The randomized controlled trial, known as the Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT study, or TEACH, included 720 hematopoietic cell transplant survivors. The findings, published in JNCCN—Journal of the National Comprehensive Cancer Network, indicate that simple educational materials delivered by mail and reinforced through text messages can increase both self-examination and physician-performed skin checks. The results point to a practical strategy for extending survivorship care beyond major cancer centers.

Hematopoietic cell transplantation, also called bone marrow or stem cell transplantation, replaces damaged or diseased blood-forming cells with healthy cells. The procedure is used to treat leukemia, lymphoma, multiple myeloma and other blood cancers, as well as nonmalignant conditions such as aplastic anemia and sickle cell disease. Although transplantation can be lifesaving, the intensive chemotherapy, radiation, immune suppression and long-term immune-system disruption associated with the procedure can produce delayed complications, including an elevated risk of secondary cancers.

Among these complications, skin cancer is particularly important because it can often be detected during routine examinations or by patients themselves. HCT survivors face nearly twice the risk of squamous cell carcinoma compared with the general population, while basal cell carcinoma, melanoma and Merkel cell carcinoma are also concerns. Skin cancers may begin appearing three to five years after transplantation, when many survivors have already transitioned from transplant specialists to primary care providers. This change in care setting can create gaps in surveillance, particularly when patients and physicians are unaware of the specific risks associated with HCT.

The City of Hope intervention was designed to address both sides of that problem. Every participant received mailed educational materials explaining why HCT survivors are at increased risk, how to conduct a systematic self-examination and what suspicious lesions may look like. The materials included images to help participants recognize warning signs such as a changing mole, a new growth, a sore that does not heal or a lesion with unusual color or irregular borders. All participants also received recurring text messages intended to reinforce the information and encourage continued screening behavior.

Approximately half of the participants were assigned to an additional physician-activation group. In that group, the patients’ primary care doctors received information describing the relationship between HCT and skin cancer, along with guidance on conducting full-body skin examinations. This provider-focused component was intended to make skin surveillance a routine part of primary care rather than a responsibility that ends when a patient leaves the transplant clinic.

The investigators reported that the proportion of survivors completing skin self-examinations and receiving annual clinical skin checks nearly tripled overall during the study. Patient education alone produced a clear improvement in self-examination, suggesting that survivors can become active participants in detecting possible cancers when they receive specific instructions and visual examples. The intervention did not depend on frequent specialist appointments, expensive equipment or intensive counseling, making it potentially adaptable to large survivor populations.

The strongest difference emerged when physicians were included in the intervention. Although self-examination increased among participants across the study, the proportion who also received an in-office skin examination was 40 percent higher when their primary care physicians had received the educational materials. The finding suggests that patient awareness may be sufficient to encourage personal monitoring, while physician education is especially important for ensuring that a professional examination takes place.

“This study shows that practical, scalable solutions can close that gap and may be applicable to other long-term complications in cancer survivors,” said Saro Armenian, D.O., M.P.H., the study’s first author and director of the Center for Survivorship and Outcomes at City of Hope. He said the results are already informing how the institution approaches follow-up care, particularly as survivors move from specialty settings into primary care. The model combines patient activation, clinician education and remote communication to support risk-based survivorship care without requiring a high-intensity intervention.

The researchers say the approach could be expanded to address other late effects of transplantation, including cardiovascular disease, bone loss, chronic immune complications and second malignancies. Its broader significance lies in the way it connects specialized cancer knowledge with routine medical care: survivors receive tools to monitor their own health, while primary care physicians receive the context needed to recognize risks that may not be apparent from a standard medical history. Supported by the National Cancer Institute through grant R01 CA249460, the study reinforces the principle that successful cancer treatment is not the end of care, but the beginning of long-term surveillance designed to protect survivors for decades after transplantation.

Subject of Research: Skin cancer screening among hematopoietic cell transplant survivors

Article Title: Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT (TEACH Study): A Randomized Controlled Trial

News Publication Date: 6-Aug-2026

Web References: https://jnccn.org/view/journals/jnccn/aop/article-10.6004-jnccn.2026.7030/article-10.6004-jnccn.2026.7030.xml

References: National Cancer Institute grant R01 CA249460; JNCCN—Journal of the National Comprehensive Cancer Network

Keywords: Skin cancer, hematopoietic cell transplantation, bone marrow transplantation, stem cell transplantation, cancer survivorship, skin cancer screening, squamous cell carcinoma, melanoma, primary care, patient education, physician activation, survivorship care

The PERCS initiative acknowledges the complexity and multifaceted nature of survivorship care, which extends beyond the immediate oncological treatment phase. Cancer survivors frequently face long-term and late effects of cancer and its treatment—ranging from physical health complications to psychological and social challenges. Traditionally, these survivorship needs have been addressed sporadically, and often inadequately, within primary care practices that are not specifically structured to respond to the broad spectrum of survivorship issues. The PERCS trials are designed to bridge this crucial care gap by embedding survivorship care principles directly within primary care systems, ensuring continuity and comprehensiveness.

One of the defining features of the PERCS initiative is its systemic approach to intervention development and testing. Each of the four randomized controlled trials explores innovative strategies at both the practice and health system levels, focusing on enhancing clinician education, integrating survivorship guidelines into routine practice, and utilizing health information technology to facilitate coordinated care. By leveraging these strategies, the initiative aims to empower primary care clinicians with the necessary tools, knowledge, and structural support to deliver high-quality survivorship care that addresses the full range of patient needs—from surveillance and management of cancer recurrence risks to addressing comorbid conditions and psychosocial support.

A critical technical aspect of PERCS is the emphasis placed on the infrastructure within primary care settings. The initiative contemplates the operational challenges of implementing survivorship care plans and integrating them into electronic health records (EHRs) in a manner that is seamless and actionable. By enhancing EHR functionalities, including reminders and clinical decision support systems, PERCS trials seek to institutionalize survivorship care protocols and deliver patient-centered care that is timely and evidence-based. This technological integration is particularly vital to support busy clinicians and to ensure that no aspect of survivorship care is overlooked during routine visits.

Moreover, the PERCS initiative highlights the importance of interdisciplinary collaboration. Recognizing that comprehensive survivorship care cannot be fully delivered by primary care clinicians alone, the trials incorporate mechanisms to facilitate coordination between oncologists, primary care providers, behavioral health specialists, and other relevant healthcare professionals. This team-based approach is expected to improve care outcomes by creating a cohesive network that supports cancer survivors across their complex care continuum, reducing fragmentation and enhancing the patient experience.

From a research methodology standpoint, the randomized controlled trial design ensures rigorous evaluation of the interventions developed under PERCS. This approach allows for a clear assessment of efficacy and scalability, providing robust evidence on how to best implement survivorship care innovations in diverse primary care environments. Trial outcomes will inform future policy recommendations and best practice guidelines, ultimately influencing national standards for cancer survivorship care.

Understanding the epidemiological context is crucial for appreciating the potential impact of the PERCS initiative. With an estimated 18 million cancer survivors in the US alone and growing, the burden of survivorship care needs on the healthcare system is immense. Primary care clinicians are uniquely positioned to address these needs due to their ongoing relationships with patients and their broad scope of practice. The initiative’s focus on empowering these clinicians aims to distribute the responsibility for survivorship care more equitably, alleviating strain on oncology specialists and ensuring more accessible, holistic care.

The development of practice-level interventions within PERCS also involves extensive engagement with stakeholders, including primary care clinicians, patients, and healthcare administrators. This collaborative process ensures that interventions are not only evidence-based but also feasible and acceptable in real-world settings. By tailoring solutions to the realities of primary care workflows, the initiative maximizes the likelihood of sustainable implementation, which is critical for long-term improvements in survivorship care quality.

The psychosocial dimension of survivorship care is another integral component of PERCS. Cancer survivors often experience anxiety, depression, and social isolation—issues that are historically under-recognized in primary care. The initiative’s interventions promote routine assessment and management of psychosocial needs, incorporating mental health resources and supportive services as part of comprehensive care. This holistic approach acknowledges that survivorship extends beyond physical health and includes mental well-being and quality of life.

In addition to clinician-focused strategies, PERCS integrates patient education and engagement components to empower survivors in managing their health proactively. Survivorship care plans developed through the initiative provide patients with clear information about their diagnosis, treatments, potential late effects, and recommended follow-up strategies. By enhancing patient knowledge and self-efficacy, the initiative supports shared decision-making and encourages active participation in survivorship care.

The PERCS trials collectively represent a transformative effort to reimagine the role of primary care in cancer survivorship. By addressing system-level barriers, harnessing technology, fostering multidisciplinary collaboration, and centering the patient experience, the initiative aims to establish a new paradigm of care that is comprehensive, coordinated, and sustainable. The research outcomes expected from these trials promise to shape future clinical practice and health policy, ensuring cancer survivors receive the full continuum of care they deserve.

This ambitious initiative underscores a fundamental shift in oncological care, moving from specialist-centric models to integrative, patient-centered care pathways that begin and often reside within primary care. As survivorship populations continue to expand globally, innovative frameworks such as PERCS will be essential to meet evolving clinical demands, improve long-term outcomes, and enhance survivorship quality of life.

Subject of Research: Primary care engagement and system-level interventions to improve cancer survivorship care delivery.

Article Title: Primary Care Engaged Research for Cancer Survivorship Care (PERCS) Initiative Promotes Comprehensive Care for Cancer Survivors

News Publication Date: 26-May-2026

Web References: https://www.annfammed.org/content/24/3/252.pdf

Keywords: Cancer survivorship, primary care, survivorship care plans, randomized controlled trial, health system interventions, electronic health records, psychosocial support, multidisciplinary collaboration, patient-centered care, National Cancer Institute