Comparison of skin cancer awareness and sun protection behaviours between renal transplant recipients and patients with glomerular disease treated with immunosuppressants

• Published in: Nephrology (Carlton, Vic.) Vol. 26; no. 4; pp. 294 - 302
• Main Authors: Thet, Zaw, Lam, Alfred K., Ng, Shu‐Kay, Aung, Soe Yu, Han, Thin, Ranganathan, Dwarakanathan, Borg, Jennifer, Pepito, Christine, Khoo, Tien K.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-04-2021; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Education; Female; glomerular disease; Glomerulonephritis - diagnosis; Glomerulonephritis - drug therapy; Glomerulonephritis - immunology; Health Knowledge, Attitudes, Practice; Humans; Immunocompromised Host; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Kidney transplantation; Kidney Transplantation - adverse effects; Male; Middle Aged; Neoplasms, Radiation-Induced - etiology; Neoplasms, Radiation-Induced - immunology; Neoplasms, Radiation-Induced - prevention & control; Patient Education as Topic; photoprotective behaviours; Protective clothing; Protective Factors; renal transplant; Risk Assessment; Risk Factors; Risk Reduction Behavior; Skin cancer; skin cancer awareness; Skin Neoplasms - etiology; Skin Neoplasms - immunology; Skin Neoplasms - prevention & control; Transplant Recipients; Ultraviolet radiation; Ultraviolet Rays - adverse effects; Young Adult; photoprotective behaviours; skin cancer awareness; glomerular disease; renal transplant
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13840

Background
There is no previous study that compare skin cancer awareness and photoprotective behaviours between renal transplant recipients (RTR) and patients with glomerular disease (GD).
Objectives/Methods
Sixty‐one RTR and 51 patients with GD were given a self‐reported questionnaire to evaluate skin cancer awareness and photoprotective behaviours in this cross‐sectional study. The former group received a formal education on skin cancer and the latter an informal session prior to immunosuppressant use.
Results
Ninety‐three percent (n = 57) of RTRs and 88% (n = 45) of patients with GD responded to the survey. Majority of participants from both groups were aware that ultraviolet radiation could play a role in the occurrence of skin cancers and the awareness increased in participants with higher education (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.15‐1.95, P = .003). Ninety‐eight percent vs 71% were aware that immunosuppressants can increase the risk of developing cancer (P < .001) and higher awareness was noted in younger participants (OR = 0.92, 95% CI = 0.87‐0.97, P = .003). Suboptimal photoprotective behaviours (sun avoidance, sunscreen usage and sun‐protective clothing) were noted in both cohorts and slightly lower sun protection rates were reported in RTR when compared with patients having GD. The level of sun protective measures in RTR based on high, moderate and minimal use of photoprotective measures were 21%, 46% and 33%, respectively. In terms of patients with GD, the latter practices were 13%, 50% and 37%, respectively (P = .560). Higher educational status was significantly associated with better sunscreen usage in RTR (P = .017) whereas this finding was not observed in patients with GD.
Conclusion
Patients with GD and RTR should have formal education on the risks of skin cancers before starting immunosuppressants. Follow‐up education and surveillance is required to improve skin protective practices in these patients.
SUMMARY AT A GLANCE
This cross‐sectional single centre study evaluated the risk of skin cancer and photo‐protective behaviour in kidney transplant recipients and patients with glomerular disease exposed to chronic immunosuppression. The authors showed that despite the understanding that chronic exposure to immunosuppression predisposes to a higher risk of skin cancers, over one in five patients do not adhere to simple photo‐protective behaviours suggesting the need for more education.