1
|
Haney MO, Ordin YS, Arkan G. Skin Cancer-Sun Knowledge and Sun Protection Behaviors of Liver Transplant Recipients in Turkey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:137-144. [PMID: 28887780 DOI: 10.1007/s13187-017-1279-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to compare liver transplant recipients (LTRs) with the general population regarding their knowledge of skin cancer, sun health, sun protection behaviors, and affecting factors. This cross-sectional study was conducted in Turkey between March 2016 and September 2016 with 104 LTRs and 100 participants from the general population group (GPG). The mean age of the LTRs was 53.2 ± 11.8 and that of the GPG was 42.7 ± 14.5. The LTRs' skin cancer and sun knowledge were significantly lower than in the GPG, but there was no difference between the two groups in terms of their sun protection behavior scores. The most commonly used sun protection behaviors of LTRs were not being outside and not sunbathing between 10 a.m. and 4 p.m., wearing clothing that covers the skin, and avoiding the solarium. Behaviors commonly practiced by the GPG were wearing sunglasses, wearing sunscreen with a sun protection factor of 15 or higher before going outside, wearing sunscreen at the beach, while swimming or doing physical activity outside, and reapplying it every 2 h. Results of our study will contribute to the development of education and training programs for LTRs on skin cancer. The results also demonstrated the importance of practicing adequate sun protection behaviors which will certainly impact their future health.
Collapse
Affiliation(s)
- Meryem Ozturk Haney
- Public Health Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
| | - Yaprak Sarigol Ordin
- Surgical Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
| | - Gulcihan Arkan
- Public Health Nursing Department, Dokuz Eylul University Faculty of Nursing, Dokuz Eylul University Health Campus, Inciralti, 35340, Izmir, Turkey.
| |
Collapse
|
2
|
Dietary grape seed proanthocyanidins inactivate regulatory T cells by promoting NER-dependent DNA repair in dendritic cells in UVB-exposed skin. Oncotarget 2018; 8:49625-49636. [PMID: 28548949 PMCID: PMC5564793 DOI: 10.18632/oncotarget.17867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/29/2017] [Indexed: 11/25/2022] Open
Abstract
Ultraviolet B (UVB) radiation induces regulatory T cells (Treg cells) and depletion of these Treg cells alleviates immunosuppression and inhibits photocarcinogenesis in mice. Here, we determined the effects of dietary grape seed proanthocyanidins (GSPs) on the development and activity of UVB-induced Treg cells. C3H/HeN mice fed a GSPs (0.5%, w/w)-supplemented or control diet were exposed to UVB (150 mJ/cm2) radiation, sensitized to 2,4-dinitrofluorobenzene (DNFB) and sacrificed 5 days later. FACS analysis indicated that dietary GSPs decrease the numbers of UVB-induced Treg cells. ELISA analysis of cultured sorted Treg cells indicated that secretion of immunosuppressive cytokines (interleukin-10, TGF-β) was significantly lower in Treg cells from GSPs-fed mice. Dietary GSPs also enhanced the ability of Treg cells from wild-type mice to stimulate production of IFNγ by T cells. These effects of dietary GSPs on Treg cell function were not found in XPA-deficient mice, which are incapable of repairing UVB-induced DNA damage. Adoptive transfer experiments revealed that naïve recipients that received Treg cells from GSPs-fed UVB-irradiated wild-type donors that had been sensitized to DNFB exhibited a significantly higher contact hypersensitivity (CHS) response to DNFB than mice that received Treg cells from UVB-exposed mice fed the control diet. There was no significant difference in the CHS response between mice that received Treg cells from UVB-irradiated XPA-deficient donors fed GSPs or the control diet. Furthermore, dietary GSPs significantly inhibited UVB-induced skin tumor development in wild-type mice but not in XPA-deficient mice. These results suggest that GSPs inactivate Treg cells by promoting DNA repair in dendritic cells in UVB-exposed skin.
Collapse
|
3
|
Jäckel D, Schlothauer NI, Zeeb H, Wagner G, Sachse MM. [Skin cancer screening and treatment costs : Utilisation of the skin cancer screening and skin cancer treatment costs in organ transplant recipients]. Hautarzt 2018; 69:570-575. [PMID: 29651516 DOI: 10.1007/s00105-018-4159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Organ transplant recipients have an up to 250-times higher risk to develop skin cancer. This article evaluated the utilisation of skin cancer screening and the treatment costs for skin cancer in organ transplant recipients. Patients of the health insurance AOK Bremen/Bremerhaven had been identified and the need for skin cancer prevention trainings was derived. METHODS The number of organ transplant recipients (ICD code Z94.0-4) with and without any history of skin cancer (ICD code C43/C44), the utilisation of dermatologic health care services, and the costs for treatments with the diagnosis Z94.0-4 with and without C43/C44 were evaluated. The analyses were carried out for the period from 2009-2014 by using the accounting systems of the AOK. RESULTS Between 2009 and 2014, 231 organ transplant recipients had been recorded. By mid-2014, 20% of these insured persons developed skin cancer and the mean incidence was 2.76% per year. On average, 43% of these patients were seen by a dermatologist at least once a year, whereby only 15% of the organ transplant recipients participated in the annual skin cancer screening. In 29% of the patients without any history of skin cancer, a skin examination was never performed by a dermatologist or a general practitioner. In all, 17 inpatient cases of organ transplant recipients with the primary diagnosis C43/C44 were analyzed. This resulted in total costs of 54,707 € (on average about 3200 € per case). CONCLUSIONS The increased incidence of skin cancer and the associated treatment costs indicate the need for skin cancer prevention training.
Collapse
Affiliation(s)
- D Jäckel
- Rechts- und Staatswissenschaftliche Fakultät, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Deutschland. .,Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven, Bremerhaven, Deutschland.
| | - N I Schlothauer
- ehemals Versorgungsmanagement/Medizin, AOK Bremen/Bremerhaven, Bremen, Deutschland
| | - H Zeeb
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland
| | - G Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven, Bremerhaven, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven, Bremerhaven, Deutschland
| |
Collapse
|
4
|
Gellén E, Papp BG, Janka EA, Gáll T, Paragh G, Emri G, Nemes B, Remenyik É. Comparison of pre- and post-transplant sun-safe behavior of kidney transplant recipients: What is needed to improve? PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:322-329. [DOI: 10.1111/phpp.12387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Emese Gellén
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Bence G. Papp
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Eszter A. Janka
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Tibor Gáll
- Department of Preventive Medicine; Faculty of Public Health; University of Debrecen; Debrecen Hungary
| | - György Paragh
- Department of Dermatology; Department of Cell Biology; Roswell Park Comprehensive Cancer Center; Buffalo NY USA
| | - Gabriella Emri
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Balázs Nemes
- Department of Surgery; Transplantation Centre; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Éva Remenyik
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| |
Collapse
|
5
|
Patel PH, Bibee K, Lim G, Malik SM, Wu C, Pugliano-Mauro M. Evaluating Retention of Skin Cancer Education in Kidney Transplant Recipients Reveals a Window of Opportunity for Re-education. Transplant Proc 2018; 49:1318-1324. [PMID: 28736001 DOI: 10.1016/j.transproceed.2017.03.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Skin cancer is the most common malignancy after solid organ transplant and can lead to significant morbidity. The likelihood of developing squamous cell carcinomas and melanomas is 100 and 2.4 times more likely, respectively, in kidney transplant recipients when compared with the general population. There are few data regarding the assessment and influence of solid organ transplant recipient (SOTR) knowledge of skin cancer and its effect on short- and long-term awareness and behavior. METHODS The purpose of this study was to assess the baseline knowledge of SOTR immediately after transplantation, and then to reassess their knowledge following a 5-minute educational video. We also wanted to determine whether lifestyle modifications had been implemented 4 to 8 months after the intervention. RESULTS Forty patients were enrolled within 2 months of transplantation. Eighty-seven percent of patients were renal transplant recipients, and 75% of patients were available for long-term follow-up. There was a significant increase in knowledge in the immediate postintervention period, which was sustained at 4- to 8-month follow-up, as assessed by patient questionnaire. Patients appeared to be applying this knowledge by participating in lifestyle risk modification and positive sun-protective behavior. CONCLUSIONS Our study suggests that incorporating additional skin cancer education into the early transplant timeline (perhaps in the first one or two outpatient follow-up visits) with an easy to administer educational video and question and answer form increases patient knowledge and influences positive sun-protective behavior.
Collapse
Affiliation(s)
- P H Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - K Bibee
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - G Lim
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - S M Malik
- Department of Medicine, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
| | - C Wu
- Department of Medicine, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
| | - M Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
6
|
Tufaro AP, Azoury SC, Crompton JG, Straughan DM, Reddy S, Prasad NB, Shi G, Fischer AC. Rising incidence and aggressive nature of cutaneous malignancies after transplantation: An update on epidemiology, risk factors, management and surveillance. Surg Oncol 2015; 24:345-52. [DOI: 10.1016/j.suronc.2015.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023]
|
7
|
David V, Feldman D, Danner-Boucher I, Rhun AL, Guyomarch B, Ravilly S, Marchand C. Identifying the Educational Needs of Lung Transplant Recipients with Cystic Fibrosis. Prog Transplant 2015; 25:18-25. [DOI: 10.7182/pit2015526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To elucidate the education needs of patients who have undergone lung transplant for cystic fibrosis while participating in the development of therapeutic education programs in French transplant centers. Methods From January 2009 to March 2012, in-depth educational diagnosis interviews were conducted with 42 adult transplant recipients with cystic fibrosis who were being followed up at 7 French transplant centers. Several areas were explored: health status, social and occupational outcomes, knowledge about the disease and treatments, and experience of the disease. The interviews combined open- and closed-ended questions for more systematic exploration of knowledge about the disease and treatments. Results After receiving the transplant, the patients' health had improved and their lives were returning to normal. They had acquired much usable knowledge about managing their disease. Educational needs regarding transplant-related complications and management of immunosuppressive drugs were evident. The analysis also demonstrated the need to better inform patients about pregnancy and new social rights and to offer them psychological support in adjusting to their new health status. Conclusion Therapeutic education of patients should continue well after transplant to maintain safety knowledge and meet patients' new needs. A comprehensive therapeutic education program for transplant candidates that includes the preparatory, immediate posttransplant, and late posttransplant phases is needed.
Collapse
Affiliation(s)
- Valérie David
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| | - David Feldman
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| | - Isabelle Danner-Boucher
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| | - Anne Le Rhun
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| | - Beatrice Guyomarch
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| | - Sophie Ravilly
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| | - Claire Marchand
- Hôpital Mère et Enfant, Nantes (VD), CHU Nantes (DF, ALR), CHU Nantes-Nord, Saint-Herblain (ID-B, BG), Vaincre la Mucoviscidose, Paris (SR), Université Paris 13, Bobigny (CM), France
| |
Collapse
|
8
|
Robinson JK, Guevara Y, Gaber R, Clayman ML, Kwasny MJ, Friedewald JJ, Gordon EJ. Efficacy of a sun protection workbook for kidney transplant recipients: a randomized controlled trial of a culturally sensitive educational intervention. Am J Transplant 2014; 14:2821-9. [PMID: 25395386 PMCID: PMC4236256 DOI: 10.1111/ajt.12932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/23/2014] [Accepted: 07/12/2014] [Indexed: 01/25/2023]
Abstract
A culturally sensitive educational intervention that encouraged sun protection behaviors among kidney transplant recipients (KTRs) was developed and the short-term efficacy was evaluated. Non-Hispanic White, Hispanic/Latino and non-Hispanic Black patients, who received a transplant 2-24 months prior to the study, were randomized into two study groups: intervention versus standard of care. Electronic reminders tailored to the weather conditions were sent every 2 weeks by text message or email. Self-reported surveys and biologic measurements were obtained prior to the intervention and 6 weeks later. Among the 101 study participants, there was a statistically significant increase in knowledge, recognition of personal risk of developing skin cancer, willingness to change sun protection behavior and self-reported performance of sun protection in participants receiving the intervention in comparison with those receiving standard of care (p < 0.05). The pigment darkening of the sun-exposed forearm and sun damage of the forearm and sunburns/skin irritation from the sun were significantly less in participants receiving the intervention (p < 0.05). Providing sun protection education at the beginning of summer with reminders tailored to weather conditions helped KTRs adopt sun protection practices. This sun protection program for KTRs may be incorporated into the care provided by the nephrologist or transplant surgeon.
Collapse
Affiliation(s)
- June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yanina Guevara
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rikki Gaber
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marla L. Clayman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary J. Kwasny
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John J. Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elisa J. Gordon
- Center for Healthcare Studies & Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
9
|
Use of a Brief Educational Video Administered by a Portable Video Device to Improve Skin Cancer Knowledge in the Outpatient Transplant Population. Dermatol Surg 2014; 40:1233-9. [DOI: 10.1097/dss.0000000000000148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
10
|
Berben L, Denhaerynck K, Dobbels F, Engberg S, Vanhaecke J, Crespo-Leiro MG, Russell CL, De Geest S. Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study: study protocol. J Adv Nurs 2014; 71:642-54. [DOI: 10.1111/jan.12519] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Lut Berben
- Institute of Nursing Science; University of Basel; Switzerland
- Health Services and Nursing Research; KU Leuven; Belgium
| | | | | | - Sandra Engberg
- Clinical Education; School of Nursing; University of Pittsburgh; Pennsylvania USA
| | - Johan Vanhaecke
- Division of Cardiology; University Hospitals Leuven; Belgium
| | - Maria G. Crespo-Leiro
- Heart Failure and Heart Transplant Unit; Hospital Universitario A Coruña Spain; La Coruña Spain
| | | | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Switzerland
- Health Services and Nursing Research; KU Leuven; Belgium
| | | |
Collapse
|
11
|
Hanna K, Fassett RG, Gill E, Healy H, Kimlin M, Ross L, Ash S. Serum 25-hydroxy vitamin D concentrations are more deficient/insufficient in peritoneal dialysis than haemodialysis patients in a sunny climate. J Hum Nutr Diet 2014; 28:209-18. [PMID: 24720834 DOI: 10.1111/jhn.12234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research has identified associations between serum 25(OH)D and a range of clinical outcomes in chronic kidney disease and wider populations. The present study aimed to investigate vitamin D deficiency/insufficiency in dialysis patients and the relationship with vitamin D intake and sun exposure. METHODS A cross-sectional study was used. Participants included 30 peritoneal dialysis (PD) (43.3% male; 56.87 ± 16.16 years) and 26 haemodialysis (HD) (80.8% male; 63.58 ± 15.09 years) patients attending a department of renal medicine. Explanatory variables were usual vitamin D intake from diet/supplements (IU day(-1) ) and sun exposure (min day(-1) ). Vitamin D intake, sun exposure and ethnic background were assessed by questionnaire. Weight, malnutrition status and routine biochemistry were also assessed. Data were collected during usual department visits. The main outcome measure was serum 25(OH)D (nm). RESULTS Prevalence of inadequate/insufficient vitamin D intake differed between dialysis modality, with 31% and 43% found to be insufficient (<50 nm) and 4% and 33% found to be deficient (<25 nm) in HD and PD patients, respectively (P < 0.001). In HD patients, there was a correlation between diet and supplemental vitamin D intake and 25(OH)D (ρ = 0.84, P < 0.001) and average sun exposure and 25(OH)D (ρ = 0.50, P < 0.02). There were no associations in PD patients. The results remained significant for vitamin D intake after multiple regression, adjusting for age, gender and sun exposure. CONCLUSIONS The results highlight a strong association between vitamin D intake and 25(OH)D in HD but not PD patients, with implications for replacement recommendations. The findings indicate that, even in a sunny climate, many dialysis patients are vitamin D deficient, highlighting the need for exploration of determinants and consequences.
Collapse
Affiliation(s)
- K Hanna
- Queensland University of Technology, Brisbane, QLD, Australia
| | - R G Fassett
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | - E Gill
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - H Healy
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - M Kimlin
- Queensland University of Technology, Brisbane, QLD, Australia
| | - L Ross
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S Ash
- Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
12
|
|
13
|
O'Reilly Zwald F, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part II. Management of skin cancer in solid organ transplant recipients. J Am Acad Dermatol 2011; 65:263-279. [PMID: 21763562 DOI: 10.1016/j.jaad.2010.11.063] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/30/2010] [Accepted: 11/20/2010] [Indexed: 12/13/2022]
Abstract
The management of skin cancer in solid organ transplant recipients is a challenge to both the dermatologist and transplant physician. Part II of this continuing medical education review offers an approach to the management of this increasing problem. The importance of specialty dermatology clinics providing access to transplant patients, frequent skin cancer screening, patient education, and multidisciplinary care is discussed. The management of low risk squamous cell carcinoma with topical therapies, photodynamic therapy, systemic retinoids, and capecitabine is reviewed. Revision of immunosuppression in the management of high-risk patients is discussed in association with the potential role of sentinel lymph node biopsy for aggressive disease. Finally, management of in-transit and metastatic squamous cell carcinoma is reviewed, with a discussion of the role of more recent innovative therapies, including epidermal growth factor receptor inhibitors in advanced squamous cell carcinoma in solid organ transplant recipients.
Collapse
Affiliation(s)
- Fiona O'Reilly Zwald
- Department of Dermatology and Division of Transplantation, Department of Surgery, Emory University, Atlanta, Georgia.
| | - Marc Brown
- Department of Dermatology and Oncology, University of Rochester, Rochester, New York
| |
Collapse
|
14
|
Robinson JK, Alam M, Ashourian N, Khan M, Kundu R, Laumann AE, Schlosser BJ, Yoo S, Gordon EJ. Skin cancer prevention education for kidney transplant recipients: a systematic evaluation of Internet sites. Prog Transplant 2011. [PMID: 21265287 DOI: 10.7182/prtr.20.4.9877500752888660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Repeated patient education about skin cancer prevention is important to self-care after transplant. OBJECTIVE Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. DESIGN Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. PARTICIPANTS An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. MAIN OUTCOME MEASURES Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results-Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (kappa = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n=4). Few sites recommended using protective clothing (n=5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n=1). Five sites recommended skin self-examination. CONCLUSION Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
Collapse
Affiliation(s)
- June K Robinson
- Northwestern University Feinberg School of Medicine, Chicago, Ilinois, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Robinson JK, Alam M, Ashourian N, Khan M, Kundu R, Laumann AE, Schlosser BJ, Yoo S, Gordon EJ. Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites. Prog Transplant 2010; 20:344-9. [DOI: 10.1177/152692481002000407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Repeated patient education about skin cancer prevention is important to self-care after transplant. Objective Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Design Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. Participants An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Main Outcome Measures Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination Conclusion Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
Collapse
Affiliation(s)
- June K. Robinson
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Murad Alam
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Neda Ashourian
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Misbah Khan
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Roopal Kundu
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Anne E. Laumann
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | | | - Simon Yoo
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Elisa J. Gordon
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| |
Collapse
|
16
|
|