Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

Abstract

Introduction Pulmonary nodules are detected in over a million Americans each year. Prior qualitative work suggests the detection of incidental pulmonary nodules can be burdensome for patients, but it is unknown whether these findings generalize to a broader sample of patients. We categorized patients’ knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, and their impressions of clinician communication. Methods We administered a cross-sectional survey to adults with an incidental pulmonary nodule recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital. Results Of 490 surveys mailed, 244 (50%) responded. Median nodule size was 7 mm; mean patient age was 67 years; 29% were female, and 86% were white. A quarter (26%) of respondents reported clinically significant distress related to their nodule as measured by the Impact of Event scale, our primary outcome. Patients reported multiple concerns including uncertainty about the nodule’s etiology (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall there was no correlation between perceived and actual risk (r=−0.007, p=0.93). Among the 23% of patients who did receive cancer risk information from their provider, they were more likely to find this information reassuring (16%) than scary (7%). Conclusion A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.

Mapping the spectrum of psychological and behavioural responses to low‐dose CT lung cancer screening offered within a Lung Health Check

“…Participants with indeterminate results reported increases in distress consistent with previous research . However, there was an apparent lack of concern about incidental findings (eg COPD) among some participants who were understandably pleased their scan showed no sign of lung cancer but in some cases regarded this an ‘all‐clear’ for their respiratory health.…”

“…Participants with indeterminate results reported increases in distress consistent with previous research. 6,8,22 However, there was an apparent lack of concern about incidental findings (eg COPD) among some participants who were understandably pleased their scan showed no sign of lung cancer but in some cases regarded this an 'all-clear' for their respiratory health. This suggests that incidental findings carry low risk of psychological distress which is reassuring, but also implies risk of over-reassurance akin to 'clear' screening results raised by a previous study.…”

Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules

“…Previous studies examining the psychological impact of a pulmonary nodule diagnosis have found contrasting results. (18,19,24,35,36) Two studies in America found that individuals diagnosed with pulmonary nodules reported emotional distress (measured using the IES) shortly after diagnosis (time not specified)(35) and up to 2 or more years after diagnosis (19, 36).These findings differ from our study and those of the NELSON trial, with the latter showing an early (2 months after diagnosis)(18) and temporary clinically important increase in IES scores in individuals with nodules. (19) Additionally, the NELSON trial did not find that health-related quality of life (HRQoL) was affected by a pulmonary nodule diagnosis (19), which contrasts with a study in France.…”

Management of incidental nodules in lung cancer screening: ready for prime-time?

“…Also, the psychological impact on patients is an aspect that needs more attention [21]. According to Freiman et al [22], 25% of patients experience clinically significant nodule-related distress, directly influencing patients' quality of life. The classifier needs optimisation, as this study suggests that 3% of the cancer patients might be missed.…”