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

Abstract

The long-term effects of lung cancer computed tomography (CT) screening on health-related quality of life (HRQoL) have not yet been investigated.In the Dutch-Belgian Randomised Lung Cancer Screening Trial (NELSON trial), 1,466 participants received questionnaires before randomisation (T0), 2 months after baseline screening (screen group only; T1) and at 2-yr follow-up (T2). HRQoL was measured as generic HRQoL (12-item shortform questionnaire and EuroQoL questionnaire), anxiety (Spielberger State-Trait Anxiety Inventory) and lung cancer-specific distress (impact of event scale (IES)). Repeated measures of ANOVA were used to analyse differences between the screen and control groups, and between indeterminate (requiring a follow-up CT) and negative screening result groups.At T0 and T2 there were no significant differences in HRQoL scores over time between the screen and control groups, or between the indeterminate or negative second-round screening result group. There was a temporary increase in IES scores after an indeterminate baseline result (T0: mean 4.0 (95% CI 2.8-5.3); T1: mean 7.8 (95% CI 6.5-9.0); T2: mean 4.5 (95% CI 3.3-5.8)).At 2-yr follow-up, the HRQoL of screened subjects was similar to that of control subjects, the unfavourable short-term effects of an indeterminate baseline screening result had resolved and an indeterminate result at the second screening round had no impact on HRQoL.

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

“…Lung cancer screening results in incidental findings, some of which lead to further investigations, resulting in moderate additional costs of €8.95 [U.S. $12.67] per patient at baseline and €2.25 [U.S. $3.19] at 5-year follow-up [38]. Another point of discussion is the influence of indeterminate baseline screening results on the quality of life of the patients during lung cancer screening [39]. False positive nodules led to biopsy in 1.2% of the patients who were not found to have lung cancer in both the NLST and the NELSON trial [36].…”

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

“…Silvestri et al 92 reported that smokers perceived fewer benefits and were less likely to consider lung cancer screening than non-smokers. Non-participants in NELSON 88 were more likely to be female and former smokers, and to have a lower perceived risk of lung cancer and less-positive beliefs about the benefits of lung screening than participants. 93 In the first 88,897 individuals approached to take part in UKLS, participation was more likely in ex-smokers and those in higher socioeconomic groups.…”

“…83,84 The psychosocial impact of LDCT screening for lung cancer has been examined in controlled trials outside the UK, in terms of effects of both trial allocation and screening results. [85][86][87][88][89][90][91] Overall, evidence from these trials suggests that LDCT screening does not produce long-term anxiety or other adverse effects that could deter high-risk individuals from further help-seeking or future participation in a lung screening programme. However, it is important to examine psychosocial effects within the UKLS context to ensure that any future lung screening programme is tailored to the specific needs of the UK high-risk population.…”

“…The psychosocial impact of trial group assignment has been examined in both the NELSON trial 88 and the DLCST. 85 In NELSON, 88 the intervention and control groups were equivalent in a range of psychosocial outcomes, both general and cancer-specific.…”

Low-Dose Computed Tomography Screening for Lung Cancer

“…No long-term psychological harm was found in the NELSON trial. In those with negative results, anxiety and distress fell from baseline; following an abnormal result, anxiety and distress were transient and tended to have returned to baseline by the next screening round [28]. However, the harms-psychological, physical and financial-suffered by those with overdiagnosed tumours have not been quantified and are likely to be substantial.…”