A systematic review of available research has suggested that, although sun protection education is effective in changing patient behaviors post-transplantation, the effects of these changes on skin cancer incidence following solid-organ transplants is unclear. This is a mixed finding and suggests that, although the education is getting people to engage in more sun-protective behavior, whether those changes actually help anyone remains to be seen.
In Brief: Organ Transplants and Skin Cancer
A “solid organ transplant” refers to a transplant performed on an organ that is neither hollow nor liquid. The term encompasses most things people commonly think of as organs, such as the heart, kidneys, liver, and lungs, but does not feature parts of the body like the intestines (hollow) or blood (liquid). In order to prevent rejection, patients who undergo transplants are regularly given immunosuppressant drugs and are at increased risk for developing infections.
Chronic immunosuppression is also a known risk factor for skin cancer, so post-transplant patients are routinely educated on sun protection and are advised to perform self-examinations and get dermatologists to perform full-body skin examinations. This study was conducted to analyze the effectiveness of sun-protective education on this uniquely vulnerable population.
Seven studies, published between 1995 and 2016, were included in the review. Of these seven, five were randomly controlled clinical trials. This is one of the better types of research trails, especially when a randomly controlled blind trial is logistically impossible. You cannot effectively blind participants or scientists when evaluating sun protection education.
Two of the five studies showed that giving patients education on sun protection improved sun-protective activities and reduced skin pigmentation and skin damage associated with sun exposure. The remaining three studies compared different types of patient education and found that they were all effective at changing sun-protective habits.
You may have already noticed, but none of these studies actually looked at incidences of skin cancer. This lack of data on the primary clinical outcome (skin cancer) was acknowledged by the researchers, likely to their great annoyance. It is hard to tell if you are preventing skin cancer without anyone actually measuring who starts getting tumors.
Consequently, the researchers could only make conclusions based on the evidence they have. Systematic analysis is one of the ways science can, through demonstrating repeated and consistent trends among findings, try and draw broader conclusions. Unfortunately, such analysis is limited by the pool of research it can draw from. Sun-protection education in post-transplantation groups is an extremely narrow part of skin cancer research, and this review helps shine a light on an area that needs more attention.
Wu, S., et. al., “A qualitative systematic review of the efficacy of sun protection education in organ transplant recipients,” JAAD, 2016; http://dx.doi.org/10.1016/j.jaad.2016.06.031.