Abstract
BACKGROUND: Childhood cancer survivors (CCS) face elevated skin cancer risk, especially after radiotherapy or hematopoietic stem cell transplantation (HSCT). The authors evaluated the prevalence and predictors of sun protection, sunburn, and physician skin examination (PSE) among CCS in Switzerland. METHODS: The authors surveyed CCS diagnosed <21 years and surviving ≥5 years after diagnosis about sun protection, sunburns during last summer, and PSE within the last year. They retrieved cancer-related data from the Swiss Childhood Cancer Registry and used multivariable logistic regression, stratified by age group, to identify predictors. RESULTS: The authors included 1048 children (5-15 years), 572 adolescents (16-19 years), and 1959 adults (≥20 years). Regular sun protection was reported by 89% of children, 65% of adolescents, and 77% of adults, and sunburns by 23%, 49%, and 43%, respectively. PSE prevalence among those treated with radiotherapy was 21%, 18%, and 17%, and among HSCT recipients 36%, 28%, and 28%, respectively. Radiotherapy was unrelated to sun protection and PSE, but associated with fewer sunburns (odds ratio [OR], 0.63-0.77). HSCT recipients were more likely to have attended a PSE (OR, 2.06-3.75), but not radiotherapy recipients. Across age groups, survivors born more recently were less likely to protect from sun (OR, 0.94-0.97) and more likely to report sunburn (OR, 1.04-1.14). CONCLUSION: Sunburn prevalence was high despite good sun protection. Only few at heightened risk for skin cancer due to their treatment history attend PSEs as recommended by the Children's Oncology Group. Health care practitioners should systematically integrate yearly PSE after radiotherapy or HSCT and encourage consistent sun protection, particularly among younger generations and adolescents. TRIAL REGISTRATION: Clinicaltrials.gov (NCT03297034).