Quality of Life and Healthcare Use in a Randomized Controlled Lung Cancer Screening Study

Mazzone, Peter J.; Obuchowski, Nancy A.; Fu, Alex Z.; Phillips, Micheal D.; Meziane, Moulay

doi:10.1513/annalsats.201301-007oc

Cited by 18 publications

(9 citation statements)

References 20 publications

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“…3,7–10,24,25 Yet, our results differ somewhat from the literature on the impact of screen-detected pulmonary nodules. 15,26–28 Some lung cancer screening trials do suggest that patients experience mild short-term distress, 15 anxiety, 29 or impairments in quality of life 30 after nodule detection. But in the National Lung Screening Trial (the largest study of lung cancer screening), there was no significant change in anxiety or quality of life among patients with a screen-detected nodule, compared to those with normal screening tests.…”

Section: Discussionmentioning

confidence: 99%

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

Freiman

Clark

Slatore

et al. 2016

Journal of Thoracic Oncology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Freiman

Clark

Slatore

et al. 2016

Journal of Thoracic Oncology

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“…[29][30][31] Such tracking systems have been recommended as a critical component of highquality screening programs, 32 along with establishment of registries. 9 Development of both should include methods to improve patient-centered care. In addition to tracking systems, high-quality patient-clinician communication may improve patient adherence to follow-up recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] Although some patients enrolled in lung cancer screening trials have shown an increase in negative psychosocial outcomes such as distress and anxiety, fi ndings are inconsistent. [8][9][10] Among patients with incidentally detected nodules in routine clinical settings, distress seems to be common and occasionally severe. [11][12][13][14] Patients who have been notifi ed about incidental lung nodules have inadequate knowledge about what nodules are, the causes, the risk a nodule could be cancer, and the follow-up plan.…”

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confidence: 99%

Primary Care Providers and a System Problem

Golden

Wiener

Sullivan

et al. 2015

Chest

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“…The average odds ratios of early diagnosis in programme designs were predicted to be 2. [27] Probability someone responds to the initial invite and returns the questionnaire 0.307 UKLS trial [6] Probability someone joins screening programme given they are eligible 0.465 UKLS trial [6] Sensitivity of low-dose CT test for lung cancer 0.709 UKLS trial [6] Specificity of low-dose CT test for lung cancer 0.624 UKLS trial [6] Utility of male smoker in the UK general population/occult lung cancer 0.7816 Health Survey for England [27] Utility of female smoker in the UK general population/occult lung cancer 0.7531 Health Survey for England [27] Disutility associated with a false-positive screen − 0.063 Mazzone et al [30] Disutility associated with anxiety of a screening event − 0.010 NELSON trial [29] Duration of disutility from false-positive screen 3 months Assumption…”

Section: Secondary Health Outcomesmentioning

confidence: 99%

Lung cancer screening by low-dose computed tomography: a cost-effectiveness analysis of alternative programmes in the UK using a newly developed natural history-based economic model

et al. 2020

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Background A systematic review of economic evaluations for lung cancer identified no economic models of the UK setting based on disease natural history. We first sought to develop a new model of natural history for population screening, then sought to explore the cost-effectiveness of multiple alternative potential programmes. Methods An individual patient model (ENaBL) was constructed in MS Excel® and calibrated against data from the US National Lung Screening Trial. Costs were taken from the UK Lung Cancer Screening Trial and took the perspective of the NHS and PSS. Simulants were current or former smokers aged between 55 and 80 years and so at a higher risk of lung cancer relative to the general population. Subgroups were defined by further restricting age and risk of lung cancer as predicted by patient self-questionnaire. Programme designs were single, triple, annual and biennial arrangements of LDCT screens, thereby examining number and interval length. Forty-eight distinct screening strategies were compared to the current practice of no screening. The primary outcome was incremental cost-effectiveness of strategies (additional cost per QALY gained). Results LDCT screening is predicted to bring forward the stage distribution at diagnosis and reduce lung cancer mortality, with decreases versus no screening ranging from 4.2 to 7.7% depending on screen frequency. Overall healthcare costs are predicted to increase; treatment cost savings from earlier detection are outweighed by the costs of over-diagnosis. Single-screen programmes for people 55–75 or 60–75 years with ≥ 3% predicted lung cancer risk may be cost-effective at the £30,000 per QALY threshold (respective ICERs of £28,784 and £28,169 per QALY gained). Annual and biennial screening programmes were not predicted to be cost-effective at any cost-effectiveness threshold. Limitations LDCT performance was unaffected by lung cancer type, stage or location and the impact of a national screening programme of smoking behaviour was not included. Conclusion Lung cancer screening may not be cost-effective at the threshold of £20,000 per QALY commonly used in the UK but may be cost-effective at the higher threshold of £30,000 per QALY.

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Quality of Life and Healthcare Use in a Randomized Controlled Lung Cancer Screening Study

Cited by 18 publications

References 20 publications

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

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

Primary Care Providers and a System Problem

Lung cancer screening by low-dose computed tomography: a cost-effectiveness analysis of alternative programmes in the UK using a newly developed natural history-based economic model

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