Lung Cancer Screening: Is a positive result and a diagnosis of pulmonary nodules associated with a negative psychological impact?
Lung cancer screening is currently recommended in the USA as it has been shown to potentially reduce lung cancer mortality by 20%. It is not yet part of routine care in the UK, and it is important to ensure that any benefits outweigh the harms prior to implementation, including psychological harms. Screening results in incidental findings, such as pulmonary nodules, whose diagnosis may also have a negative psychological impact. This study aims to assess psychological responses following a positive blood test (Early CDT®-Lung test) for early detection of lung cancer and a CT scan and subsequent diagnosis of pulmonary nodules within a UK population.
Participants (n=337) in the Early Cancer Detection Test – Lung Cancer Scotland Study (ECLS Study) randomised controlled trial who had a positive Early CDT®-Lung test were invited to participate in a nested psychological outcomes study. Those agreeing to participate completed questionnaires measuring psychological responses (thoughts, perceptions and affect) at baseline and 1, 3 and 6 months post trial recruitment. This was in addition to a chest x ray and 6-monthly CT scanning for 2 years. Changes in psychological outcomes over time were assessed using multilevel modelling and will be compared between participants with a new diagnosis of pulmonary nodules on their first CT scan and those without.
The overall questionnaire response rate was 93%. In the Early CDT®-Lung test positive group, compared to baseline values, positive affect was significantly (p<0.05) lower at 1, 3 and 6 months. Negative affect was significantly (p<0.05) higher at 1 and 3 months. Impact of worry, worry about getting lung cancer, anxiety about results and their perceived risk of lung cancer were significantly (p<0.05) higher at all time-points. Comparisons of changes in outcomes over time between those with and without newly diagnosed nodules will be available at the conference.
Initial findings show that participants with a positive Early CDT®-Lung test have a range of negative psychological responses at 1, 3 and 6 months compared to baseline. This emphasises the importance of assessing the psychological response to a diagnosis of pulmonary nodules, and these analyses will be presented at the conference.