Research Department of Behavioural Science and Health, University College London, London, UK.
School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
Thorax. 2020 Dec;75(12):1065-1073. doi: 10.1136/thoraxjnl-2020-215054. Epub 2020 Oct 21.
Previous studies of psychological burden in low-dose CT (LDCT) lung cancer screening trials may lack generalisability due to participation bias and control arms having elevated distress.
Current and former smokers (n=787, aged 60-75) within a real-world screening demonstration pilot completed measures of lung cancer worry at three time points (T: appointment, T: next day, T: 3 months) and anxiety and depression at two time points (T and T). A 'screening unaware' community sample (n=383) with the same age and smoking characteristics completed these measures once (T). Mean scores were compared by sample type and LDCT result.
Compared with the community sample (T), mean scores were higher in the screening sample, and statistically significantly increased in adjusted analyses, for lung cancer worry at T and T (mean (M): 9.32; 95% CI 8.96 to 9.69 vs M: 11.34; 11.09 to 11.59 and M: 11.88; 11.49 to 12.27), for anxiety at T and T (M: 3.32; 2.94 to 3.70 vs M: 4.73; 4.42 to 5.04 and M: 5.78; 5.33 to 6.23) and depression at T (M: 3.85; 3.44 to 4.27 vs M: 4.15; 3.76 to 4.55). Scores were highest for those with indeterminate (eg, T anxiety M: 6.93; 5.65 to 8.21) and incidental findings (primary care follow-up M: 5.34; 4.67 to 6.02) and those ineligible for screening (M: 6.51; 5.25 to 7.77). Being female, younger, not in paid employment, not married/cohabiting with a partner and lower education predicted poorer psychological outcomes at T, but not T after adjusting for baseline scores. Mean scores remained within 'normal' clinical ranges.
Psychological distress was raised among high-risk individuals undergoing LDCT screening in a real-world setting, but overall differences were unlikely to be clinically meaningful. It will be critical to monitor the psychological impact of services longitudinally across diverse settings, including subgroups vulnerable to clinically elevated distress.
The Lung Screen Uptake Trial was registered prospectively with the International Standard Registered Clinical/soCial sTudy (ISRCTN) (Number: ISRCTN21774741) on 23 September 2015 and the National Institutes of Health ClinicalTrials.gov database (NCT02558101) on 22 September 2015.
以往低剂量 CT（LDCT）肺癌筛查试验中的心理负担研究可能因参与偏倚和对照臂的焦虑而缺乏普遍性。
在一项真实世界的筛查示范试验中，当前和以前的吸烟者（n=787，年龄 60-75 岁）在三个时间点（T：预约、T：次日、T：3 个月）完成肺癌担忧的测量，以及在两个时间点（T 和 T）完成焦虑和抑郁的测量。具有相同年龄和吸烟特征的“筛查无意识”社区样本（n=383）在一次（T）完成了这些测量。按样本类型和 LDCT 结果比较平均得分。
与社区样本（T）相比，筛查样本的肺癌担忧得分更高，且在调整分析中统计学显著增加，在 T 和 T 时为 9.32（95%CI 8.96 至 9.69）与 11.34（11.09 至 11.59）和 11.88（11.49 至 12.27），T 和 T 时的焦虑为 3.32（2.94 至 3.70）与 4.73（4.42 至 5.04）和 5.78（5.33 至 6.23），T 时的抑郁为 3.85（3.44 至 4.27）与 4.15（3.76 至 4.55）。不确定（例如，T 焦虑 M：6.93；5.65 至 8.21）和偶然发现（初级保健随访 M：5.34；4.67 至 6.02）和不符合筛查条件（M：6.51；5.25 至 7.77）的个体得分最高。在调整基线得分后，女性、年龄较小、无薪就业、未婚/与伴侣同居和教育程度较低与 T 时的较差心理结果相关，但与 T 时无关。平均得分仍处于“正常”临床范围。
在真实环境中进行 LDCT 筛查的高危个体中，心理困扰有所增加，但总体差异不太可能具有临床意义。从长远来看，在不同环境中（包括易发生临床焦虑的亚组），对服务的心理影响进行监测至关重要。
Lung Screen Uptake Trial 前瞻性注册于国际标准注册临床试验/社会研究（ISRCTN）（编号：ISRCTN84145334），于 2015 年 9 月 23 日；美国国立卫生研究院临床试验数据库（NCT02558101）于 2015 年 9 月 22 日。
