Achieving integrated self-directed Cancer aftercare (ASICA) for melanoma: how a digital intervention to support total skin self-examination was used by people treated for cutaneous melanoma

Abstract

Background Melanoma incidence has quadrupled since 1970 and melanoma is now the second most common cancer in individuals under 50. Targeted immunotherapies for melanoma now potentially enable long-term remission even in advanced melanoma, but these melanoma survivors require ongoing surveillance, with implications for NHS resources and significant social and psychological consequences for patients. Total skin self-examination (TSSE) can detect recurrence earlier and improve clinical outcomes but is underperformed in the UK. To support survivors, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed to prompt and improve TSSE performance, with subsequent reporting of concerns and submission of skin photos to a Dermatology Nurse Practitioner (DNP). ASICA was delivered as a randomized pilot trial. Methods This paper reports on process evaluation. Data on participants’ demographics and the concerns they reported during the trial were tabulated and displayed using Microsoft Excel and SPSS. We explored which participants used ASICA, and how frequently, to report any skin concerns. We also determined how the interactions had worked in terms of quality of skin photographs submitted, clinical assessments made by the DNP, and the assessments and decisions made for each concern. Finally, we explored significant events occurring during the trial. Data on participants’ demographics and the concerns they reported during the trial were tabulated and displayed using SPSS. A semi-structured interview was undertaken with the DNP to gain perspective on the range of concerns presented and how they were resolved. Results Of 121 recruited melanoma patients receiving ASICA for 12 months, 69 participants submitted a total of 123 reports detailing 189 separate skin-related concerns and including 188 skin photographs. Where participants fully complied with follow-up by the DNP, concerns were usually resolved remotely, but 19 (10.1%) were seen at a secondary care clinic and 14 (7.4%) referred to their GP. 49 (25.9%) of concerns were not completely resolved due to partial non-compliance with DNP follow-up. Conclusion Melanoma patients randomized to the ASICA intervention were able to report skin-related concerns that could be resolved remotely through interaction with a DNP. Feasibility issues highlighted by ASICA will support further development and optimization of this digital tool. Trial registration Clinical Trials.gov, NCT03328247. Registered on 1 November 2017

Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression

“…A total of 1566 studies were identified in the database search. After removing duplicates, the screening process, and complete reading of the records that met the eligibility criteria, 17 RCTs were finally included in the review [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. The complete process is shown in Figure 1.…”

“…The age of the participants ranged from 12.6 to 54.3 years. The digital strategies used in the included RCTs were web-based interventions in 8 studies [35,40,42,43,46,[48][49][50], 6 involved apps [36][37][38]44,45,47], 3 involved SMS [35,36,39], 2 involved video [34,41], and 1 involved a wearable device [47]. Conversely, the comparator groups involved no intervention in 11 studies [35,37,[43][44][45][46][47][48]50] and active controls in 6 studies [34,36,38,39,41,49].…”

“…The total number of dropouts for all arms of the included studies was 1120, with 681 (60.80%) in experimental interventions and 439 (39.20%) in controls. The reason for the dropout of participants was reported as loss during follow-up in 9 of the 17 RCTs [34,37,38,[40][41][42][43]47,49] and not answering the final questionnaire in 4 studies [39,44,45,50]; 2 studies did not report the reason for dropout [35,48]. The main characteristics of the studies are displayed in Table 2.…”

“…The meta-analysis of proportions included 22 arms (k) of study and 2610 subjects among whom there were 419 dropouts. An overall pooled dropout rate of 9.5% (95% CI, 5.0-17.5) was calculated (Figure 2; [34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50]). In the subgroup meta-analysis, digital strategies showed a higher dropout rate of 11.6% (95% CI 6.8-19.0) compared to 10.0% (95% CI 5.5-17.7) in the comparators.…”

“…A slight trend for a higher number of dropouts was observed in digital strategies with an OR of 1.16 (95% CI 0.98-1.36), but there were no significant differences between the experimental and control approaches (P=.39). The I 2 was 6% (95% CI 0-38) indicating a lack of heterogeneity between the studies analyzed for the overall and subgroup meta-analysis (Figure 3; [34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50]). We performed a meta-analysis of subgroups divided by the type of digital strategy and the comparison groups.…”