Impact of computed tomography screening for lung cancer on participants in a randomized controlled trial (NELSON trial)

Abstract

BACKGROUND. Computed tomography (CT) screening is an important new tool for the early detection of lung cancer. In the current study, the authors assessed the discomfort associated with CT scanning and the subsequent wait for results and health‐related quality of life (HRQoL) over time. METHODS. A total of 351 participants in the Dutch‐Belgian randomized controlled trial for lung cancer screening in high‐risk subjects (the NELSON trial) who had an appointment for a baseline CT scan were asked to complete questionnaires regarding their experienced discomfort and HRQoL before, 1 day after, and approximately 6 months after the CT scan. HRQoL was measured as generic HRQoL (12‐item Short Form [SF‐12] and EuroQol questionnaire [EQ‐5D]), generic anxiety (State‐Trait Anxiety Inventory [STAI‐6]), and lung cancer‐specific distress (Impact of Event Scale [IES]). Approximately 76.9% of the participants completed all 3 questionnaires. RESULTS. Approximately 87% to 99% of participants reported experiencing no discomfort related to the CT scan. The median SF‐12, EQ‐5D, STAI‐6, and IES scores did not appear to change relevantly over time. Approximately 46.0% and 51.3%, respectively, of the participants reported discomfort in connection with having to wait for the results of the CT scan and dreading those results. These patients had relevantly higher STAI‐6 and IES scores (P < .01) (unfavorable) at all 3 assessments. CONCLUSIONS. The current evaluation of the potential adverse effects of CT screening for lung cancer on HRQoL demonstrated no negative effects. However, waiting for the CT scan results was reported to be discomforting by approximately half of the participants. Minimizing the waiting time for the test results is therefore recommended. Cancer 2008. © 2008 American Cancer Society.

Quality of Life and Healthcare Use in a Randomized Controlled Lung Cancer Screening Study

“…The first reported increased lung cancer-specific anxiety in those found to have an indeterminate lung nodule (15). In the second, participants were reported to have discomfort related to having to wait for the results of the CT scan and dreading those results (16). Our results support those of the NELSON trial.…”

Long-term effects of lung cancer computed tomography screening on health-related quality of life: the NELSON trial

“…Few studies have examined the HRQoL effects of lung cancer screening with computed tomography (CT) [2][3][4][5]. Subjects receiving an indeterminate or positive result for a baseline CT screening have reported increased anxiety or fear of cancer [2] and more lung cancerspecific distress than subjects with a negative result [3].…”

“…Subjects receiving an indeterminate or positive result for a baseline CT screening have reported increased anxiety or fear of cancer [2] and more lung cancerspecific distress than subjects with a negative result [3]. At short-term follow-up, when all subjects had negative CT results, these unfavourable effects on HRQoL were shown to have decreased and the differences between subjects with initially negative or positive/indeterminate results were no longer observed [2,4,5]. CT scanning caused only a little discomfort and had no major impact on HRQoL [4].…”

The Inconclusive Evidence on CT Screening for Lung Cancer

“…The limited studies to date confirmed that those screened experience psychological distress while waiting for screening test results [25] and found that individuals with abnormal results perceived an increased risk of lung cancer and increased anxiety that diminished over time [26]. These findings suggest that patient education regarding the actual risk of lung cancer, known false positive rates, and expected benefits may help mitigate adverse psychological effects.…”