Childhood cancer survivors who were treated with radiation are at a 30-fold increased risk for developing basal cell carcinoma and a 2.5- to 5-fold increased risk for developing melanoma 2 decades after treatment exposure. Despite the increased risk and incidence of skin cancer in this population, improving adherence to skin cancer screening recommendations has been challenging.

Researchers conducted a randomized controlled comparative effectiveness trial to evaluate various methods for improving early detection of skin cancer among childhood cancer survivors. The results were published in The Journal of Clinical Oncology.

Participants were recruited from the Childhood Cancer Survivor Study (CCSS), with 728 patients who had been treated with radiotherapy as children were enrolled and randomly assigned 1:1:1 to 3 groups:

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  • Education through patient activation (PAE), includes text messaging, print materials, and a website with information on skin cancer
  • Education through patient and provider activation (PAE + MD)
  • Patient and provider activation with teledermoscopy (PAE + MD + TD)

Primary outcomes were participant-reported physician skin examination, participant-reported self-skin examination, and number of body parts self-examined at 12 months and 18 months after the intervention.

Rates of physician skin cancer screening at 12 months increased in all 3 groups: PAE, from 23.8% to 39.1%; PAE + MD, from 23.9% to 38.5%; and PAE + MD + TD, from 24.1% to 45.6%.

Skin self-examinations also were significantly increased at 18 months in all 3 groups: PAE, from 28.8% to 49.5%; PAE + MD, from 31% to 57.6%; PAE + MD + TD, from 29.4% to 58.4%.

Lastly, the mean number of body parts self-examined at 18 months increased in all 3 groups: PAE, 2.4 to 4.5; PAE + MD, 2.5 to 4.2; PAE + MD + TD, 2.3 to 4.7.

Differences in rate of increase was not statistically significant across the 3 intervention groups for all outcomes (P =.49, P =.43, P =.43, respectively).

The intervention was designed to incrementally include more resources, yet education through patient activation print materials combined with mHealth strategies (ie, text messaging and Advancing Survivors Knowledge [ASK] website) were as effective as other more resource-intensive strategies, explained the researchers.

“On the basis of our findings, for survivors of childhood cancer treated with radiation, we recommend that future implementation trials of early detection of skin cancer using self- and provider-administered skin examinations be centered on low-cost patient activation strategies including a combination of print and mHealth strategies,” the researchers concluded.

The study did have some limitations. Participants were members of a CCSS cohort and key demographic characteristics were largely similar; therefore, they may not be representative of all childhood cancer survivors. The study’s use of patient-reported outcomes may have resulted in some recall bias. Additionally, the study did not include a true nonactive control arm.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Geller AC, Coroiu A, Keske RR, et al. Advancing survivors knowledge (ASK Study) of skin cancer surveillance after childhood cancer: a randomized controlled trial in the childhood cancer survivor study. J Clin Oncol. Published online January 9, 2023. doi:10.1200/JCO.22.00408