CT lung cancer screening puts patients on edge

CT lung cancer screening is associated with high distress levels in nearly half of patients who are screened, according to a study to be discussed on October 28 during the Chest 2015 annual meeting in Montreal.

In the study, researchers from Stony Brook Cancer Center in Stony Brook, NY, looked at low-dose CT lung cancer screening and its potential emotional toll in their new screening program, which offers smoking cessation support and counseling throughout the screening process. They found that 43% of patients had elevated anxiety levels before screening, and this distress persisted in some individuals even after the results showed no sign of cancer.

Elevated distress levels can act as barriers to care and negatively affect quality of life in screening subjects, said nurse practitioner and lead author April Plank in a statement.

The Stony Brook team examined data from 175 patients in their lung cancer screening program, which includes CT scans, clinical evaluation, tobacco cessation counseling, and psychosocial support for screening subjects.

They measured distress before and after screening using the National Comprehensive Cancer Network Distress Thermometer, with scores of 4 or more representing significant distress and 10 representing extreme distress.

Before screening, 43% of patients had distress scores of 4 or greater -- guilt over tobacco use and fear of cancer diagnosis were the major drivers. One-third of subjects still had a distress score of at least 4 after screening, despite being told that they did not have cancer.

Risk factors for higher distress before screening included female gender, being younger than 60, and having a family history of lung cancer. For postscreening distress, risk factors included female gender and having a personal history of lung disease.

Distress monitoring and even clinical intervention should be available as needed to support the well-being of patients undergoing lung cancer screening, the team concluded.

"It is imperative that lung cancer screening programs take into consideration the psychological well-being of patients -- especially women, current smokers, and those with a history of lung disease, who appear to be at greater risk for psychological and emotional distress," Plank said.