title: Advancing Survivors' Knowledge (ASK) about skin cancer study: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Advances in treatment have increased childhood cancer 5-year survival rates to greater than 80%. However, children previously treated with radiation are at significantly increased risk of developing subsequent neoplasms, the most common of which are skin cancers. The National Cancer Institute and Children's Oncology Group have issued recommendations for survivors treated with radiation to perform monthly skin self-examinations and receive a physician skin examination at least annually, as early detection has demonstrated markedly improved outcomes in the diagnosis and treatment of skin cancers. The goal of the present study is to increase rates of skin self-examinations and clinical skin examinations among adult survivors of childhood cancer treated with radiation.
  
  
  METHODS
  This randomized controlled trial uses a 3-group comparative effectiveness design comparing: (1) Patient Activation and Education (PAE) including text messaging, print and web-based tutorials over 12 months; (2) PAE plus physician activation (PAE + MD) adding physician activation/educational materials about survivors' increased skin cancer risk and conducting full-body skin exams; and (3) PAE plus physician activation, plus teledermoscopy (PAE + MD + TD) adding participant receipt of a dermatoscope intended to empower them to photograph suspect moles or lesions for review by the study dermatologist.
  
  
  CONCLUSIONS
  The current study addresses barriers to screening in this population by providing educational and motivational information for both survivors and physicians regarding the value of periodic skin examinations. It also utilizes innovative mobile health technology to encourage and motivate (that is activate) survivors to conduct skin self-examinations, request physician exams, and obtain treatment when worrisome lesions are found. Finally, as a comparative effectiveness trial, this study isolates the effects of adding specific components to the patient activation intervention to test the most effective intervention for enhancing skin examination vigilance among this high-risk group.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT02046811 ; Registration date: 22 January 2014.
authors: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA. casey_daniel@dfci.harvard.edu.
authors: Casey L
authors: CL
authors: Daniel
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA. greg.armstrong@stjude.org.
authors: Gregory T
authors: GT
authors: Armstrong
authors: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA. rkeske@hsph.harvard.edu.
authors: Robyn R
authors: RR
authors: Keske
authors: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA. jdavine@hsph.harvard.edu.
authors: Jessica A
authors: JA
authors: Davine
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA. aaron.mcdonald@stjude.org.
authors: Aaron J
authors: AJ
authors: McDonald
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, LW601, 02215-5450, Boston, MA, USA. kim_sprunckharrild@dfci.harvard.edu.
authors: Kim M
authors: KM
authors: Sprunck-Harrild
authors: Department of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, 02215-5450, Boston, MA, USA. catherine_coleman@dfci.harvard.edu.
authors: Catherine
authors: C
authors: Coleman
authors: Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Bldg 2, Rm 451, 02115-6009, Boston, MA, USA. shaneuse@hsph.harvard.edu.
authors: Sebastien J
authors: SJ
authors: Haneuse
authors: Department of Pediatrics, Emory University, Emory Children's Center, 2015 Uppergate Drive, 4th floor, 30322-1014, Atlanta, GA, USA. ann.mertens@choa.org.
authors: Ann C
authors: AC
authors: Mertens
authors: Kaiser Permanente, 1800 Harrison Street, 16th Floor, #161R03, 94612-3463, Oakland, CA, USA. karen.m.emmons@kp.org.
authors: Karen M
authors: KM
authors: Emmons
authors: Memorial-Sloan Kettering Cancer Center, 1275 York Ave, 10065-6007, New York, NY, USA. marghooa@mskcc.org.
authors: Ashfaq A
authors: AA
authors: Marghoob
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 44, 10065-6007, New York, NY, USA. elkine@mskcc.org.
authors: Elena B
authors: EB
authors: Elkin
authors: Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 East 53rd St, 2nd Floor, 10022-5243, New York, NY, USA. duszas@mskcc.org.
authors: Stephen W
authors: SW
authors: Dusza
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA. les.robison@stjude.org.
authors: Leslie L
authors: LL
authors: Robison
authors: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA. ageller@hsph.harvard.edu.
authors: Alan C
authors: AC
authors: Geller
mesh_terms: D002170:Canada; D057186:Comparative Effectiveness Research; D046169:Dermoscopy / Q000379:methods; D055088:Early Detection of Cancer; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D009042:Motivation; D009369:Neoplasms / Q000532:radiotherapy*; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000209:etiology*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D011237:Predictive Value of Tests; D012107:Research Design; D012307:Risk Factors; D016353:Self-Examination; D012878:Skin Neoplasms / Q000175:diagnosis / Q000209:etiology*; D017741:Survivors / Q000523:psychology*; D019113:Telepathology / Q000379:methods; D060145:Text Messaging; D014481:United States