Melanoma Awareness Aimed at Siblings Has Limited Effect

BOSTON, July 10 -- Siblings of melanoma patients reacted with mixed success to an intensive awareness intervention protocol, according to investigators here.

In a randomized trial, siblings of melanoma patients who got an intensive educational program were more likely to know what melanoma looks like and to have examined all their moles than were siblings who got usual care. The latter consisted of a suggestion from affected siblings' doctor that the patients notify family members and suggest they be screened.

On the other hand, the intensive-care group was no more likely than the usual-care group to use sun protection, such as applying sunscreen or wearing a hat, Alan Geller, M.P.H., R.N., of the Boston University School of Medicine here reported online today in Cancer.

The diagnosis of melanoma in one family member provides an "important opportunity to intervene with others," Geller and colleagues wrote.

First-degree relatives of melanoma patients have a two- to eight-fold increased risk of developing the cancer, the researchers noted, and "thus represent a risk group who may experience a 'teachable moment'" when their siblings are diagnosed. To test the idea, 15 clinicians at four Boston-area teaching hospitals agreed to enlist patients and their siblings in a randomized trial.

First, Geller and colleagues said, 360 patients were asked if they had siblings and would agree to have them contacted by the researchers; 330 had siblings and 298 agreed to participate. All told, the researchers contacted 667 siblings, of whom 494 agreed to take part and filled out a baseline survey.

Immediately after they completed the survey, the siblings were randomized to usual care or intensive care. Intensive care was an initial motivational and goal-setting telephone session, three sets of computer-generated materials specifically tailored to individual responses from the baseline survey, three telephone counseling sessions with a health educator, and links to free screening programs.

Follow-up surveys at six and 12 months assessed three primary outcome variables:

• Having a skin cancer screening examination by a dermatologist within 12 months of the baseline survey.
• Conducting a personal skin self-examination, defined as careful examination of all moles, including those on the back at least once in the year after the baseline survey.
• Always or often using sunscreen with a sun protection factor (SPF) 15 or greater when in the sun for more than 15 minutes during the previous summer.

The study found no significant differences in the proportion of siblings who had a dermatologist's exam, although those in the intensive-care group were twice as likely to express confidence about seeking such an examination. The odds ratio was 2.14, with a 95% confidence interval from 1.23 to 3.73.

There were also no differences in the use of sunscreen, the study found, although those in the IC group were less likely than the UC group to report having been tanned in the previous summer, although not significantly so. The odds ratio was 0.72, with a 95% confidence interval from 0.47 to 1.09.

On the other hand, the intensive-care group was significantly more likely to have conducted a skin self-examination and looked at all their moles, including those on the back; the odds ratio was 1.76, with a 95% confidence interval from 1.06 to 2.91. Also, the intensive-care group was more likely to have compared moles to see whether any stood out. The odds ratio was 2.20, with a 95% confidence interval from 1.22 to 3.98.

The study was limited by its reliance on self-reporting, Geller and colleagues said, which might lead to over-reporting of physician and self examinations. It also relied on more or less distant recall for participants to say whether they had tanned or used sunscreen during the previous summer.

The authors also pointed out that the participants were drawn from a small number of practices affiliated with academic centers which may have affected the results.

"For two of the primary outcomes, sun protection and physician examination, there were no differences between intervention and control group subjects from baseline to follow-up," they wrote. "This might suggest that standard education of patients in academic teaching hospitals is sufficient; however sharper differences might emerge if this study was replicated in nonacademic settings."