LDCT screening for lung cancer does not induce long-term anxiety or distress
A review of studies that evaluated patient-centered outcomes of low-dose computed tomography (LDCT) screening for lung cancer found that overall health-related quality of life is not significantly impacted in persons who undergo the screening procedure. Nor does screening result in long-term changes in anxiety or distress. However, distress levels are increased in the short term with positive results.
The National Lung Cancer Screening Trial demonstrated that three annual LDCT screens can decrease lung cancer mortality by 20% and overall mortality by 7%, compared with standard lung radiographs. These results led to the recommendation that persons age 55 to 80 years with an extensive cigarette smoking history (30 or more pack-years) undergo annual LDCT screening; however, how the LDCT screens affect patient-centered outcomes such as distress, anxiety, and quality of life is not known.
Christopher G. Slatore, MD, MS, from the Department of Veterans Affairs Hospital in Portland, Oregon, and colleagues systematically reviewed 8,215 abstracts for randomized controlled trials or large cohort studies that used LDCT to screen asymptomatic adults at high risk for lung cancer due to smoking history. Slatore's team found five studies that reported data on patient-centered outcomes such as distress, anxiety, and quality of life: Two studies from the Danish Lung Cancer Screening Trial (DLCST); two studies from the Nederlands Leuvens Longkanker Screening Onderzoek (NELSON) trial; and one study from the Pittsburgh Lung Screening Study (PLuSS), a cohort study. The review was published in the Journal of Thoracic Oncology (2014; doi:10.1097/JTO.0000000000000210).
Lung cancer screening with LDCT was found to be associated with short-term psychological discomfort in many people but did not have a long-term impact on distress, worry, or health-related-quality of life. False-positive results were associated with short-term increases in distress; however, over time this distress decreased to the same levels as those with negative results. Negative results were associated with short-term decreases in distress.
“Given that false-positive results can never be entirely eliminated from LDCT screening and the suggestion that there is some short-term distress associated with a positive result, careful consideration of eligibility criteria, optimization of diagnostic algorithms, and thorough discussions of risks, benefits, values, preferences, results, implications of results, and follow-up plans with patients may improve patient-centered outcomes,” noted Slatore.