Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
BMJ Open. 2019 Jan 17;9(1):e024719. doi: 10.1136/bmjopen-2018-024719.
The impact of lung cancer screening with low-dose chest CT (LDCT) on participants' anxiety levels and health-related quality of life (HRQoL) is an important consideration in the implementation of such programmes. We aimed to describe changes in anxiety and HRQoL in a high-risk Canadian cohort undergoing LDCT lung cancer screening.
2537 subjects who had 2% or greater lung cancer risk over 6 years using a risk prediction tool were recruited from eight centres across Canada in the Pan-Canadian Early Detection of Lung Cancer Study (2008-2010). We compared HRQoL and anxiety levels before and after screening of 1237 participants with LDCT (excluding a subset of 1300 participants who also underwent autofluorescence bronchoscopy screening), as well as after investigations performed because of a positive screening examination. The 12-item short-form Physical and Mental Component Scales (SF-12), EQ-5D-3L scores and State Trait Anxiety Inventory-State anxiety were used at each assessment.
Overall, there were no clinically significant differences in HRQoL outcomes between baseline and each of the survey time points following initial screening. No mean change in anxiety in the overall cohort was noted following baseline LDCT, but more participants had clinically significant increase in anxiety versus decrease after baseline screening (increase >minimal clinically important difference (MCID) (n=180) vs decrease >MCID (n=50), p<0.001). This finding persisted but to a lesser degree at the 12 month time point (increase >MCID (n=146) vs decrease >MCID (n=87), p<0.001).
CT screening for lung cancer has no major overall impact on HRQoL among participants, although a minority of participants (number-needed-to-harm=7 after baseline screening and 18 at 1 year) demonstrated clinically significant increased anxiety levels.
NCT00751660; Results.
肺癌筛查中使用低剂量胸部 CT（LDCT）对参与者焦虑水平和健康相关生活质量（HRQoL）的影响是实施此类计划的一个重要考虑因素。我们旨在描述在加拿大高风险队列中进行 LDCT 肺癌筛查时焦虑和 HRQoL 的变化。
2008-2010 年，从加拿大 8 个中心招募了 2537 名使用风险预测工具 6 年内肺癌风险为 2%或更高的受试者，参与 Pan-Canadian Early Detection of Lung Cancer Study（PCLCS）。我们比较了 1237 名接受 LDCT 筛查（排除了另外 1300 名接受 autofluorescence bronchoscopy 筛查的参与者子集）的参与者以及因阳性筛查检查而进行的调查后，HRQoL 和焦虑水平的变化。在每次评估中，使用 12 项简短式健康调查量表物理和精神成分量表（SF-12）、EQ-5D-3L 评分和状态特质焦虑量表状态焦虑。
总体而言，在初始筛查后的每个调查时间点，HRQoL 结果没有临床显著差异。在基线 LDCT 后，整个队列的焦虑没有平均变化，但与基线筛查后相比，更多的参与者焦虑程度增加（增加>最小临床重要差异（MCID）（n=180）vs 减少>MCID（n=50），p<0.001）。这一发现持续存在，但在 12 个月时程度较小（增加>MCID（n=146）vs 减少>MCID（n=87），p<0.001）。
肺癌 CT 筛查对参与者的 HRQoL 没有总体重大影响，尽管少数参与者（基线筛查后为 7 人，1 年后为 18 人）表现出临床显著的焦虑水平增加。
NCT00751660；结果。
