City of Hope Study Shows Education Program Can Dramatically Improve Skin Cancer Screening Among Hematopoietic Cell Transplant Survivors
Experts at City of Hope®, one of the nation’s leading cancer research and treatment organizations, are highlighting the importance of skin cancer prevention and early detection among people who have undergone hematopoietic cell transplantation (HCT). New research from City of Hope demonstrates that a relatively simple, scalable, and cost-effective education strategy can substantially increase skin cancer screening among HCT survivors while also encouraging greater involvement from primary care physicians.
The study, titled “Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT (TEACH Study): A Randomized Controlled Trial,” was published on August 6, 2026, in JNCCN—Journal of the National Comprehensive Cancer Network. The research examines how educational outreach delivered to both patients and their primary care providers can help address an important gap in long-term cancer survivorship care.
According to the researchers, HCT survivors face a significantly elevated risk of developing skin cancer, yet many do not receive recommended screening once they transition away from specialized transplant care. The findings suggest that technology-supported education and ongoing communication could provide an effective way to improve preventive care without requiring intensive interventions or frequent in-person visits.
Increased Skin Cancer Risk After Transplantation
Hematopoietic cell transplantation, also commonly referred to as bone marrow or stem cell transplantation, is an important treatment option for people with a variety of serious diseases. It is frequently used in the management of blood cancers such as leukemia, lymphoma, and multiple myeloma, and can also be used to treat certain nonmalignant conditions, including aplastic anemia and sickle cell disease.
While transplantation can provide lifesaving benefits, survivors may face a range of long-term health risks resulting from their underlying disease, previous treatments, immune system changes, and complications associated with transplantation.
One of these concerns is an increased risk of skin cancer.
Research indicates that HCT survivors have nearly twice the risk of developing squamous cell carcinoma compared with the general population. They may also face increased risks of other forms of skin cancer, including basal cell carcinoma, melanoma, and Merkel cell carcinoma.
The timing of these cancers is also important. Skin cancers can begin appearing approximately three to five years after transplantation, meaning that the need for preventive monitoring continues long after the initial transplant treatment has been completed.
For this reason, regular skin self-examinations and routine professional skin examinations are important components of long-term survivorship care.
Addressing a Screening Gap
Despite the increased risk, skin cancer screening rates among HCT survivors remain relatively low.
The challenge can become particularly pronounced when patients transition from specialized transplant centers to community-based primary care. During this transition, responsibility for monitoring long-term health risks may shift from oncology and transplant specialists to primary care physicians.
Primary care providers may not always be aware of the specific long-term cancer risks associated with a patient’s transplant history.
City of Hope researchers therefore sought to determine whether a coordinated education strategy could improve screening behaviors among both survivors and the physicians responsible for their ongoing care.
The study was led by Saro Armenian, D.O., M.P.H., the Barron Hilton Chair in Pediatrics and director of the Center for Survivorship and Outcomes within the Hematologic Malignancies Research Institute at City of Hope.
Dr. Armenian and his colleagues focused on creating an intervention that could be delivered remotely and scaled to a large population without requiring extensive clinical resources.
Randomized Study Included 720 HCT Survivors
The research team enrolled 720 HCT survivors and randomly assigned them to two groups.
Participants received educational materials delivered through the mail. These resources explained the increased risk of skin cancer following transplantation and provided practical guidance on how survivors could examine their own skin.
The educational materials also included photographs of suspicious skin lesions to help participants recognize changes that could potentially require medical evaluation.
To reinforce the information provided in the mailed materials, all study participants also received regular text messages.
The researchers designed this component of the intervention to provide ongoing reminders and encourage participants to incorporate skin examinations into their regular health routines.
Adding Physician Education
For approximately half of the participants, the intervention extended beyond patient education.
City of Hope also sent educational materials directly to the participants’ primary care physicians.
These materials explained the association between hematopoietic cell transplantation and increased skin cancer risk and provided guidance regarding the importance of conducting comprehensive, full-body skin examinations.
This two-part approach allowed researchers to compare the effects of patient-focused education alone with a coordinated strategy involving both patients and healthcare providers.
The goal was to determine whether activating physicians in addition to patients could further improve screening rates.
Screening Rates Nearly Tripled
The results demonstrated a substantial improvement in skin cancer screening behaviors.
Overall, the percentage of participants who performed skin self-examinations and received annual skin examinations from their physicians nearly tripled during the study.
The findings indicate that even relatively low-intensity interventions can produce meaningful changes in preventive healthcare behavior among cancer survivors.
Patient education alone was particularly effective in encouraging self-examination.
According to the researchers, all participants who received patient-directed educational materials demonstrated improvements in their ability and willingness to perform regular skin self-checks.
However, the addition of physician education produced an additional benefit when it came to professional skin examinations.
Physician Education Made a Significant Difference
Among patients whose primary care physicians received the additional educational materials, the proportion who received an in-office skin examination was 40% higher than among patients whose physicians did not receive the information.
The finding highlights an important aspect of survivorship care: educating patients may improve their awareness and personal health behaviors, but healthcare provider engagement remains critical when preventive screening requires a clinical examination.
Dr. Armenian described the effectiveness of patient education as one of the notable findings of the study.
He explained that patients were more likely to perform skin self-examinations even without an intensive intervention. At the same time, the additional improvement in physician-led examinations demonstrated the value of educating healthcare providers about transplant-related cancer risks.
A Technology-Enabled Approach to Survivorship Care
The TEACH study represents a broader shift toward technology-enabled survivorship programs that can support patients after they complete active cancer treatment.
Traditional survivorship care often relies heavily on scheduled visits with specialists. While these visits remain important, they may become less frequent as patients move further away from their transplant treatment.
Remote interventions, including mailed educational materials, text-message reminders, and direct communication with primary care providers, offer an opportunity to maintain preventive care between specialist appointments.
Such approaches may be particularly useful for patients who live far from specialized cancer centers or who have limited access to survivorship clinics.
Because the City of Hope intervention required relatively few resources, researchers believe the model could potentially be adapted for use across larger populations.
Importance of Coordinated Patient and Physician Engagement
Patient activation programs have previously been used to encourage healthier behaviors in chronic disease management and cancer survivorship.
However, the City of Hope team noted that these strategies have rarely been implemented in a coordinated manner involving both HCT survivors and the primary care physicians responsible for their ongoing care.
The TEACH study therefore offers a potentially new model for addressing long-term cancer risks.
By giving patients the information they need to monitor their own health while simultaneously ensuring that primary care physicians understand the patient’s elevated risk, the approach creates two complementary layers of protection.
Patients become more aware of changes that may require attention, while physicians are better prepared to recognize and evaluate suspicious lesions during routine care.
Implications for Long-Term Cancer Survivorship
The findings have implications that extend beyond skin cancer screening.
Cancer survivors frequently face health risks that can emerge years after completion of treatment. These late effects can include secondary cancers, cardiovascular complications, endocrine disorders, bone health problems, and other chronic conditions.
As the number of long-term cancer survivors continues to grow, healthcare systems need practical strategies for ensuring that patients remain engaged in preventive care long after their initial treatment ends.
City of Hope has made survivorship a central component of its cancer care philosophy, viewing ongoing follow-up as an essential part of the patient’s treatment journey rather than a separate phase after cancer therapy.
The institution’s researchers continue to investigate why late treatment effects occur, which patients are most vulnerable, and how early detection and intervention can reduce long-term health consequences.
Findings Already Influencing City of Hope Care
The study’s findings are already being incorporated into City of Hope’s approach to survivorship care.
Dr. Armenian explained that the results are helping the organization evaluate how remote and low-intensity strategies can support patients as they transition from specialized oncology care into primary care.
The approach also aligns with broader efforts to develop risk-based and technology-enabled survivorship models capable of reaching larger populations.
Rather than requiring every patient to receive the same level of follow-up, risk-based programs can focus resources on individuals with the greatest likelihood of developing specific long-term complications.
Supporting Earlier Detection
Early detection remains one of the most important strategies for improving outcomes from skin cancer.
Many skin cancers can be successfully treated when identified at an early stage, whereas delayed diagnosis can result in more extensive disease and more complicated treatment.
For HCT survivors, regular monitoring is especially important because of their elevated risk and the potential for skin cancers to emerge several years after transplantation.
The City of Hope study demonstrates that improving awareness among both patients and physicians can help close an important screening gap.
Broader Significance for Survivorship Programs
The publication of the TEACH study highlights the potential of simple, scalable interventions to improve long-term cancer care. By combining patient education, physician activation, and technology-supported reminders, City of Hope researchers demonstrated that screening behaviors among HCT survivors can be substantially improved.
The study also reinforces the importance of maintaining close communication between specialty cancer centers and primary care providers after patients transition out of transplant-focused care.
As cancer survival continues to improve, ensuring that survivors receive appropriate monitoring for late complications will become increasingly important. Programs such as the one evaluated by City of Hope could provide healthcare systems with a practical framework for delivering preventive care to large numbers of high-risk survivors.
Supported by the National Cancer Institute through grant R01 CA249460, the research provides further evidence that survivorship care can be strengthened through targeted education and technology-enabled communication. For HCT survivors, the findings offer a straightforward message: understanding the increased risk of skin cancer, performing regular self-examinations, and maintaining annual professional skin checks can play an important role in protecting long-term health.
About City of Hope
City of Hope’s mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the United States, and one of the leading research centers for diabetes and other life-threatening illnesses.
City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked among the nation’s top cancer centers by U.S. News & World Report at its core, City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work.
City of Hope’s growing national system includes its Los Angeles campus, Orange County, California, campus, a network of clinical care locations across Southern California and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas. City of Hope’s affiliated group of organizations includes Translational Genomics Research Institute and AccessHopeTM.