The person behind the nodule: a narrative review of the psychological impact of lung cancer screening

Abstract

Lung cancer is the leading cause of cancer mortality globally, responsible for an estimated 1.76 million deaths worldwide in 2018 alone. Screening adults at high risk of lung cancer using low-dose computed tomography (LDCT) significantly reduces lung cancer mortality by finding the disease at an early, treatable stage. Many countries are actively considering whether to implement screening for their highrisk populations in light of the recently published Dutch-Belgian trial 'NELSON'. In deciding whether to implement a national screening programme, policymakers must weigh up the evidence for the relative risks posed to the entire screened population, including the potential psychological burden. This narrative review aimed to critically summarise the evidence for both negative and positive psychological responses experienced throughout the LDCT screening pathway, to describe their magnitude, duration and clinical relevance, and to draw out different aspects of measurement design crucial to their interpretation. A further aim was to discuss the available evidence for individual differences in psychological response, as well as interventions designed to promote psychological well-being. In summary, there was no evidence that the LDCT screening process caused adverse psychological outcomes overall, although those receiving indeterminate and suspicious LDCT results did report clinically raised anxiety and lung cancer-specific distress in the shortterm. There was early evidence that demographic factors, smoking status and screening-ineligibility could be associated with individual differences in propensity to experience distress. Qualitative data suggested health beliefs could be modifiable mediators of these individual differences, but their aetiology requires quantitative and prospective research. There was also some evidence of positive psychological responses that could be capitalised on, and of the potential for person-centred communication interventions to achieve this. Further research needs to be embedded in real-world LDCT lung cancer screening services and use conditionspecific measures to monitor outcomes and test evidence-based communication interventions in promoting psychological well-being.

The Future of Lung Cancer Screening: Current Challenges and Research Priorities

“…The NLST, NELSON and the Pan-Canadian Early Detection of Lung Cancer Study (PAN-CAN) trials found no evidence of clinically adverse psychological impacts on generic health-related quality of life measures overall at short- or long-term follow-up for screened cohorts. 30 Scores of anxiety and depression have been shown to differ by LDCT result with increased scores for those receiving indeterminate and suspicious results. However, these have been short-lived.…”

The psychological impact of esophageal cancer screening on anxiety and depression in China

“…Several studies have also shown that the fear of cancer and psychological distress of participants who received uncertain nodules or abnormal screening results increased obviously in a short-term period, but the difference may be not clinically significant ( 7 , 11 , 32 ). In Contrast, several studies have pointed out that the diagnosis of pulmonary nodules by lung cancer screening does not seem to lead to adverse psychological harm ( 18 , 33 ); (b) Breast cancer screening: 70% of participants with positive screening results of breast cancer suffered from severe psychological distress and increased anxiety and depression, especially for patients whose screening results need further examination. No psychological impact was found in those who received negative screening results ( 17 ).…”

“…Previous studies on the psychological impact of cancer screening are inconsistent. Current research in this field mainly focuses on the following types of cancer: lung cancer, breast cancer, colorectal cancer, cervical cancer and ovarian cancer ( 7 , 16 – 18 ). However, research on the psychological impact caused by EC screening is still limited and unclear.…”

Should psychological distress be listed as a surgical indication for indeterminate pulmonary nodules: protocol for a prospective cohort study in real-world settings

“…Substantial studies have been carried out to investigate the psychological burden in lung cancer screening recipients (4,7,8). Indeterminate or suspicious screening results were usually followed by a short-term increase of psychological burden to a clinically significant level (9,10).…”

“…Various instruments were used to measure the psychological state among recipients of lung cancer screening, including the European Quality of Life (EQ-5D), the State-Trait Anxiety Inventory (STAI), the impact of event scale (IES), consequences of screening in Lung Cancer (COS-LC), as well as the Hospital Anxiety and Depression Scale (HADS) (4,7,8). Except for HADS, most of these scales are generic HRQoL measures which include dimensions of psychological outcomes.…”