Abstract
The aim of this study was to compare liver transplant recipients (LTRs) with the general population regarding their knowledge of skin cancer, sun health, sun protection behaviors, and affecting factors. This cross-sectional study was conducted in Turkey between March 2016 and September 2016 with 104 LTRs and 100 participants from the general population group (GPG). The mean age of the LTRs was 53.2 ± 11.8 and that of the GPG was 42.7 ± 14.5. The LTRs’ skin cancer and sun knowledge were significantly lower than in the GPG, but there was no difference between the two groups in terms of their sun protection behavior scores. The most commonly used sun protection behaviors of LTRs were not being outside and not sunbathing between 10 a.m. and 4 p.m., wearing clothing that covers the skin, and avoiding the solarium. Behaviors commonly practiced by the GPG were wearing sunglasses, wearing sunscreen with a sun protection factor of 15 or higher before going outside, wearing sunscreen at the beach, while swimming or doing physical activity outside, and reapplying it every 2 h. Results of our study will contribute to the development of education and training programs for LTRs on skin cancer. The results also demonstrated the importance of practicing adequate sun protection behaviors which will certainly impact their future health.
Similar content being viewed by others
References
Centers for Disease Control and Prevention (2013). United States Cancer Statistics, 2013. Available from: http://apps.nccd.cdc.gov/uscs/top ten cancers.aspx. Accessed April 21, 2016
Hanlon A, Colegio OR (2014) The cutting edge of skin cancer in transplant recipients: scientific retreat of international transplant skin cancer collaborative and skin cancer in organ transplant patients Europe. Am J Transplant 14(5):1012–1015
Tufaro AP, Azoury SC, Crompton JG et al (2015) Rising incidence and aggressive nature of cutaneous malignancies after transplantation: an update on epidemiology, risk factors, management and surveillance. Surg Oncol 24(4):345–352
Hofbauer GF, Bouwes Bavinck JN, Euvrard S (2010) Organ transplantation and skin cancer: basic problems and new perspectives. Exp Dermatol 19(6):473–482
Keles Y, Tekin S, Duzenli M et al (2015) Post-transplantation malignancy after kidney transplantation in Turkey. Transplant Proc 47(5):1418–1420
Geissler EK (2015) Skin cancer in solid organ transplant recipients: are mTOR inhibitors a game changer? Transplant Res 4:1
Modaresi Esfeh J, Hanouneh IA, Dalal D et al (2012) The incidence and risk factors of de novo skin cancer in the liver transplant recipients. Int J Org Transplant Med 3(4):157–163
Mithoefer AB, Supran S, Freeman RB (2002) Risk factors associated with the development of skin cancer after liver transplantation. Liver Transpl 8(10):939–944
Saraiye M, Glanz K, Briss PA et al (2004) Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med 27:422–466
SZ W, Jiang P, DeCaro JE, Bordeaux JS (2016) A qualitative systematic review of the efficacy of sun protection education in organ transplant recipients. J Am Acad Dermatol 75(6):1238–1244
Bangash HK, Colegio OR (2012) Management of non-melanoma skin cancer in immunocompromised solid organ transplant recipients. Curr Treat Options in Oncol 13:354–376
Firooz A, Amin-Nejad R, Bouzari N, Nafar M, Firoozan A, Mahdavi-Mazdeh M (2007) Sun protection in Iranian kidney transplant recipients: knowledge, attitude and practice. J Eur Acad Dermatol Venereol 21:754–757
Ismail F, Mitchell L, Casabonne D et al (2006) Specialist dermatology clinics for organ transplant recipients significantly improve compliance with photoprotection and levels of skin cancer awareness. Br J Dermatol 155(5):916–925
Chockalingam R, Christopher D, Tyring SK (2015) Cutaneous squamous cell carcinomas in organ transplant recipients. J Clin Med 4(6):1229–1239
Terhost D, Drecoll U, Stockleth E, Ulrich C (2009) Organ transplant recipients and skin cancer: assessment of risk factors with focus on sun exposure. Br J Dermatol 161(Suppl. 3):85–89
Feuerstein I, Alan CG (2008) Skin cancer education in transplant recipients. Prog Transplant 18(4):232–241
Mihalis E, Wysong A, Boscardin WJ, Tang JY, Chren MM, Arron ST (2013) Factors affecting sunscreen use and sun avoidance in a U.S. national sample of organ transplant recipients. Br J Dermatol 168(2):346–353
Ulrich C, Jurgensen JS, Degen A et al (2009) Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case-control study. Br J Dermatol 161(Suppl. 3):78–84
Robinson JK, Rigel DS (2004) Sun protection attitudes and behaviours of solid-organ transplant recipients. Dermatol Surg 30:610–615
Thomas BR, Barnabas A, Agarwal K et al (2013) Patient perception of skin-cancer prevention and risk after liver transplantation. Clin Exp Dermatol 38:851–856
Donovan JC, Rosen CF, Shaw JC (2004) Evaluation of sun-protective practice of organ transplant recipients. Am J Transplant 4:1852–1858
Donovan JC, Shaw JC (2006) Compliance with sun protection following organ transplantation. Arch Dermatol 142:1232–1233
Szepietowski JC, Reich A, Nowicka D, Weglowska J, Szepietowski T (2005) Sun protection in renal transplant recipients: urgent need for education. Dermatology 211(2):93–97
Iannacone MR, Pandeya N, Isbel N (2015) Sun protection behavior in organ transplant recipients in Queensland, Australia. Dermatology 231:360–366
Day AK, Wilson C, Roberts RM, Hutchinson AD (2014) The skin cancer and sun knowledge (SCSK) scale: validity, reliability, and relationship to sun-related behaviors among young western adults. Health Educ Behav 41(4):440–448
Ozturk Haney M, Bahar Z, BeÅŸer A, Arkan G, Cengiz B (2016) Psychometric testing of the Turkish version of the skin cancer and sun knowledge scale in nursing students. J Canc Educ. https://doi.org/10.1007/s13187-016-1041-2
Robinson JK, Rigel DS, Amonette RA (1997) Trends in sun exposure knowledge, attitudes, and behaviors: 1986 to 1996. J Am Acad Dermatol 37:179–186
Herman S, Rogers HD, Ratner D (2007) Immunosuppression and squamous cell carcinoma: a focus on solid organ transplant recipients. Skinmed 6(5):234–238
Penn I (1987) Neoplastic consequences of transplantation and chemotherapy. Cancer Detect Prev suppl 1:149–157
Seukeran DC, Newstead CG, Cunliffe WJ (1998) The compliance of renal transplant recipients with advice about sun protection measures. Br J Dermatol 138:301–303
Naylor MF, Boyd A, Smith DW et al (1995) High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol 31:170–175
Berg D, Otley CC (2002) Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol 47:1–17
Santmyire BR, Feldman SR, Fleischer AB (2001) Lifestyle high-risk behaviors and demographics may predict the level of participation in sun-protection behaviors and skin cancer primary prevention in the united states. Cancer 92(5):1315–1324
Hay J, Coups EJ, Ford J, DiBonaventura M (2009) Exposure to mass media health information, skin cancer beliefs, and sun protection behaviors in a United States probability sample. J Am Acad Dermatol 61(5):783–792
Falk M, Anderson CD (2013) Influence of age, gender, education al level and self-estimation of skin type on sun exposure habits and readiness to increase sun protection. Cancer Epidemiol 37:127–132
Branström R, Kasparian NA, Chang Y et al (2010) Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomark Prev 19(9):2199–2210
Mermelstein RJ, Riesenberg LA (1992) Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychol 11(6):371–376
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
To conduct the study, written permission was obtained from the Ethics Committee of the Dokuz Eylul University, the hospitals and primary health care center where the study was to be conducted, and the municipality. After the purpose and the design of the study were explained to the participants, their written consent was obtained and the study was carried out with those who volunteered.
Ethics Statement
This study was reviewed and approved by the Dokuz Eylül University Ethical Committee.
Electronic Supplementary Material
ESM 1
(DOC 49 kb)
Rights and permissions
About this article
Cite this article
Haney, M.O., Ordin, Y.S. & Arkan, G. Skin Cancer-Sun Knowledge and Sun Protection Behaviors of Liver Transplant Recipients in Turkey. J Canc Educ 34, 137–144 (2019). https://doi.org/10.1007/s13187-017-1279-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13187-017-1279-3