Impact of lung cancer screening results on participant health-related quality of life and state anxiety in the National Lung Screening Trial

Ilana F Gareen, Fenghai Duan, Erin M Greco, Bradley S Snyder, Phillip M Boiselle, Elyse R Park, Dennis Fryback, Constantine Gatsonis, Ilana F Gareen, Fenghai Duan, Erin M Greco, Bradley S Snyder, Phillip M Boiselle, Elyse R Park, Dennis Fryback, Constantine Gatsonis

Abstract

Background: Low-dose computed tomography (LDCT) lung screening has been associated with a 20% reduction in lung cancer mortality. A major barrier to the adoption of lung screening is the potential negative psychological impact of a false-positive (FP) screen, occurring in 20% to 50% of those screened. The objective of this study was to assess the impact of abnormal findings on health-related quality of life (HRQoL) and anxiety in the American College of Radiology (ACRIN)/National Lung Screening Trial (NLST).

Methods: The NLST was a randomized screening trial comparing LDCT with chest X-ray screening (CXR). This study was part of the original protocol. A total of 2812 participants at 16 of 23 ACRIN sites who had baseline HRQoL assessments were asked to complete the Short Form-36 and the State Trait Anxiety Inventory (form Y-1) questionnaires to assess short-term (1 month) and long-term (6 months) effects of screening. FP were lung cancer-free at 1 year, and true-positives (TP) were not.

Results: Of the total participants, 1024 (36.4%) participants were FP, 63 (2.2%) were TP, 344 (12.2%) had significant incidental findings (SIFs), and 1381 (49.1%) had negative screens. Participants had been randomized to LDCT (n = 1947) and CXR (n = 865). Short-term and long-term HRQoL and state anxiety did not differ across participants with FP, SIF, or negative screens. Short-term and long-term HRQoL were lower and anxiety was higher for TP participants compared to participants with FP, SIF, and negative screens.

Conclusions: In a large multicenter lung screening trial, participants receiving a false-positive or SIF screen result experienced no significant difference in HRQoL or state anxiety at 1 or at 6 months after screening relative to those receiving a negative result.

Keywords: anxiety; clinical trials; lung cancer; quality of life; screening.

© 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Figures

Figure 1
Figure 1
Number of ACRIN NLST participants with data available for analyses of health-related quality of life at each screening time point.
Figure 2
Figure 2
Mean change in score from baseline and 95% confidence intervals: (A) Physical Component Score (PCS), (B) Mental Component Score (MCS), and (C) STAI Score by time point of data collection.

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