Psychosocial consequences in the Danish randomised controlled lung cancer screening trial (DLCST)

Rasmussen, Jakob Fraes; Siersma, Volkert; Pedersen, Jesper Holst; Brodersen, John

doi:10.1016/j.lungcan.2014.11.003

Cited by 55 publications

(56 citation statements)

References 30 publications

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“…This finding may reflect unscreened participants' disappointment or frustration at having been identified as high risk but denied the opportunity to gain reassurance from screening, supported by the finding that a greater proportion were less satisfied with their decision to participate compared with the intervention arm. Similarly, the DLCST reported negative consequences in the unscreened control arm at 16 and 2 years 7…”

Section: Discussionmentioning

confidence: 90%

“…The Danish Lung Cancer Screening Trial (DLCST)6 7 and Dutch-Belgian NELSON trial8 found no differential effect of trial allocation on a range of psychosocial outcomes at 1 and 2 years follow-up, respectively. Temporary adverse effects of receiving abnormal results have been observed in high-risk participants randomised to LDCT screening 9–11.…”

Section: Introductionmentioning

confidence: 99%

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Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial

Brain

Lifford

Carter

et al. 2016

Thorax

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BackgroundThe UK Lung Cancer Screening (UKLS) trial is a randomised pilot trial of low-dose CT (LDCT) screening for individuals at high risk of lung cancer. We assessed the long-term psychosocial impact on individuals participating in the UKLS trial.MethodsA random sample of individuals aged 50–75 years was contacted via primary care. High-risk individuals who completed T0 questionnaires (baseline) were randomised to LDCT screening (intervention) or usual care (no screening control). T1 questionnaires were sent 2 weeks after baseline scan results or control assignment. T2 questionnaires were sent up to 2 years after recruitment. Measures included cancer distress, anxiety, depression and decision satisfaction.ResultsA total of 4037 high-risk individuals were randomised and they completed T0 questionnaires (n=2018 intervention, n=2019 control). Cancer distress was higher at T1 in intervention arm participants who received positive screening results (p≤0.001), but not at T2 (p=0.04). T2 anxiety (p≤0.001) and depression (p≤0.01) were higher in the control arm, but the absolute differences were small and not clinically relevant. At both time points, fewer control than screened participants were satisfied with their decision to participate in UKLS (p≤0.001). Regardless of trial allocation, cancer distress was higher in women (p≤0.01), participants aged ≤65 years (p≤0.001), current smokers (p≤0.001), those with lung cancer experience (p≤0.001) and those recruited from the Liverpool area (p≤0.001).ConclusionLung cancer screening using LDCT appears to have no clinically significant long-term psychosocial impact on high-risk participants. Strategies for engaging and supporting underserved groups are the key to implement routine lung cancer screening in the UK.Trial registration numberISRCTN 78513845; results.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial

Brain

Lifford

Carter

et al. 2016

Thorax

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“…22 Another study comparing DLCST participants to a sample of the general population at baseline found significantly higher negative psychosocial scores in the latter group in all psychological burden measures. This was attributed to significant differences between the trial participants and a comparable population control, including more women, higher socio-economic status, longer education, higher employment rate, and more central urban location in the trial group.…”

Section: Resultsmentioning

confidence: 97%

Psychological Burden Associated With Lung Cancer Screening: A Systematic Review

Raz

Brown

et al. 2016

Clinical Lung Cancer

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Introduction Lung cancer screening (LCS) with low dose computed tomography (LDCT) reduces mortality and is recommended for high-risk current and former smokers. Several potential harms associated with LCS have been identified, including the potential for psychological burden. To summarize the current state of the scientific knowledge on psychological burden associated with LCS, we performed a systematic search of the contemporary quantitative and qualitative research literature. Methods We included randomized controlled trials and cohort studies that evaluated the impact of LCS with LDCT on psychological burden and health-related quality of life (HRQOL) as assessed by validated and non-validated measures. PubMed, CINAHL, PsychINFO, and Scopus were searched for English language articles published between 2004 and January 2015. Data abstraction and quality assessment were conducted by two independent reviewers. Results Thirteen studies were included that met our inclusion criteria. Overall, results were variable with some studies reporting worse psychological burden for patients with indeterminate results at pre-screening, post-screening and short-term follow-up (<6 months post-screen). These adverse effects diminished or resolved at long-term follow-up (>6 months post-screen). Conclusion LCS may be associated with short-term adverse psychological burden, particularly after a false positive result. However, these adverse effects diminished over time. The current evidence is small, with limitations in study design and use of outcome measures. More high-quality research is needed to determine the frequency, duration, and overall magnitude of LCS-related psychological burden in non-clinical trial settings.

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“…To conduct innovative patient-centered research, the field should incorporate feedback from diverse stakeholders to understand the unmet needs of patients, their families, and their clinicians. Some patients suffer psychological harm when a pulmonary nodule is discovered during screening (81)(82)(83)(84)(85) or incidentally (19,20,86,87). We identified communication processes as the most likely factors that that could be modified to improve patient-centered outcomes.…”

Section: Patient-centered Outcomesmentioning

confidence: 99%

An Official American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management

Slatore¹,

Horeweg²,

Jett³

et al. 2015

Am J Respir Crit Care Med

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Psychosocial consequences in the Danish randomised controlled lung cancer screening trial (DLCST)

Cited by 55 publications

References 30 publications

Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial

Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial

Psychological Burden Associated With Lung Cancer Screening: A Systematic Review

An Official American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management

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