Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): psychosocial consequences and impact on health-related quality of life—a multicentre prospective cross-sectional study

• Published in: BMJ open Vol. 11; no. 9; p. e048721
• Main Authors: Andersson, Elisabeth, Dai Ydrefelt, Ying, Johannesson, Marit, Lundbäck, Maria, Mannila, Maria, Persson, Margaretha, Swahn, Eva, Bolejko, Anetta
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Breast cancer; Cancer and Oncology; Cancer och onkologi; Cardiovascular disease; Clinical Medicine; Cross-sectional studies; Klinisk medicin; Lung cancer; Medical and Health Sciences; Medical ethics; Medical imaging; Medical screening; Medicin och hälsovetenskap; Mortality; Population; Population-based studies; Preventive medicine; Public Health; Quality of life; Questionnaires; Radiologi och bildbehandling; Radiology, Nuclear Medicine and Medical Imaging; Smoking; Socioeconomic factors; Surveillance; Tomography; Sweden; medical ethics; public health; preventive medicine
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-048721

ObjectivesTo investigate whether surveillance of pulmonary nodules detected with low-dose CT (LDCT) impacted health-related quality of life and psychosocial consequences in the Swedish population-based study, Swedish CArdioPulmonary bioImage Study (SCAPIS).DesignA prospective cross-sectional study.Settings and participantsThis multicentre (five sites) observational study, which included a cohort from SCAPIS, consisted of 632 participants with indeterminate pulmonary nodules detected with LDCT. These participants continued surveillance for up to 36 months, during which lung cancer was not detected (surveillance group). Additionally, 972 participants with a negative pulmonary LDCT scan were included as a control group. Matching criteria were LDCT date (±2 weeks), gender and site.Outcome measuresAll participants completed a health-related quality of life questionnaire (RAND-36) and the Consequences of Screening (COS) questionnaire, an average of 3 years after LDCT was conducted at entry into SCAPIS.ResultsParticipants were 51–70 years old at study commencement. Overall, the two groups did not differ in demographic or psychosocial variables, smoking habits or pulmonary medical history. Individuals from countries other than Sweden and those with low socioeconomic status were less likely to participate (p<0.001). No effects on health-related quality of life were observed via RAND-36. In COS, the surveillance group demonstrated a higher OR for anxiety about lung cancer (OR 3.96, 95% CI 2.35 to 6.66, p<0.001), experiencing a sense of dejection (OR 1.35, 95% CI 1.06 to 1.72, p=0.015) and thoughts about existential values (OR 1.30, 95% CI 1.04 to 1.60, p=0.018).ConclusionsLung surveillance with LDCT contributed to significant experiences of sense of dejection, anxiety about lung cancer and development of thoughts about existential values among participants in the surveillance group compared with the controls. The risk of side effects should be communicated for informed decision-making about (non-)attendance in lung cancer screening.