study surveys 6 months later. RESULTS Eighty one patients completed informed consent, however 12 patients did not complete trial enrollment procedures due to device incompatibility, leaving 69 patients who were randomized and analyzed [mean age 54.3 years, standard deviation 13.9). SSE rates increased significantly from 58% at baseline to 83% at 6 months (odds ratio 2.64, 95% confidence interval 1.20-4.09), with no difference among the intervention groups. The group with examination reminders alone had the highest (94%) overall satisfaction, and the group with accountability partners alone accounted for the lowest (71%). CONCLUSION A mobile app alone, or with reminders and/or accountability partners, was found to be an effective tool that can help to increase SSE rates. Skin examination reminders may help provide a better overall experience for a subset of patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02520622.
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Affiliation(s)
- Andrew J Marek
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Department of Medicine, MedStar Harbor Hospital, Baltimore, MD, USA.
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zeeshan A Khan
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Hubbard G, Kyle RG, Neal RD, Marmara V, Wang Z, Dombrowski SU. Promoting sunscreen use and skin self-examination to improve early detection and prevent skin cancer: quasi-experimental trial of an adolescent psycho-educational intervention. BMC Public Health 2018; 18:666. [PMID: 29843654 PMCID: PMC5975556 DOI: 10.1186/s12889-018-5570-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Skin cancer rates are increasing. Interventions to increase adolescent sunscreen use and skin self-examination (SSE) are required. Methods Quasi-experimental design; 1 control and 4 intervention group schools in Scotland, UK. Participants were 15–16 year old students on the school register. The intervention was a theoretically-informed (Common-Sense Model and Health Action Process Approach) 50-min presentation, delivered by a skin cancer specialist nurse and young adult skin cancer survivor, to students in a classroom, supplemented by a home-based assignment. Outcome variables were sunscreen use intention, SSE intention/behaviour, planning, illness perceptions and skin cancer communication behaviour, measured 2 weeks pre- and 4 weeks post- intervention using self-completed pen and paper survey. School attendance records were used to record intervention up-take; students self-reported completion of the home-based assignment. Pearson’s chi-square test, analysis of variance, and non-parametric Wilcoxon Signed Ranks Test were used to measure outcomes and associations between variables. Focus groups elicited students’ (n = 29) views on the intervention. Qualitative data were analysed thematically. Results Five of 37 invited schools participated. 639 (81%) students in intervention schools received the intervention; 33.8% completed the home-based assignment. 627 (69.6%) of students on the school register in intervention and control schools completed a questionnaire at baseline; data for 455 (72.6%) students were available at baseline and follow-up. Focus groups identified four themes – personal experiences of skin cancer, distaste for sunscreen, relevance of SSE in adolescence, and skin cancer conversations. Statistically significant (p < 0.05) changes were observed for sunscreen use, SSE, planning, and talk about skin cancer in intervention schools but not the control. Significant associations were found between sunscreen use, planning and 2 illness perceptions (identity and consequence) and between SSE, planning and 3 illness perceptions (timeline, causes, control). Conclusions It is feasible to promote sunscreen use and SSE in the context of an adolescent school-based psychoeducation intention. Further research is required to improve study uptake, intervention adherence and effectiveness. Trial registration ISRCTN11141528 Electronic supplementary material The online version of this article (10.1186/s12889-018-5570-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gill Hubbard
- School of Health, Social Care and Life Sciences, Centre for Health Sciences, University of the Highlands and Islands (UHI), Old Perth Road, Inverness, IV2 3JH, Scotland.
| | - Richard G Kyle
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Richard D Neal
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Vincent Marmara
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta, Humanities B (FEMA), Msida, MSD, 2080, Malta
| | - Ziyan Wang
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
| | - Stephan U Dombrowski
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
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12
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Miller KA, In GK, Jiang SY, Ahadiat O, Higgins S, Wysong A, Cockburn MG. Skin Cancer Prevention Among Hispanics: a Review of the Literature. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Spronk I, Korevaar JC, Burgers JS, Albreht T, Schellevis FG. Review of guidance on recurrence risk management for general practitioners in breast cancer, colorectal cancer and melanoma guidelines. Fam Pract 2017; 34:154-160. [PMID: 28207044 DOI: 10.1093/fampra/cmw140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance. OBJECTIVE To explore what guidance is available for GPs on managing recurrence risks for breast cancer, colorectal cancer and melanoma, and to examine whether recurrence risk management differs between these tumour types. METHODS Breast cancer, colorectal cancer and melanoma clinical practice guidelines were identified via searches on internet and the literature, and experts were approached to identify guidelines. Guidance on recurrence risk management that was (potentially) relevant for GPs was extracted and summarized into topics. RESULTS We included 24 breast cancer, 21 colorectal cancer and 15 melanoma guidelines. Identified topics on recurrence risk management were rather similar among the three tumour types. The main issue in the guidelines was recurrence detection through consecutive diagnostic testing. Guidelines agree on both routine and nonroutine tests, but, recommended frequencies for follow-up are inconsistent, except for mammography screening for breast cancer. Only six guidelines provided targeted guidance for GPs. CONCLUSION This inventory shows that recurrence risk management has overlapping areas between tumour types, making it more feasible for GPs to provide this care. However, few guidance on recurrence risk management is specific for GPs. Recommendations on time intervals of consecutive diagnostic tests are inconsistent, making it difficult for GPs to manage recurrence risks and illustrating the need for more guidance targeted for GPs.
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Affiliation(s)
- Inge Spronk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Jako S Burgers
- Dutch College of General Practitioners, Utrecht, The Netherlands.,School CAPHRI, Department Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Tit Albreht
- Centre for Health System Analyses, National Institute of Public Health, Ljubljana, Slovenia
| | - François G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine/EMGO Institute for health and care research, VU University Medical Center, Amsterdam, The Netherlands
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14
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Eriksson H, Lyth J, Andersson TML. The proportion cured of patients diagnosed with Stage III-IV cutaneous malignant melanoma in Sweden 1990-2007: A population-based study. Int J Cancer 2016; 138:2829-36. [PMID: 26815934 DOI: 10.1002/ijc.30023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/30/2015] [Accepted: 01/15/2016] [Indexed: 02/03/2023]
Abstract
The survival in cutaneous malignant melanoma (CMM) is highly dependent on the stage of the disease. Stage III-IV CMM patients are at high risk of relapse with a heterogeneous outcome, but not all experience excess mortality due to their disease. This group is referred to as the cure proportion representing the proportion of patients who experience the same mortality rate as the general population. The aim of this study was to estimate the cure proportion of patients diagnosed with Stage III-IV CMM in Sweden. From the population-based Swedish Melanoma Register, we included 856 patients diagnosed with primary Stage III-IV CMM, 1990-2007, followed-up through 2013. We used flexible parametric cure models to estimate cure proportions and median survival times (MSTs) of uncured by sex, age, tumor site, ulceration status (in Stage III patients) and disease stage. The standardized (over sex, age and site) cure proportion was lower in Stage IV CMMs (0.15, 95% CI 0.09-0.22) than non-ulcerated Stage III CMMs (0.48, 95% CI 0.41-0.55) with a statistically significant difference of 0.33 (95% CI = 0.24-0.41). Ulcerated Stage III CMMs had a cure proportion of 0.27 (95% CI 0.21-0.32) with a statistically significant difference compared to non-ulcerated Stage III CMMs (difference 0.21; 95% CI = 0.13-0.30). The standardized MST of uncured was approximately 9-10 months longer for non-ulcerated versus ulcerated Stage III CMMs. We could demonstrate a significantly better outcome in patients diagnosed with non-ulcerated Stage III CMMs compared to ulcerated Stage III CMMs and Stage IV disease after adjusting for age, sex and tumor site.
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Affiliation(s)
- Hanna Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, and Deptartment of Oncology, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Johan Lyth
- Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Nahar VK, Allison Ford M, Brodell RT, Boyas JF, Jacks SK, Biviji-Sharma R, Haskins MA, Bass MA. Skin cancer prevention practices among malignant melanoma survivors: a systematic review. J Cancer Res Clin Oncol 2015; 142:1273-83. [PMID: 26642962 DOI: 10.1007/s00432-015-2086-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/21/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE This systematic review was conducted to evaluate and summarize the existing literature on prevalence of ultraviolet radiation (UVR) exposure, sun protection, and screening behaviors among individuals diagnosed with malignant melanoma (MM). METHODS The search was performed in PubMed, CINAHL, PsycINFO, ScienceDirect, EMBASE, and ERIC from inception of each database through July 2014. Studies were included if (1) individuals diagnosed with MM were the primary sample, (2) measured UVR exposure, primary and secondary preventive behaviors, (3) original research communication that constitutes an entire set of empirical data, (4) observational design, and (5) English peer-reviewed. Studies were excluded if (1) all of the inclusion criteria were not met and (2) duplicates, conference abstracts, editorials, news, letters to the editor, comments, reviews, feature articles, white papers, and guidelines. RESULTS The search resulted in 255 articles that were screened for relevance; however, only 15 articles met all of the inclusion criteria. Most of the studies were cross-sectional (n = 10), used self-administered surveys (n = 8), and were conducted in North America (n = 10). The sample sizes ranged considerably, but were mostly Caucasian (n = 6) and included a higher proportion of women (n = 8). Evidence demonstrated that individuals with MM still engaged in sunbathing, indoor tanning, and reported sunburns. Moreover, survivors reported inadequate levels of both sun protection and skin self-examinations. CONCLUSIONS The findings highlight the need for intensifying intervention strategies to reduce the risk of new primary MMs in this group. Future research should increase in rigor and include more diverse populations and regions.
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Affiliation(s)
- Vinayak K Nahar
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA. .,Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.
| | - M Allison Ford
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.,Department of Pathology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.,Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Javier F Boyas
- Department of Social Work, University of Mississippi, 208 Longstreet Hall, PO Box 1848, Oxford, MS, 38677, USA
| | - Stephanie K Jacks
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA
| | - Rizwana Biviji-Sharma
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, IUPUI, 714 N. Senate Ave, Suite 250, Indianapolis, IN, 46202, USA
| | - Mary A Haskins
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
| | - Martha A Bass
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
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16
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Youl PH, Soyer HP, Baade PD, Marshall AL, Finch L, Janda M. Can skin cancer prevention and early detection be improved via mobile phone text messaging? A randomised, attention control trial. Prev Med 2015; 71:50-6. [PMID: 25524612 DOI: 10.1016/j.ypmed.2014.12.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the impact of a theory-based, SMS (text message)-delivered behavioural intervention (Healthy Text) targeting sun protection or skin self-examination behaviours compared to attention control. METHOD Overall, 546 participants aged 18-42 years were randomised using a computer-generated number list to the skin self-examination (N=176), sun protection (N=187), or attention control (N=183) text messages group. Each group received 21 text messages about their assigned topic over 12 months (12 weekly messages for 3 months, then monthly messages for the next 9 months). Data were collected via telephone survey at baseline, 3, and 12 months across Queensland from January 2012 to August 2013. RESULTS One year after baseline, the sun protection (mean change 0.12; P=0.030) and skin self-examination groups (mean change 0.12; P=0.035) had significantly greater improvement in their sun protection habits (SPH) index compared to the attention control group (reference mean change 0.02). The increase in the proportion of participants who reported any skin self-examination from baseline to 12 months was significantly greater in the skin self-examination intervention group (103/163; 63%; P<0.001) than the sun protection (83/173; 48%) or attention control (65/165; 36%) groups. There was no significant effect of the intervention for participants' self-reported whole-body skin self-examination, sun tanning, or sunburn behaviours. CONCLUSION The Healthy Text intervention was effective in inducing significant improvements in sun protection and any type of skin self-examination behaviours. TRIAL REGISTRATION The Australian and New Zealand Clinical Trials register (ACTRN12612000577819). FUNDING Cancer Australia 1011999.
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Affiliation(s)
- Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Alison L Marshall
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Linda Finch
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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17
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Lingala B, Li S, Wysong A, Truong AK, Kim D, Chang ALS. Low rate of dermatology outpatient visits in Asian-Americans: an initial survey study for associated patient-related factors. BMC DERMATOLOGY 2014; 14:13. [PMID: 25085260 PMCID: PMC4130701 DOI: 10.1186/1471-5945-14-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022]
Abstract
Background Asian-Americans represent the fastest growing minority group in the United States, but are under-represented patients in outpatient dermatology clinics. At the same time, skin cancer rates in individuals of Asian descent are increasing, but skin cancer detection appears to be delayed in Asian-Americans compared to white individuals. Some health-care provider related factors for this phenomenon have been reported in the literature, but the patient-related factors are unclear. Methods This exploratory study to identify patient-related factors associated with dermatology visits in Asian-Americans was performed after Institutional Review Board (IRB) approval. An anonymous, online survey utilizing validated items was conducted on adults who self-identified as Asian-American in Northern California. Univariate and multivariate logistic regression for dermatology visits as indicated by responses to the question of “ever having had skin checked by a dermatologist” were performed on survey responses pertaining to demographic information, socioeconomic factors, acculturation, knowledge of melanoma warning signs and SSE belief and practice. Results 89.7% of individuals who opened the online survey completed the items, with 469 surveys included in the analysis. Only 60% reported ever performing a SSE, and only 48% reported ever having a skin examination by a dermatologist. Multivariate models showed that “ever performing SSE” (p < 0.0001), marital status (p = 0.02), family history of skin cancer (p = 0.03) and generation in the United States (p = 0.02) were significant predictors of the primary outcome of “ever had skin checked by a dermatologist”. Conclusions Identification of patient-related factors that associate with dermatology clinic visits in Asian-Americans is important so that this potential gap in dermatologic care can be better addressed through future studies.
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Affiliation(s)
| | | | | | | | | | - Anne Lynn S Chang
- Department of Dermatology, Stanford University, Pavilion C, 2nd Floor, 450 Broadway St, Redwood City 94063, CA, USA.
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18
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Dyson J, Cowdell F. Development and psychometric testing of the ‘Motivation and Self-Efficacy in Early Detection of Skin Lesions’ index. J Adv Nurs 2014; 70:2952-63. [DOI: 10.1111/jan.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Judith Dyson
- Faculty of Health and Social Care; University of Hull; UK
| | - Fiona Cowdell
- Faculty of Health and Social Care; University of Hull; UK
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19
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Eriksson H, Lyth J, Månsson-Brahme E, Frohm-Nilsson M, Ingvar C, Lindholm C, Naredi P, Stierner U, Carstensen J, Hansson J. Later stage at diagnosis and worse survival in cutaneous malignant melanoma among men living alone: a nationwide population-based study from Sweden. J Clin Oncol 2014; 32:1356-64. [PMID: 24687828 DOI: 10.1200/jco.2013.52.7564] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the association between cohabitation status, clinical stage at diagnosis, and disease-specific survival in cutaneous malignant melanoma (CMM). METHODS This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based registers followed up through 2012. RESULTS After adjustment for age at diagnosis, level of education, living area, period of diagnosis, and tumor site, the odds ratios (ORs) of higher stage at diagnosis were significantly increased among men living alone versus men living with a partner (stage II v stage I: OR, 1.42; 95% CI, 1.29 to 1.57; stage III or IV v stage I: OR, 1.43; 95% CI, 1.14 to 1.79). The OR for stage II versus stage I disease was also increased among women living alone (OR, 1.15; 95% CI, 1.04 to 1.28). After adjustments for the factors listed earlier, the CMM-specific survival was significantly decreased among men living alone (hazard ratio [HR] for death, 1.48; 95% CI, 1.33 to 1.65; P < .001). After additional adjustments for all potential and established prognostic factors, CMM-specific survival among men living alone versus men living with a partner remained significantly decreased (HR, 1.31; 95% CI, 1.18 to 1.46; P < .001), suggesting a residual adverse effect on survival not accounted for by these parameters. CONCLUSION In all age groups among men, living alone is significantly associated with reduced CMM-specific survival, partially attributed to a more advanced stage at diagnosis. This emphasizes the need for improved prevention and early detection strategies for this group.
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Affiliation(s)
- Hanna Eriksson
- Hanna Eriksson, Eva Månsson-Brahme, Margareta Frohm-Nilsson, and Johan Hansson, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm; Johan Lyth and Christer Lindholm, Regional Cancer Center Southeast, Linköping University Hospital; Johan Lyth and John Carstensen, Linköping University, Linköping; Christian Ingvar, Lund University, Lund; Peter Naredi, Sahlgrenska Academy; and Ulrika Stierner, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures. J Invest Dermatol 2013; 134:937-945. [PMID: 24335896 DOI: 10.1038/jid.2013.465] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 11/09/2022]
Abstract
Minority populations have disproportionately more advanced stage melanoma and worse survival. To clarify the impact of race and ethnicity on late-stage melanoma diagnosis, we performed spatial analysis of geocoded melanoma cases diagnosed in Florida, 1999-2008, to identify geographic clusters of higher-than-expected incidence of late-stage melanoma and developed predictive models for melanoma cases in high-risk neighborhoods accounting for area-based poverty, race/ethnicity, patient insurance status, age, and gender. In the adjusted model, Hispanic ethnicity and census tract-level poverty are the strongest predictors for clustering of late-stage melanoma. Hispanic whites were 43% more likely to live in neighborhoods with excessive late-stage melanoma (P<0.001) compared with non-Hispanic whites (NHW). For every 1% increase in population living in poverty, there is a 2% increase in late-stage melanoma clustering (P<0.001). Census tract-level poverty predicted late-stage melanoma similarly among NHW and Hispanic whites. The impact of insurance coverage varied among populations; the most consistent trend was that Medicaid coverage is associated with higher odds for late-stage melanoma. The finding that Hispanics are most likely to reside in high-risk neighborhoods, independent of poverty and insurance status, underscores the importance of addressing, and overcoming community-level barriers to melanoma care.
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22
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Körner A, Coroiu A, Martins C, Wang B. Predictors of skin self-examination before and after a melanoma diagnosis: the role of medical advice and patient's level of education. Int Arch Med 2013; 6:8. [PMID: 23446040 PMCID: PMC3599942 DOI: 10.1186/1755-7682-6-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cutaneous melanoma is the fastest growing tumor of the skin and the median life span of patients with advanced disease is less than a year. Melanoma-related mortality can be reduced through early detection via clinical skin exams and patient self-examination. Despite the potential to reducing the medical burden associated with clinical skin exams, systematic and regular skin self-examinations (SSE) are rarely performed. The current study examined psychosocial predictors of SSE and changes in SSE behavior from pre- to post-diagnosis in order to guide future melanoma prevention initiatives. FINDINGS A consecutive sample of 47 melanoma survivors was drawn from a tertiary care clinic. Most melanomas had been detected by patients, spouses and other laypersons. Higher education was related to more frequent SSE at pre-diagnosis, more thorough SSE at post-diagnosis, and more frequent reports of having been advised to perform SSE at post-diagnosis. SSE behaviors increased significantly from pre- to post-diagnosis. CONCLUSIONS These findings suggest that different patient subgroups display varied knowledge base, readiness for change, and receptiveness for medical advice. Thus, interventions seeking to enhance skin self-exam practice may be most effective when the individual's psychosocial characteristics are taken into account.
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Affiliation(s)
- Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montréal, Canada.
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23
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e-Health Tools for Targeting and Improving Melanoma Screening: A Review. J Skin Cancer 2012; 2012:437502. [PMID: 23304515 PMCID: PMC3530856 DOI: 10.1155/2012/437502] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/22/2012] [Indexed: 11/20/2022] Open
Abstract
The key to improved prognosis for melanoma is early detection and diagnosis, achieved by skin surveillance and secondary prevention (screening). However, adherence to screening guidelines is low, with population-based estimates of approximately 26% for physician-based skin cancer screening and 20–25% for skin self-examination. The recent proliferation of melanoma detection “e-Health” tools, digital resources that facilitate screening in patients often outside of the clinical setting, may offer new strategies to promote adherence and expand the proportion and range of individuals performing skin self-examination. The purpose of this paper is to catalog and categorize melanoma screening e-Health tools to aid in the determination of their efficacy and potential for adoption. The availability and accessibility of such tools, their costs, target audience, and, where possible, information on their efficacy, will be discussed with potential benefits and limitations considered. While e-Health tools targeting melanoma screening are widely available, little has been done to formally evaluate their efficacy and ability to aid in overcoming screening barriers. Future research needs to formally evaluate the potential role of e-Health tools in melanoma prevention.
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24
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Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Natale-Pereira A, Goydos JS. Skin cancer surveillance behaviors among US Hispanic adults. J Am Acad Dermatol 2012. [PMID: 23182066 DOI: 10.1016/j.jaad.2012.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little skin cancer prevention research has focused on the US Hispanic population. OBJECTIVE This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. METHODS A population-based sample of 788 Hispanic adults residing in 5 southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. RESULTS The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. LIMITATIONS The cross-sectional design limits conclusions regarding the causal nature of observed associations. CONCLUSIONS Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors.
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Affiliation(s)
- Elliot J Coups
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey.
| | - Jerod L Stapleton
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shawna V Hudson
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey
| | | | | | - Marsha Gordon
- The Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ana Natale-Pereira
- Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - James S Goydos
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Guther S, Ramrath K, Dyall-Smith D, Landthaler M, Stolz W. Development of a targeted risk-group model for skin cancer screening based on more than 100 000 total skin examinations. J Eur Acad Dermatol Venereol 2011; 26:86-94. [DOI: 10.1111/j.1468-3083.2011.04014.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bristow IR, de Berker DA, Acland KM, Turner RJ, Bowling J. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res 2010; 3:25. [PMID: 21040565 PMCID: PMC2987777 DOI: 10.1186/1757-1146-3-25] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 11/01/2010] [Indexed: 01/07/2023] Open
Abstract
Malignant melanoma is a life threatening skin tumour which may arise on the foot. The prognosis for the condition is good when lesions are diagnosed and treated early. However, lesions arising on the soles and within the nail unit can be difficult to recognise leading to delays in diagnosis. These guidelines have been drafted to alert health care practitioners to the early signs of the disease so an early diagnosis can be sought.
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Affiliation(s)
- Ivan R Bristow
- School of Health Sciences, University of Southampton, SO17 1BJ, UK.
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