Solid-organ recipients are largely unaware of their elevated risk, according to a study

  

SAN ANTONIO—Kidney and other solid organ recipients are largely unaware of their elevated risk for skin cancer, according to data presented here at the American Academy of Dermatology annual meeting.

 

The incidence of skin cancer in solid organ transplant recipients is up to 200-fold that of age-matched controls largely due to the required immunosuppressive medications, according to the latest estimates. Yet, many of these recipients are unaware of this risk and efforts to educate them have been sadly lacking.

 

“Educating transplant patients about the risk of skin cancer is essential, but multiple studies have shown that education during their hospital stay is not retained by patients and is not enough to change patient behavior regarding sun protection,” said Summer Youker, MD, assistant professor of dermatology at Saint Louis University School of Medicine, St. Louis, Mo.

 

More aggressive malignancy

 

Dr. Youker, who presented the latest data on skin cancer and solid organ transplant recipients at the meeting, said skin cancers tend to be more aggressive and spread more quickly in solid organ transplant recipients compared to other patient populations. Many nephrologists and urologists are probably not aware that their kidney recipients tend to have skin cancer occur up to 30 years earlier than the general population. Additionally, solid organ transplant recipients have an increased rate of skin cancer recurrence after treatment and a much higher overall rate of metastasis.

 

In 2006, there were 29,000 solid organs transplanted in the United States, contributing to a total of 223,000 people living with functional organ transplants at the end of the year. Dr. Youker cited studies showing that as many as 82% of kidney transplant recipients develop skin cancer 20 years after transplantation, and a study of Australian heart transplant recipients found that 27% of deaths occurring four years after transplantation were due to skin cancer.

 

Dr. Youker and her colleagues recently completed a study of 298 solid organ transplant patients (65% male). Of these, 219 were kidney transplant recipients. All of the subjects attended outpatient transplant clinics and completed a two-page survey to evaluate their comprehension of skin cancer risk, their compliance with skin cancer preventive measures, and their attitudes about sunscreen use and skin screenings. Sixty-two percent of respondents reported that they were not informed about the risk of skin cancer following their organ transplant, despite documented verbal education while in the hospital. In fact, only 21% of patients had seen a dermatologist since their transplant, with even less (14%) receiving annual skin exams.

 

Inadequate sunscreen use

 

Of the reasons respondents gave for not seeing a dermatologist, 64% said they “did not know about the increased risk” and 7% said that they “do not want to attend another doctor's appointment.” Only 28% of respondents reported wearing sunscreen regularly, a slight increase from 22% who reported wearing sunscreen regularly before transplantation. Reasons for not wearing sunscreen varied widely among survey participants, with 33% responding, “I forget to put it on,” and 25% reporting “I don't think it is important to use sunscreen.” A total of 16% said they are “not in the sun very much,” 11% said “I like looking tan,” 8% said they “don't like the way it feels,” and 5% said it “takes too much time” to put on.

 

“Our findings confirmed that the majority of transplant patients surveyed did not know they were at risk of developing skin cancer, and many of the reasons they gave for not practicing proper sun protection or seeing a dermatologist could be remedied by developing an intensive educational approach that raises awareness of the prevalence of this real health threat,” Dr. Youker said. “Because the time around organ transplantation is consumed with the more pressing issues of rejection and infection, patients cannot be expected to recall information regarding the risk of sun exposure. Clearly, another method of informing patients of their risk is needed.”

Dr. Youker cited a related study published in Archives of Dermatology (2006;142:712-718). The study, titled “Educational Outcomes Regarding Skin Cancer in Organ Transplant Recipients,” found that patients who received an intensive educational program in which written reminders reinforced the risk of skin cancer fared significantly better in terms of complying with the recommended sun protection tips than those who did not receive this education.

 

The best approach, she said, may be to send transplant recipients regular correspondence in the mail or via email concerning the risk of skin cancer, and referring them to a dermatologist for initial skin screening, regular follow-up, and ongoing education. A dermatologist can assess the patient's individual risk factors and offer detailed education about skin cancer prevention.