ASICA-Achieving Self-directed Integrated Cancer Aftercare in melanoma

• Research type

  Research Study

• Full title

  Achieving Self-directed Integrated Cancer Aftercare (ASICA) in melanoma: A randomized patient-focused trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma

• IRAS ID

  223906

• Contact name

  Peter Murchie

• Contact email

  p.murchie@abdn.ac.uk

• Sponsor organisation

  University of Aberdeen

• Duration of Study in the UK

  1 years, 11 months, 30 days

• Research summary

  Summary of Research

  Melanoma is common. Approximately 14,500 people in the UK were diagnosed with melanoma in 2013. The incidence of melanoma has increased 360% since the late 1970s. Approximately 20% of patients with early-stage melanoma experience a recurrence and 4-8% develop a new primary melanoma. The risk of having a recurrence or developing a new primary melanoma is highest in the first five years after initial treatment. For this reason, current UK melanoma treatment guidelines recommend that all people treated for melanoma attend regular hospital follow-up appointments to help detect any recurrences or new primaries that may have developed. It is also recommended that patients conduct monthly total-skin-self-examinations (TSSE). The ASICA trial is investigating whether a digital app can help people with melanoma to use a hand-held tablet computer to do more regular and effective total-skin-self-examinations, and whether this would lead to earlier detection of recurrent and new primary melanomas. The ASICA app uses the internet to enable people to electronically communicate the findings of their TSSE. Adult patients (age 18 or over) who have been treated within the preceding 24 months for a stage 0-2C primary cutaneous melanoma and who consent to take part in the trial will be randomised either to the ASICA app in addition to their normal follow-up or to routine follow-up only. We aim to recruit 240 participants across 2 UK NHS Hospitals. The main outcomes of the study are the impact of receiving ASICA on cancer worry (Cancer Worry Scale), anxiety and depression (HADS) and quality of life (EQ-5D) up to 12 months from enrolment.

  Summary of Results
  Background

  Melanoma is a common disease and numbers of people with it have gone up since the late 1970s. Melanoma is now the second most common cancer in the UK in those under 50 years old. Successful new treatments help people to live for longer. This means that more melanoma survivors need constant check-ups to spot new or returning melanoma at a very early stage. UK recommendations say that everyone treated for melanoma should check their skin once a month by Total-Skin-Self-Examination (TSSE). This is the best way to spot returning and new melanoma. TSSE can help find returning melanoma earlier and make it easier to cure. However, research shows that not everyone is following the recommendations to check their skin every month.

  With that in mind, researchers at the University of Aberdeen created the Achieving Self-directed Integrated Cancer Aftercare (ASICA) app. The app was designed to do 3 things: 1) to encourage and improve people’s skin examination routine, 2) to help people report skin worries and 3) to help people to send skin photos to a specialist nurse with the use of a tablet and the internet.
  
  What we did and how

  Main ASICA study
  Two hundred and forty people that had melanoma in the past and lived in the Grampian and Cambridge areas agreed to take part in the study. We randomly put these people in two different groups. For the next year, half of those used the app and half of those continued to receive their normal melanoma follow-up care only. We checked how everyone was getting-on by sending people questionnaires to complete and return to us.

  The questionnaires asked:
  • How often and how confident they felt doing their skin checks.
  • If they had any visits to their GP about any skin worries.
  • If they had any operations or other treatments on their skin.
  • as well as questions about their general health, melanoma worry and anxieties.

  Interviews
  We also interviewed 22 people from both groups who took part in the study. We made sure that this group of people included a good range of ages, both men and women and people who lived in the city and the country. We also spoke to the specialist nurse. We did these interviews to have a better understanding of people’s experiences of skin checks, and how they found the app. We also had comments to make it better.

  What we found

  The main study found some interesting things:

  First, worry about melanoma went down in both groups during the course of the study.
  Second, people using the app said that they checked their skin more often and more completely than those in the group that did not use the app.
  Third, the people that used the app also said they were more confident about making plans and actually checking their skin.
  Fourth, of those using the app some people found it easier to use it than others. It also seemed that people who were positive about checking their skin in the first place found the app easier to use. How old you were, how well-off you were and where you lived were less important.
  Fifth, and perhaps most interesting, it seemed that using the app seemed to make people feel slightly better about the overall quality of their life compared to those who didn’t use it.

  The interviews gave some more detailed information:
  The people we interviewed all said they checked their skin, but the people that used the app said it had helped them to do it more regularly. Almost all the people we interviewed were positive about using technology (e.g. their smartphone) for their healthcare. They also thought the app was a good thing, whether they had used it or not. People who had used the tablet and the app were generally positive about their experiences but had several suggestions on how to make it better. In particular they wanted to use the app on their own smartphones instead of the tablet in the future.

  How did people use ASICA?
  In the group who used ASICA (120 people), over half of them had used it to send the specialist nurse information about a worry they had about their skin. All together our nurse was sent information about 188 concerns during the study year. In more than 80% of cases, the nurse could reassure people without them having to travel to hospital. This suggests this app could lead to a big change in care if it was rolled-out across the whole NHS.

  Conclusion

  Melanoma patients who used ASICA, could send worries about their skin to a nurse using the internet and have them sorted without having to travel to hospital. Using the app in addition to the regular care for 12 months did not make people more worried or anxious and seemed to slightly improve general quality of life. We learned that the app was appreciated by most of the people who used it, but not by everybody. We also heard about several ways to make it better in future. We now want to work with some of the original users to make the app even better.

• REC name

  North of Scotland Research Ethics Committee 2

• REC reference

  17/NS/0040

• Date of REC Opinion

  14 Apr 2017

• REC opinion

  Favourable Opinion