Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
J Invest Dermatol. 2019 Sep;139(9):1898-1905.e2. doi: 10.1016/j.jid.2019.02.033. Epub 2019 Apr 5.
Because rates of skin cancer are greater among adult survivors of childhood cancer who received radiation therapy than among the general population, the National Cancer Institute recommends skin self-examinations and annual physician examination. There has been no comprehensive assessment of survivors' adherence to the skin cancer screening guidelines associated with skin self-examination (SSE) and physician whole-body skin examination (PSE). We conducted a cross-sectional survey of radiation-treated, adult 5-year survivors of childhood cancer, diagnosed between 1970 and 1986, in the Childhood Cancer Survivor Study cohort. Multivariate multinomial logit regression investigated the association between demographic, cancer diagnosis, patient activation, cancer treatment characteristics, and skin cancer screening practice. Among 728 survivors, 13.1% reported performing SSE in the prior 2 months plus receiving PSE in the prior 12 months, and 16.4% and 11.0% reported performing only an SSE or a PSE, respectively; 59.5% of survivors reported having had neither. Participants at the highest patient activation score were most likely to report SSE plus PSE compared with neither (adjusted relative risk ratio = 4.16, 95% confidence interval = 1.34-12.85). Most adult survivors of childhood cancer who had radiation therapy do not practice strategies that promote early detection of skin cancer. Interventions designed to activate survivors to increase their participation in screening are needed.
由于接受过放射治疗的儿童癌症成年幸存者中皮肤癌的发病率高于一般人群，因此美国国家癌症研究所建议进行皮肤自我检查和年度医生检查。目前尚未对幸存者对与皮肤自我检查（SSE）和医生全身皮肤检查（PSE）相关的皮肤癌筛查指南的依从性进行全面评估。我们对儿童癌症幸存者研究队列中 1970 年至 1986 年间诊断出的、接受过放射治疗的、成年的 5 年儿童癌症幸存者进行了横断面调查。多变量多项逻辑回归分析了人口统计学、癌症诊断、患者激活、癌症治疗特征与皮肤癌筛查实践之间的关系。在 728 名幸存者中，有 13.1%的人报告在过去 2 个月内进行了 SSE 检查，并且在过去 12 个月内接受了 PSE 检查，有 16.4%和 11.0%的人分别报告仅进行了 SSE 或 PSE 检查；59.5%的幸存者报告两者都没有进行过。处于最高患者激活评分的参与者最有可能报告 SSE 加 PSE，而不是两者都没有（调整后的相对风险比=4.16，95%置信区间=1.34-12.85）。大多数接受过放射治疗的儿童癌症成年幸存者并未采取任何策略来早期发现皮肤癌。需要设计干预措施来激活幸存者，以增加他们对筛查的参与。
