title: Patient perception of skin-cancer prevention and risk after liver transplantation.
abstract: BACKGROUND
  Sun exposure is a major risk factor for the development of skin cancer. This is particularly relevant in immunosuppressed liver-transplant recipients (LTRs). Preventative strategies may help minimize the skin-cancer risk in this patient group.
  
  
  METHODS
  We assessed 670 patients in our post-transplant clinic, using questionnaires. Patient data were collected, and we assessed whether patients had received education (such as formal talks or information from transplant coordinators or from hepatologists) on skin, sun exposure and skin cancer. In a subset of 280 of the LTRs who responded, we recorded their recall of sun-protection advice and assessed the level of patient adherence to such advice.
  
  
  RESULTS
  The response rate was 57.5% (349/607), with a mean responder age of 51.1 years (range 19-84) and an average post-transplant time of 7.1 years (range 0-27). In the recall assessment, 37.2% reported that they were given advice about their skin, while 18.1% were seen by a dermatologist, and education on sun exposure and the risks of skin cancer was given to 65.6% and 47.9%, respectively. Over three-quarters (78%; 185/280) of the patients used mechanical sun protection (i.e. hats/clothing), while 66% reported using sunscreen; 31.8% of these used a sunscreen of the recommended sun protection factor (SPF) of > 30. Twelve patients had developed squamous cell carcinoma after a mean of 10.9 years (1-23) post-transplant; half of these had used either no sunscreen or one with an SPF of < 15.
  
  
  CONCLUSIONS
  Despite the fact that LTRs are given information on sun-exposure and SC before and after transplantation, recall of such advice and use of sun-protection methods was only moderate, indicating that regular reinforcement of SC education is needed.
authors.affiliation: Institute of Liver Studies, London, UK.
authors.forename: B R
authors.initials: BR
authors.lastname: Thomas
authors.forename: A
authors.initials: A
authors.lastname: Barnabas
authors.forename: K
authors.initials: K
authors.lastname: Agarwal
authors.forename: V
authors.initials: V
authors.lastname: Aluvihare
authors.forename: A R
authors.initials: AR
authors.lastname: Suddle
authors.forename: E M
authors.initials: EM
authors.lastname: Higgins
authors.forename: J G
authors.initials: JG
authors.lastname: O'Grady
authors.forename: N D
authors.initials: ND
authors.lastname: Heaton
authors.forename: M A
authors.initials: MA
authors.lastname: Heneghan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards*; D012307:Risk Factors; D012878:Skin Neoplasms / Q000209:etiology / Q000517:prevention & control*; D013473:Sunscreening Agents; D011795:Surveys and Questionnaires; D014466:Ultraviolet Rays / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents