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Optimal time to provide skin cancer and photoprotection education to pediatric solid organ transplant recipients

2017; Elsevier BV; Volume: 77; Issue: 1 Linguagem: Inglês

10.1016/j.jaad.2017.02.033

1097-6787

Lily Chen, Feng Gao, Carrie C. Coughlin,

Cutaneous lymphoproliferative disorders research

To the Editor: Skin cancer is the most frequent malignancy in pediatric patients after renal transplantation.1Euvrard S. Kanitakis J. Cochat P. Claudy A. Skin cancers following pediatric organ transplantation.Dermatol Surg. 2004; 30: 616-621Crossref PubMed Google Scholar In children with other solid organ transplants, only posttransplant lymphoproliferative disease is more common.1Euvrard S. Kanitakis J. Cochat P. Claudy A. Skin cancers following pediatric organ transplantation.Dermatol Surg. 2004; 30: 616-621Crossref PubMed Google Scholar, 2Penn I. De novo malignancy in pediatric organ transplant recipients.Pediatr Transplant. 1998; 2: 56-63PubMed Google Scholar A large percentage of a person's lifetime sun exposure occurs before 18 to 21 years of age; estimates range from 25% to 50%.3Dadlani C. Orlow S.J. Planning for a brighter future: a review of sun protection and barriers to behavioral change in children and adolescents.Dermatol Online J. 2008; 14: 1PubMed Google Scholar Required immunosuppressive treatment during this window contributes to an increased risk for skin cancer in pediatric organ transplant recipients (POTRs). Because POTRs may face complicated medical regimens and restrictions posttransplantation, they and their guardians may prefer to delay skin cancer education, as has been documented for adult renal transplant patients.4Kim N. Boone S. Ortiz S. et al.Squamous cell carcinoma in solid organ transplant recipients: influences on perception of risk and optimal time to provide education.Arch Dermatol. 2009; 145: 1196-1197Crossref PubMed Scopus (12) Google Scholar Our study assessed when POTRs and their guardians felt ready to (1) receive initial skin cancer and photoprotection education, (2) start using photoprotection measures, and (3) receive follow-up education. After approval by the Washington University School of Medicine Institutional Review Board, we surveyed 50 families with POTRs <18 years of age during routine posttransplant clinic visits with their transplant teams. Twenty-five families included children <7 years of age (guardian only participation) and 25 included children ≥7 years of age (child and guardian participation). All children ≥7 years of age signed assent and guardians signed consent for participation. Participants completed questionnaires (child and adult versions) about medical history, skin type, skin cancer knowledge, and preferred timing of skin cancer and photoprotection education. Questions about their preference for timing of skin cancer education were repeated after an educational section with information about skin cancer in transplant recipients to determine whether basic knowledge about skin cancer risk affected the desired timing of skin cancer education. Participant characteristics are shown in Table I. Eighty-five percent of guardians and 73% of children believed the best time to receive initial brief photoprotection and skin cancer education is before or immediately after transplantation. After receiving basic knowledge about their child's risk for skin cancer, guardians' preferences for this early education rose significantly (P = .03) to 94% (Fig 1).Table IBaseline characteristicsChildren POTRs Characteristics (N = 50)Mean age, y (range)9.2 (0-17)Average time since transplant, y (range)5 (0-17)Female sex, n (%)25 (50)Race, n (%) White37 (74) Black5 (10) Other8 (16)Organ transplanted, n (%) Kidney14 (28) Liver20 (40) Double lung6 (12) Heart10 (20)Self-responses (N = 25)Mean age, y (range)13.0 (7-17)Self-identified Fitzpatrick skin type, n (%)∗One POTR did not answer. I-II8 (33) III-IV9 (38) V-VI7 (29)Has anyone talked with you about caring for you skin (posttransplant)? Yes, n (%)15 (60) No, n (%)10 (40)Has anyone talked with you about your risk for skin cancer (posttransplant)? Yes, n (%)13 (52) No, n (%)12 (48)Guardians (N = 50) Characteristics Mean age, y (range)†Thirteen guardians did not answer.36.6 (22-59) Female sex, n (%)42 (84.0) Education, n (%)High school graduate or less17 (34)Some college or more33 (66) Has anyone talked with you about caring for your child's skin (posttransplant)?Yes, n (%)43 (86)No, n (%)7 (14) Has anyone talked with you about your child's risk for skin cancer (posttransplant)?Yes, n (%)48 (96)No, n (%)2 (4)POTR, Pediatric organ transplant recipient.∗ One POTR did not answer.† Thirteen guardians did not answer. Open table in a new tab POTR, Pediatric organ transplant recipient. Eighty-eight percent of guardians and 68% of children also felt ready to start using photoprotection behaviors during this time frame, and 73% and 64%, respectively, believed that the best time to receive educational reminders is once per year or more often. The median age of children at the time of transplant was 3.7 years. Guardians with younger children (<3.7 years of age) at the time of transplant tended to prefer later education (23% vs. 10%), though the difference was not significant (P = .24), possibly because of the small sample size. We found a striking discrepancy in the responses between children and their guardians when asked if someone had talked to them about photoprotection and the risk for skin cancer posttransplant; children were much less aware (Table I), showing a need for improved communication. Our results show that POTRs and their guardians prefer to receive skin cancer and photoprotection education before or immediately after transplant, which is earlier than that found in adult renal transplant recipients. This knowledge should influence the dermatologic care and counseling of POTRs and their guardians as well as the development of pediatric-specific educational materials. Moving forward, our study can inform research on the adoption and habituation of sun-protective behaviors in POTRs, especially as they age and transition to adulthood. We thank Washington University School of Medicine/St. Louis Children's Hospital renal, liver, cardiac, and pulmonary transplant services.