Psychosocial Consequences and Perceived Risk Following Screening for Lung Cancer
- Presenter:
Chair: James Burgess; Discussant: TBA Tue June 6, 2006 10:45-12:15 Room 213
Background: New technologies offer a promise of earlier detection and thus earlier treatment for lung cancer. Although there is still debate as to whether screening and early detection in fact decreases mortality from lung cancer, the incidence of individuals being screened for lung cancer has been increasing in recent years. However, 30-40% of individuals screened with scanning CT receive a finding of an “indeterminate non-calcified lung nodule”, with a recommendation for further periodic (annual) screening. The goal of this research is to measure the psychological and health care resource utilization consequences for individuals participating in a lung cancer screening program.
Methods: 400 participants were enrolled as they enrolled in a study exploring the efficacy of lung cancer screening. Participants completed surveys prior to screening and immediately following receipt of the screening results. Survey instruments included questionnaires on: health perceptions, cancer worry, social support, anxiety, and health care utilization. Demographic information and screening results were obtained from the original lung cancer screening study. Screening results were classified as 1) no diagnostic follow-up or physician referral recommended (n=200); 3) advise periodic follow-up CT for one or more indeterminate non-calcified lung nodule (n=133), and 4) strong physician referral for lung cancer suspicion (n=25). The results below consider the change in survey scores between the baseline and post-screening surveys.
Results: The overall score on health perceptions fell significantly for all participants, but most for those in categories 3 and 4. Similarly, the effects of worrying about cancer (e.g. having trouble sleeping) increased significantly for all categories, and the level of worry about having cancer increased for categories 3 and 4. There were no significant changes in any measures of social support. Individuals in categories 3 and 4 had significantly higher measures for state anxiety, and those in category 1 had neither a reduction in anxiety, nor in the level of worry that they might have or get cancer.
Individuals’ perceived risk that they had lung cancer currently (~20%) or would develop cancer over their life time (~30%) was similar for all categories at baseline. This is substantially higher than the true risk of approximately 1-3%. Following screening, perceived risk in category 1 individuals dropped slightly, and did not change for category 3 participants. Perceived risk in category 4 individuals increased significantly to 39% for current cancer and 49% for every developing lung cancer. Actual risk of cancer in category 4 individuals, which was relayed to them following screening, is approximately 15%, indicating that individuals do not update their believes efficiently.
Conclusions: Anxiety and worries that they might have cancer increased in those individuals who received an “indeterminate” finding from lung cancer screening. Individuals with a negative screen did not appear to have less anxiety or worries following screening. Individuals did not rationally update their perceived risk of cancer following screening and information dissemination. Recommendations for screening and screening decisions should be informed by these results.
