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Sun exposure reduction by melanoma survivors with wearable sensor providing real-time UV exposure and daily text messages with structured goal setting

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Abstract

Despite knowledge of subsequent melanoma risk and the benefit of sun protection in risk reduction, melanoma survivors often do not engage in adequate sun protection and continue to sunburn at rates similar to individuals without a history of skin cancer. This novel intensive intervention provided a wearable UV sensor delivering real-time UV exposure with a smartphone and daily text messages. On days 1–10 (period 1), behavioral facilitation and outcome expectancies messages were provided. On day 10, participants reviewed and reflected on their daily UV exposure on the previous 10 days and set goals for improving sun protection. Then on days 11–21 (period 2) self-efficacy and self-regulation messages were provided. Sixty melanoma survivors were randomized (1:1) to receive structured or unstructured goal setting queries on day 10. Controlling for cloudy/rain conditions with less UV due to weather, there was a time effect with a significant decrease in UV exposure from periods 1–2 [period 1–2, F (59) = 22.60, p < 0.0001]. In this short-term study, melanoma survivors managed their daily UV exposure to stay below their maximum tolerated UV dose. ClinicalTrials.gov Protocol Record NCT0334796, date of registration Nov 15, 2017.

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Data availability

The data are not publicly available due to their containing information that could compromise the privacy of research participants. Deidentified data are available upon request from the corresponding author, [JKR].

References

  1. Wu YP, Aspinwall LG, Conn BM, Stump T, Grahmann B, Leachman SA (2016) A systematic review of interventions to improve adherence to melanoma preventive behaviors for individuals at elevated risk. Prev Med 88:153–167

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bränström R, Kasparian NA, Chang YM, Affleck P, Tibben A, Aspinwall LG et al (2010) Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomark Prev 19(9):2199–2210

    Article  Google Scholar 

  3. Holman DM, Berkowitz Z, Guy GP Jr, Hartman AM, Perna FM (2014) The association between demographic and behavioral characteristics and sunburn among U.S. adults - National Health Interview Survey, 2014. Prev Med 63:6–12

    Article  PubMed  PubMed Central  Google Scholar 

  4. Buller DB, Cokkinides V, Hall HI et al (2011) Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: review from national surveys and case studies of 3 states. J Am Acad Dermatol 65:S114–S123

    Article  PubMed  Google Scholar 

  5. Holman DM, Ding H, Guy GP et al (2018) Prevalence of sun protection use and sunburn and association of demographic and behavioral characteristics with sunburn among US adults. JAMA Dermatol 154(5):51–568

    Article  Google Scholar 

  6. Erdmann F, Lortet-Tieulent J, Schuz J et al (2013) International trends in the incidence of malignant melanoma 1953–2008–are recent generations at higher or lower risk? Int J Cancer 132(2):385–400

    Article  CAS  PubMed  Google Scholar 

  7. Whiteman DC, Green AC, Olsen CM (2016) The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. J Investig Dermatol 136(6):1161–1171

    Article  CAS  PubMed  Google Scholar 

  8. Green AC, Williams GM, Logan V, Strutton GM (2010) Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 29:257–263

    Article  PubMed  Google Scholar 

  9. Diao DY, Lee TK (2013) Sun-protective behaviors in populations at high risk for skin cancer. Psychol Res Behav Manag 20:9–18

    Google Scholar 

  10. Freiman A, Yu J, Loutfi A, Wang B (2004) Impact of melanoma diagnosis on sun-awareness and protection: efficacy of education campaigns in a high-risk population. J Cutan Med Surg 8:303–309

    Article  PubMed  Google Scholar 

  11. Soto E, Lee H, Saladi RN, Gerson Y, Manginani S, Lam K, Persaud AN, Wong R, Alexandrescu DT, Fox JL (2010) Behavioral factors of patients before and after diagnosis with melanoma: a cohort study–are sun-protection measures being implemented? Melanoma Res 20:147–152

    Article  PubMed  Google Scholar 

  12. Idorn LW, Datta P, Heydenreich J, Philipsen PA, Wulf HC (2013) Sun behaviour after cutaneous malignant melanoma: a study based on ultraviolet radiation measurements and sun diary data. Br J Dermatol 168(2):367–373

    Article  CAS  PubMed  Google Scholar 

  13. Idorn LW, Datta P, Heydenreich J, Philipsen PA, Wulf HC (2014) A 3-year follow-up of sun behavior in patients with cutaneous malignant melanoma. JAMA Dermatol 150:163–168

    Article  PubMed  Google Scholar 

  14. Nahar VK, Allison Ford M, Brodell RT et al (2016) Skin cancer prevention practices among malignant melanoma survivors: a systematic review. J Cancer Res Clin Oncol 142:1273–1283

    Article  CAS  PubMed  Google Scholar 

  15. Vogel RI, Strayer LG, Engelman L, Nelson HH, Blaes AH, Anderson KE, Lazovitch D (2017) Sun exposure and protection behaviors among long-term melanoma survivors and population controls. Cancer Epidemiol Biomark Prev 26(4):607–613

    Article  Google Scholar 

  16. Moore SC, Lee IM, Weiderpass E et al (2016) Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Int Med 176(6):8160825

    Article  Google Scholar 

  17. Coups EJ, Ostroff JA (2005) A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 40:702–711

    Article  PubMed  Google Scholar 

  18. Heo SY, Kim J, Gutruf P, Banks A, Wei P, Pielak R, Balooch G, Araki H, Rollo D, Gaede C, Patel M, Yun Y, Robinson JK, Xu S, Rogers JA (2018) Wireless, battery-free, miniaturized dosimeters for monitoring exposure to solar radiation. Sci Transl Med 10(470):eaau1643. https://doi.org/10.1126/scitranslmed.aau1643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Thieden E, Philipsen PA, Sandby-Moller J, Wulf HC (2005) Sunscreen use related to UV exposure, age, sex, and occupation based on personal dosimeter readings and sun-exposure behavior diaries. Arch Dermatol 141(8):967–973

    Article  PubMed  Google Scholar 

  20. Green LW, Kreuter MW (2005) Health program planning: an educational and ecological approach, 4th edn. McGraw-Hill, New York

    Google Scholar 

  21. Diffey B (2017) Sun protection: a risk management. IOP Publishing Lts, Bristol

    Google Scholar 

  22. Kollias N, Ruvolor E, Sayre RM (2011) The value of the ratio of UVA to UVB in sunlight. Photochem Photobiol 87:1474–1475

    Article  CAS  PubMed  Google Scholar 

  23. Parisi AV, Kimlin MG, Wong JC, Wilson M (2000) Personal exposure distribution of solar erythemal ultraviolet radiation in tree shade over summer. Phys Med Biol 45(2):349–356

    Article  CAS  PubMed  Google Scholar 

  24. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    Article  PubMed  Google Scholar 

  25. Robinson JK, Guevara Y, Gaber R, Clayman ML, Kwasny MJ, Friedewald JJ, Gordon EJ (2014) Efficacy of a sun protection workbook for kidney transplant recipients: a randomized controlled trial of a culturally sensitive educational intervention. Am J Transpl 14:2821–2829

    Article  CAS  Google Scholar 

  26. Robinson JK, Friedewald JJ, Desai A, Gordon EJ (2016) A randomized controlled trial of a mobile medical app for kidney transplant recipients: effect on use of sun protection. Transplant Direct 2(1):e51. https://doi.org/10.1097/TXD.0000000000000561

    Article  PubMed  Google Scholar 

  27. Elo S, Kyngäs H (2008) The qualitative content analysis process. J Adv Nurs 62(1):107–115

    Article  PubMed  Google Scholar 

  28. Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15(9):1277–1288

    Article  PubMed  Google Scholar 

  29. Charmaz K (2006) Constructing grounded theory: a practical guide through qualitative analysis. Sage Publications, London

    Google Scholar 

  30. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  31. Robinson JK, Durst DA, Gray E, Kwasny M (2020) Protection-adjusted UV dose estimated for body areas: daily self-reported sun protection modification of wearable UV sensor dose. Photodermatol Photoimmunol Photomed 00:1–8

    Google Scholar 

  32. Sache MM, Böttcher S, Pape L, Wagner G, Mehls O, Klaus G et al (2016) Face-to-face sun protection training and text messages improve sun protection behavior in adolescent organ transplant recipients: HIPPOline Feasibility study. Acta Derm Venereol 96:341–345

    Article  Google Scholar 

  33. US Department of Health and Human Services (2015) Healthy people 2020 topics & objectives: cancer. https://www.healthypeople.gov/2020/topics-objectives/topic/cancer. Accessed 3 May 2020

  34. Cheuk M, Xu D, McLean R (2014) Delivery of personal ultraviolet radiation information to smartphones. NIWA UV Workshop, Auckland, NZ April 2014. https://www.niwa.co.nz/atmosphere/uv-ozone/uv-science-workshops/2014-uv-workshop. Accessed 3 May 2020

  35. Khan AQ, Travers JB, Kemp MG (2018) Roles of UVA radiation and DNA damage responses in melanoma pathogenesis. Environ Mol Mutagen 59(5):438–460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Kamenisch Y, Baban TSA, Schuller W et al (2016) UVA-irradiation induces melanoma invasion via the enhanced warburg effect. J Investig Dermatol 136(9):1866–1875

    Article  CAS  PubMed  Google Scholar 

  37. Young AR (1998) Does UVA exposure cause human malingnant melanoma? In: Rougier A, Schaefer H (eds) Protections of the skin against ultraviolet radiations. John Libbey Eurotext, Paris, pp 25–28

    Google Scholar 

  38. Miller SA, Hamilton SL, Wester UG, Cyr WH (1998) An analysis of UVA emissions from sunlamps and the potential importance for melanoma. Photochem Photobiol 68:63–70

    Article  CAS  PubMed  Google Scholar 

  39. Coelho SG, Hearing VJ (2010) UVA tanning is involved in the increased incidence of skin cancers in fair-skinned young women. Pigment Cell Melanoma Res 23:57–63

    Article  PubMed  Google Scholar 

  40. Noonan FP, Zaidi MR, Wolnicka-Glubisz A et al (2012) Melanoma induction by ultraviolet A but not ultraviolet B radiation requires melanin pigment. Nat Commun 3:1–10

    Article  CAS  Google Scholar 

  41. Hodis E, Watson I, Kryukov G et al (2012) A landscape of driver mutations in melanoma. Cell 150:251–263

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Tewari A, Grage MM, Harrison GI, Sarkany R, Young AR (2013) UVA1 is skin deep: molecular and clinical implications. Photochem Photobiol Sci 12:95–103

    Article  CAS  PubMed  Google Scholar 

  43. Deci EL, Ryan RM (2000) The ‘what’ and ‘why’ of goal pursuits: human needs and the self-determination of behavior. Psychol Inq 11:227–268

    Article  Google Scholar 

  44. Stump TK, Spring B, Marchese SH, Alshurafa N, Robinson JK (2019) Toward a precision behavioral medicine approach to addressing high-risk sun exposure: a qualitative analysis. JAMIA Open 2(4):547–553

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mujumdar UJ, Hay JL, Monroe-Hinds YC, Hummer AJ, Begg CB, Wilcox HB, Oliveria SA, Berwick M (2009) Sun protection and skin self-examination in melanoma survivors. Psychooncology 18:1106–1115

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bowen D, Jabson J, Haddock N, Hay J, Edwards K (2012) Skin care behaviors among melanoma survivors. Psychooncology 21:1285–1291

    Article  PubMed  Google Scholar 

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Funding

Research reported in this publication was supported by the National Cancer Institute (R44 CA224658). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1050, Chicago, IL, 60611, USA

    June K. Robinson & Dalya A. Durst

  2. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Elizabeth Gray & Mary Kwasny

  3. Department of Biomedical Engineering, Center for Bio-Integrated Electronics, Simpson Querrey Institute for Bionanotechnology, Northwestern University, Evanston, IL, USA

    Seung Yun Heo, Anthony Banks & John A. Rogers

Authors
  1. June K. Robinson
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  2. Dalya A. Durst
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  3. Elizabeth Gray
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  4. Mary Kwasny
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  5. Seung Yun Heo
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  6. Anthony Banks
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  7. John A. Rogers
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Contributions

JKR, AB, JAR design and conduct of the study; JKR, DAD, SYH collection of data; JKR, EG, MK management, analysis and interpretation of data; JKR preparation of manuscript and DAD, SYH, EG, MK, AB, JAR review, or approval of the manuscript.

Corresponding author

Correspondence to June K. Robinson.

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Conflict of interest

There are no conflicts of or competing interests for the following authors (JKR, EG, MK, SYH, MWK) Mr. Banks and Dr. Rogers declare a relationship with Wearifi, Inc. and a patent on the device (U.S. Patent Application: 15/578,602 and U.S. Patent Application No.: 15/578,617).

Ethical approval

All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institution established by the Institutional Review Board of Northwestern University. This article does not contain any studies with animals performed by any of the authors.

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Written consent to participate in the study was obtained from all participants.

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Robinson, J.K., Durst, D.A., Gray, E. et al. Sun exposure reduction by melanoma survivors with wearable sensor providing real-time UV exposure and daily text messages with structured goal setting. Arch Dermatol Res 313, 685–694 (2021). https://doi.org/10.1007/s00403-020-02163-1

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  • DOI: https://doi.org/10.1007/s00403-020-02163-1

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