Lung cancer screening and the effects of competing causes of death in the ACRIN-NLST sub-study

Abstract

Background: Suicide in depressed patients is a major health concern and has gained substantial attention in public health fields. However, the role of COPD, with or without lung cancer, in suicide attempts in patients with depression remains unknown. This study aimed to assess whether COPD and lung cancer precipitates suicide attempts. Methods: We identified 1397 depressed adolescents and adults with comorbid COPD alone or alongside lung cancer. Depression types were postpartum depression (n¼145), pre-menstrual dysphoric disorder (n¼196), bipolar disorder (n¼535), or major depression (n¼521). Patients were included from 2001 to 2016 from records in 116 major hospitals in Pakistan and Afghanistan. Patients were matched according to gender (587 males, 810 females) and age (11e72 years) with 6335 (control) patients with COPD without depression. The longitudinal cohort was observed until the end of 2015. Patients with other psychiatric comorbidities were excluded from the study. Findings: Patients with both COPD and lung cancer had a greater incidence of completed suicide than those with COPD alone (2.9% versus 0.9%, p¼0.006). After adjustment for psychiatric comorbidities, a Cox-regression analysis identified lung cancer as an independent risk factor for attempted suicide later in life among depressed COPD patients (hazard ratio 3.12, 95% CI 1.44e4.27). Interpretation: Adolescents and adults who had depression and went to develop COPD and lung cancer had an elevated risk of attempted suicide later in life compared to controls with only COPD. This is the first study to demonstrate an independent influence of COPD with or without lung cancer on attempted suicide. We have not assessed risk of suicide for other psychiatric comorbidities. Funding: None. Conflicts of interest: We declare that we have no conflicts of interest.

Lung Cancer Screening With Low Dose Computed Tomography in Patients With and Without Prior History of Cancer in the National Lung Screening Trial

“…Substantial comorbidities may impact the benefit from screening, particularly in those who are at increased risk of death from competing respiratory and cardiovascular causes, and who may be at higher risk of complications from diagnostic procedures and may be unable to undergo curative treatment. 21 Studies reporting on the impact of PHC on lung cancer outcomes have yielded conflicting results. An early study of 2991 patients with resected stage I NSCLC revealed that in 192 patients with PHC, lung cancer survival was worse (hazard ratio ¼ 1.44, 95% CI: 1.16-1.78).…”

The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis

“…[50][51][52][53] Screening individuals with advanced COPD remains controversial as they may not benefit from screening due to inoperability and an increased risk of respiratory and other competing causes of death. 54,55 The utilisation of functional assessment tools, such as the BODE index, 56 is suggested to be a better way of assessing the severity and fitness of patients with advanced COPD by incorporating not only the degree of airflow obstruction but also functional dyspnea, bodymass index, and exercise capacity. 15,56 We also estimated the prevalence of four lung diseases: chronic bronchitis, asthma, bronchiectasis, and pulmonary fibrosis.…”

Characteristics of Singapore lung cancer patients who miss out on lung cancer screening recommendations

“…Further studies are needed to determine the threshold where the benefits of reducing lung cancer death outweigh the risk of dying from a competing cause, and this can serve to improve survival. [ 33 ]…”