CT scan screening is associated with increased distress among subjects of the APExS

Abstract

BackgroundThe aim of this study was to assess the psychological consequences of HRCT scan screening in retired asbestos-exposed workers.MethodsA HRCT-scan screening program for asbestos-related diseases was carried out in four regions of France. At baseline (T1), subjects filled in self-administered occupational questionnaires. In two of the regions, subjects also received a validated psychological scale, namely the psychological consequences questionnaire (PCQ). The physician was required to provide the subject with the results of the HRCT scan at a final visit. A second assessment of psychological consequences was performed 6 months after the HRCT-scan examination (T2). PCQ scores were compared quantitatively (t-test, general linear model) and qualitatively (chi²-test, logistic regression) to screening results. Multivariate analyses were adjusted for gender, age, smoking, asbestos exposure and counseling.ResultsAmong the 832 subjects included in this psychological impact study, HRCT-scan screening was associated with a significant increase of the psychological score 6 months after the examination relative to baseline values (8.31 to 10.08, p < 0.0001, t-test). This increase concerned patients with an abnormal HRCT-scan result, regardless of the abnormalities, but also patients with normal HRCT-scans after adjustment for age, gender, smoking status, asbestos exposure and counseling visit. The greatest increase was observed for pleural plaques (+3.60; 95%CI [+2.15;+5.06]), which are benign lesions. Detection of isolated pulmonary nodules was also associated with a less marked but nevertheless significant increase of distress (+1.88; 95%CI [+0.34;+3.42]). However, analyses based on logistic regressions only showed a close to significant increase of the proportion of subjects with abnormal PCQ scores at T2 for patients with asbestosis (OR = 1.92; 95%CI [0.97-3.81]) or with two or more diseases (OR = 2.04; 95%CI [0.95-4.37]).ConclusionThis study suggests that HRCT-scan screening may be associated with increased distress in asbestos-exposed subjects. If confirmed, these results may have consequences for HRCT-scan screening recommendations.

‘I still don’t know diddly’: a longitudinal qualitative study of patients’ knowledge and distress while undergoing evaluation of incidental pulmonary nodules

“…Patients’ have been previously shown to have emotional responses to incidental nodule detection. 9–11 , 22 In addition, providers’ initial communication regarding nodule detection does affect patients’ perceptions and distress. 9 Distress of this type may lead to poor adherence with further evaluations, as has been described in the context of screening for other cancers.…”

“…Patients experience significant distress after incidental nodule detection. 9–11 A systematic review of lung cancer screening trials, mostly from Europe, found that false positive screening results were often associated with short-term increases in distress, which returned to baseline levels over time. 8 Little is known about how patients’ emotional responses, knowledge of an incidental pulmonary nodule and the follow-up plan change over time, as well as the impact of distress.…”

What the Heck Is a “Nodule”? A Qualitative Study of Veterans with Pulmonary Nodules

“…Overall, in mostly European screening trials, subjects with nodules report a short-term increase in distress but no change in health-related quality of life (9-12) (13). A recent study found that patients with incidental pulmonary nodules experienced significant distress after the diagnosis (14).…”

Eligibility for low-dose computerized tomography screening among asbestos-exposed individuals

“…Although in most screening programs for other cancers these concerns have been demonstrated to be short-lived, among asbestos-exposed workers pulmonary abnormalities including pleural plaques may be detected. A study in France documented increased stress in asbestos-exposed subjects screened by LDCT with such abnormalities detected that persisted to ≥6 months (17). Increased care may therefore be needed in asbestos-exposed workers found to have such abnormalities assuring them of the benign nature of the lesions.…”