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Kwong FL, Kristunas C, Davenport C, Aggarwal R, Deeks J, Mallett S, Kehoe S, Timmerman D, Bourne T, Stobart H, Neal R, Menon U, Gentry-Maharaj A, Sturdy L, Ottridge R, Sundar S. Investigating harms of testing for ovarian cancer - psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: A cohort study embedded in the multicentre ROCkeTS prospective diagnostic study. BJOG 2024; 131:1400-1410. [PMID: 38556698 PMCID: PMC7616335 DOI: 10.1111/1471-0528.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change at 12 months post-testing, and report cancer conversion rates by age and referral pathway. DESIGN Single-arm prospective cohort study. SETTING Multicentre. Secondary care including outpatient clinics and emergency admissions. POPULATION A cohort of 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both. METHODS Women completed anxiety and distress questionnaires at recruitment and at 12 months for those who had not undergone surgery or a biopsy within 3 months of recruitment. MAIN OUTCOME MEASURES Anxiety and distress levels measured using a six-item short form of the State-Trait Anxiety Inventory (STAI-6) and the Impact of Event Scale - Revised (IES-r) questionnaire. Ovarian cancer (OC) conversion rates by age, menopausal status and referral pathway. RESULTS Overall, 1355/2596 (52.1%) and 1781/2596 (68.6%) experienced moderate-to-severe distress and anxiety, respectively, at recruitment. Younger age and emergency presentations had higher distress levels. The clinical category for anxiety and distress remained unchanged/worsened in 76% of respondents at 12 months, despite a non-cancer diagnosis. The OC rates by age were 1.6% (95% CI 0.5%-5.9%) for age <40 years and 10.9% (95% CI 8.7%-13.6%) for age ≥40 years. In women referred through fast-track pathways, 3.3% (95% CI 1.9%-5.7%) of pre- and 18.5% (95% CI 16.1%-21.0%) of postmenopausal women were diagnosed with OC. CONCLUSIONS Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under the age of 40 years have low conversion rates and we advocate reducing testing in this group to reduce the harms of testing.
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Affiliation(s)
- Fong Lien Kwong
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Caroline Kristunas
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ridhi Aggarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Sean Kehoe
- St Peter’s College, University of Oxford, Oxford, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Richard Neal
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Usha Menon
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Alex Gentry-Maharaj
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Lauren Sturdy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ryan Ottridge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Bancroft EK, Page EC, Brook MN, Pope J, Thomas S, Myhill K, Helfand BT, Talaty P, Ong KR, Douglas E, Cook J, Rosario DJ, Salinas M, Buys SS, Anson J, Davidson R, Longmuir M, Side L, Eccles DM, Tischkowitz M, Taylor A, Cruellas M, Ballestero EP, Cleaver R, Varughese M, Barwell J, LeButt M, Greenhalgh L, Hart R, Azzabi A, Jobson I, Cogley L, Evans DG, Rothwell J, Taylor N, Hogben M, Saya S, Eeles RA, Aaronson NK. The psychosocial impact of prostate cancer screening for BRCA1 and BRCA2 carriers. BJU Int 2024; 134:484-500. [PMID: 38839570 DOI: 10.1111/bju.16432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To report the long-term outcomes from a longitudinal psychosocial study that forms part of the 'Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted Screening in men at higher genetic risk and controls' (IMPACT) study. The IMPACT study is a multi-national study of targeted prostate cancer (PrCa) screening in individuals with a known germline pathogenic variant (GPV) in either the BReast CAncer gene 1 (BRCA1) or the BReast CAncer gene 2 (BRCA2). SUBJECTS AND METHODS Participants enrolled in the IMPACT study were invited to complete a psychosocial questionnaire prior to each annual screening visit for a minimum of 5 years. The questionnaire included questions on sociodemographics and the following measures: Hospital Anxiety and Depression Scale, Impact of Event Scale, 36-item Short-Form Health Survey, Memorial Anxiety Scale for PrCa, Cancer Worry Scale, risk perception and knowledge. RESULTS A total of 760 participants completed questionnaires: 207 participants with GPV in BRCA1, 265 with GPV in BRCA2 and 288 controls (non-carriers from families with a known GPV). We found no evidence of clinically concerning levels of general or cancer-specific distress or poor health-related quality of life in the cohort as a whole. Individuals in the control group had significantly less worry about PrCa compared with the carriers; however, all mean scores were low and within reported general population norms, where available. BRCA2 carriers with previously high prostate-specific antigen (PSA) levels experience a small but significant increase in PrCa anxiety (P = 0.01) and PSA-specific anxiety (P < 0.001). Cancer risk perceptions reflected information provided during genetic counselling and participants had good levels of knowledge, although this declined over time. CONCLUSION This is the first study to report the longitudinal psychosocial impact of a targeted PrCa screening programme for BRCA1 and BRCA2 carriers. The results reassure that an annual PSA-based screening programme does not have an adverse impact on psychosocial health or health-related quality of life in these higher-risk individuals. These results are important as more PrCa screening is targeted to higher-risk groups.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - Mark N Brook
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Jennifer Pope
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Sarah Thomas
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Kathryn Myhill
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Brian T Helfand
- Division of Urology, John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, Evanston, IL, USA
| | - Pooja Talaty
- Division of Urology, John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kai-Ren Ong
- West Midlands Regional Clinical Genetics Service, Birmingham Women's Hospital, Birmingham, UK
| | - Emma Douglas
- West Midlands Regional Clinical Genetics Service, Birmingham Women's Hospital, Birmingham, UK
| | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | | | - Monica Salinas
- Hereditary Cancer Program, ICO (Catalan Institute of Oncology), Barcelona, Spain
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jo Anson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Rosemarie Davidson
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mark Longmuir
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Lucy Side
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Diana M Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
- The University of Southampton Medical School, Southampton, UK
| | - Marc Tischkowitz
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Amy Taylor
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Mara Cruellas
- Hereditary Cancer Genetics Group, Medical Oncology Department, Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eduard Perez Ballestero
- Hereditary Cancer Genetics Group, Medical Oncology Department, Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ruth Cleaver
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Mohini Varughese
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Julian Barwell
- University of Leicester, Leicester, UK
- University Hospitals Leicester, Leicester, UK
| | | | - Lynn Greenhalgh
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Rachel Hart
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Ashraf Azzabi
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Irene Jobson
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lynn Cogley
- Peninsular Genetics, Derriford Hospital, Plymouth, UK
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jeanette Rothwell
- Genomic Medicine, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Natalie Taylor
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew Hogben
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Sibel Saya
- Oncogenetics Team, Institute of Cancer Research, London, UK
- The University of Melbourne, Melbourne, Australia
| | - Rosalind A Eeles
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, Institute of Cancer Research, London, UK
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Alali AA. Level of Education Matters in Regard to Participants' Compliance With Screening in the National Lung Screening Trial. J Thorac Imaging 2024; 39:W1-W4. [PMID: 37732698 DOI: 10.1097/rti.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE The success of cancer screening depends on patient adherence to the screening program. The purpose of this study is to assess how the level of education might affect participants' compliance with screening in the National Lung Screening Trial (NLST). MATERIALS AND METHODS Secondary data analyses of the participants in the NLST were performed. A total of 50,104 participants were included in this study. Participants who enrolled in the trial but refused the initial screening were compared with those who completed the screening. A multivariate logistic regression model was used to assess the association between participant noncompliance and education level. RESULTS A total of 3712 (7.41%) participants refused lung cancer screening in the NLST. Compared with the reference group, participants with an education level of eighth grade or less (odds ratio [OR]: 2.1, CI: 1.68-2.76), ninth-11th grade (OR: 1.9, CI: 1.7-2.34), high school graduates (OR: 1.3, CI: 1.22-1.54), after high school training (OR: 1.1, CI: 1-1.31), or an associate's degree (OR: 1.2, CI: 1.07-1.36) had significantly higher odds of refusing lung cancer screening. Participants with a bachelor's degree showed no significant association with compliance with screening (OR: 0.9, P = 0.86). Multivariate regression analysis also showed that younger, single, male participants with a longer duration of smoking history had significantly higher odds of refusing the screening. CONCLUSION A lower level of education was significantly associated with refusing lung cancer screening. A strategic targeted approach for this group might be necessary to promote their compliance rate.
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Affiliation(s)
- Akeel A Alali
- College of Medicine, Clinical Affairs, King Saud Bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Wadsworth LP, Wessman I, Björnsson AS, Jonsdottir G, Kristinsson SY. The half-painted picture: Reviewing the mental health impacts of cancer screening. Medicine (Baltimore) 2022; 101:e30479. [PMID: 36197248 PMCID: PMC9509034 DOI: 10.1097/md.0000000000030479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cancer screening is recommended for select cancers worldwide. Cancer screening has become increasingly effective and accessible and often increases overall survival. However, the mental health effects of cancer screening, such as its impact on depression, anxiety, and post-traumatic stress disorder, are largely unknown. Conflicting available literature indicates the negative, neutral, and positive mental health effects of cancer screening across cancer types. There are a limited number of randomized controlled trials measuring the mental health effects of cancer screening. Overall, the more negative and life-threatening the screening results, the greater the mental health effects. Screening for cancer without a known precursor, for example, due to family history, can have positive impacts such as decreased worry and increased quality of life. However, receiving a cancer diagnosis often has negative mental effects that increase with the life-threatening potential of malignancy. In this study, we review the existing literature and provide recommendations for future research to determine if and when cancer screening is the best practice.
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Affiliation(s)
- Lauren P. Wadsworth
- University of Iceland, Reykjavik, Iceland
- * Correspondence: Lauren P. Wadsworth, PhD, Genesee Valley Psychology 200 White Spruce Blvd, Suite 220, Rochester, NY 14623 (e-mail: )
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Kim A, Chung KC, Keir C, Patrick DL. Patient-reported outcomes associated with cancer screening: a systematic review. BMC Cancer 2022; 22:223. [PMID: 35232405 PMCID: PMC8886782 DOI: 10.1186/s12885-022-09261-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
Background Multi-cancer early detection tests have been developed to enable earlier detection of multiple cancer types through screening. As reflected by patient-reported outcomes (PROs), the psychosocial impact of cancer screening is not yet clear. Our aim is to evaluate the impact of cancer screening through PRO assessment. Methods A systematic review was conducted using MEDLINE, EMBASE, and reference lists of articles from January 2000 to August 2020 for relevant publications assessing the psychosocial impact of cancer screening before and within 1 year after screening in the general asymptomatic population, including following receipt of results. Studies focused on diagnostic evaluation or involving patients previously diagnosed with cancer were excluded. Results In total, 31 studies (12 randomized controlled trials; 19 observational studies) were included, reflecting PRO assessments associated with lung, breast, colorectal, anal, ovarian, cervical, and prostate cancer screening procedures. The most commonly assessed construct was symptoms of anxiety, using the State-Trait Anxiety Inventory. Cancer-specific distress and worry were also assessed using a broad range of measures. Overall, individuals tolerated screening procedures well with no major psychosocial effects. Of note, increases in symptoms of anxiety and levels of distress and worry were generally found prior to communication of screening results and following communication of indeterminate or positive results that required further testing. These negative psychosocial effects were, however, not long-lasting and returned to baseline relatively soon after screening. Furthermore, individuals with higher cancer risk, such as current smokers and those with a family history of cancer, tended to have higher levels of anxiety and distress throughout the screening process, including following negative or indeterminate results. Conclusions The psychosocial impact of cancer screening is relatively low overall and short-lived, even following false-positive test results. Individuals with a higher risk of cancer tend to experience more symptoms of anxiety and distress during the screening process; thus, more attention to this group is recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09261-5.
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Affiliation(s)
- Ashley Kim
- GRAIL, LLC, a subsidiary of Illumina, Inc., CA, Menlo Park, USA.
| | - Karen C Chung
- GRAIL, LLC, a subsidiary of Illumina, Inc., CA, Menlo Park, USA
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Effects of Curcuminoids on Systemic Inflammation and Quality of Life in Patients with Colorectal Cancer Undergoing Chemotherapy: A Randomized Controlled Trial. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1328:1-9. [PMID: 34981467 DOI: 10.1007/978-3-030-73234-9_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third and the fourth most common cancer in Iranian men and women, respectively. Curcuminoids are known to exertprotective effects against several kinds of cancers. We aim to assess the effects of curcuminoids on serum pro- and anti-inflammatory cytokines and quality of life in patients with colorectal cancer undergoing chemotherapy. MATERIAL AND METHODS This study was a double-blind placebo-controlled trial in patients with CRC (stage 3) aged ≥20 years, who had chemotherapy after the surgery and were referred to Baqiyatallah Oncology Clinic. Patients were randomly assigned to the treatment group receiving curcuminoids capsules (500 mg/day) (n = 36), or the control group taking placebo capsules (n = 36) for 8 weeks. Erythrocyte sedimentation rate (ESR) and serum levels of C-reactive protein (CRP) and 12 pro- and anti-inflammatory cytokines including tumor necrosis factor (TNF-α), interleukin-1α (IL-1α), IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, monocyte chemoattractant protein (MCP-1), interferon γ (IFN-γ), epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF)] were measured at baseline and at the end of the intervention. The EORTC-QLQ-C30 instrument was used to assess the quality of life before and after the intervention. Statistical analyses were performed using SPSS software. RESULTS A total of 67 subjects completed the study as three and two subjects were lost to follow-up in the curcuminoid and placebo groups, respectively. A significant change in CRP (p = 0.002) and ESR (p = 0.0001) was observed in patients supplemented with curcuminoids at the end of 8 weeks compared to placebo. Moreover, IL-1α showed a decreasing trend after curcuminoid supplementation compared to placebo (p = 0.077). A significant improvement in functional (p = 0.002) and global quality of life (p = 0.020) scales was observed in the curcuminoid group. CONCLUSIONS The results showed that curcuminoids supplementation for a period of 8 weeks (500 mg/day) can improve ESR and serum levels of CRP in stage-3 CRC subjects and improve the global quality of life and functional scales compared to placebo.
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Lam AC, Aggarwal R, Cheung S, Stewart EL, Darling G, Lam S, Xu W, Liu G, Kavanagh J. Predictors of participant nonadherence in lung cancer screening programs: a systematic review and meta-analysis. Lung Cancer 2020; 146:134-144. [DOI: 10.1016/j.lungcan.2020.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023]
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Bancroft EK, Saya S, Page EC, Myhill K, Thomas S, Pope J, Chamberlain A, Hart R, Glover W, Cook J, Rosario DJ, Helfand BT, Hutten Selkirk C, Davidson R, Longmuir M, Eccles DM, Gadea N, Brewer C, Barwell J, Salinas M, Greenhalgh L, Tischkowitz M, Henderson A, Evans DG, Buys SS, Eeles RA, Aaronson NK. Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations. BJU Int 2019; 123:284-292. [PMID: 29802810 PMCID: PMC6378691 DOI: 10.1111/bju.14412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening.
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Affiliation(s)
- Elizabeth K. Bancroft
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Sibel Saya
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Elizabeth C. Page
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Kathryn Myhill
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Sarah Thomas
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Jennifer Pope
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Anthony Chamberlain
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Rachel Hart
- Clinical Genetics UnitBirmingham Women's HospitalBirminghamUK
| | - Wayne Glover
- Clinical Genetics UnitBirmingham Women's HospitalBirminghamUK
| | - Jackie Cook
- Sheffield Clinical Genetics ServiceSheffield Children's HospitalSheffieldUK
| | | | - Brian T. Helfand
- John and Carol Walter Center for Urological HealthNorthShore University HealthSystemEvanstonILUSA
| | - Christina Hutten Selkirk
- John and Carol Walter Center for Urological HealthNorthShore University HealthSystemEvanstonILUSA
| | - Rosemarie Davidson
- Clinical Genetics DepartmentQueen Elizabeth University HospitalGlasgowUK
| | - Mark Longmuir
- Clinical Genetics DepartmentQueen Elizabeth University HospitalGlasgowUK
| | - Diana M. Eccles
- Wessex Clinical Genetics ServicePrincess Anne HospitalSouthamptonUK
- Faculty of MedicineUniversity of SouthamptonUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Neus Gadea
- High Risk and Cancer Prevention ClinicVall d'Hebron University HospitalBarcelonaSpain
| | - Carole Brewer
- Clinical Genetics DepartmentRoyal Devon and Exeter HospitalExeterUK
| | - Julian Barwell
- Department of GeneticsUniversity of LeicesterLeicesterUK
- Clinical GeneticsUniversity Hospitals LeicesterLeicesterUK
| | - Monica Salinas
- Hereditary Cancer ProgrammeCatalan Institute of Oncology (ICO‐IDIBELL, CIBERONC)L'Hospitalet de LlobregatBarcelonaSpain
| | - Lynn Greenhalgh
- Cheshire and Mersey Clinical Genetics ServiceLiverpool Women's HospitalLiverpoolUK
| | - Marc Tischkowitz
- Academic Department of Medical GeneticsUniversity of CambridgeCambridgeUK
| | - Alex Henderson
- Northern Genetics ServiceNewcastle upon Tyne HospitalsNewcastleUK
| | - David Gareth Evans
- Manchester Centre for Genomic MedicineCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Saundra S. Buys
- Huntsman Cancer InstituteUniversity of Utah HealthSalt Lake CityUTUSA
| | | | | | - Rosalind A. Eeles
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Neil K. Aaronson
- Division of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
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Taghizadeh N, Tremblay A, Cressman S, Peacock S, McWilliams AM, MacEachern P, Johnston MR, Goffin J, Goss G, Nicholas G, Martel S, Laberge F, Bhatia R, Liu G, Schmidt H, Atkar-Khattra S, Tsao MS, Tammemagi MC, Lam SC. Health-related quality of life and anxiety in the PAN-CAN lung cancer screening cohort. BMJ Open 2019; 9:e024719. [PMID: 30659040 PMCID: PMC6340441 DOI: 10.1136/bmjopen-2018-024719] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSIONS 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. TRIALREGISTRATION NUMBER NCT00751660; Results.
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Affiliation(s)
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonya Cressman
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Annette M McWilliams
- Department of Respiratory Medicine, Fionna Stanley Hospital and University of Western Australia, Perth, Australia
| | - Paul MacEachern
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael R Johnston
- Department of Surgery, Beatrice Hunter Cancer Research Institute and Dalhousie University, Halifax, Canada
| | - John Goffin
- Department of Oncology, The Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - Glen Goss
- Department of Medicine, The Ottawa Hospital Cancer Center, Ottawa, Ontario, Canada
| | - Garth Nicholas
- Department of Medicine, The Ottawa Hospital Cancer Center, Ottawa, Ontario, Canada
| | - Simon Martel
- Department de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Francis Laberge
- Department de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Rick Bhatia
- Department of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Heidi Schmidt
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sukhinder Atkar-Khattra
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Stephen C Lam
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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10
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Demographic, clinical, dispositional, and social-environmental characteristics associated with psychological response to a false positive ovarian cancer screening test: a longitudinal study. J Behav Med 2017; 41:277-288. [PMID: 29071653 DOI: 10.1007/s10865-017-9897-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/20/2017] [Indexed: 12/19/2022]
Abstract
Cancer screening can facilitate early detection that improves survival, but also can identify an abnormal finding that is not malignant and deemed benign. While such false positive (FP) results can impact a variety of psychological outcomes, little is known about demographic, clinical, dispositional, and social-environmental characteristics associated with psychological outcomes after a FP result. Women participating in an ovarian cancer (OC) screening program and experiencing a FP screening test result (n = 375) completed assessments at baseline and 4-months. Results indicated greater social constraint and less education were linked to greater OC-specific distress at both assessments. Short-term predictors included less optimism and no previous abnormal test, while longer-term predictors were fewer previous screens and the interaction between OC family history and monitoring coping style. Younger age, less education, less optimism, greater social constraint, and family history of OC were associated with greater perceptions of OC risk. Brief interventions prior to screening may minimize the negative impact of a false positive result and not interfere with compliant participation in screening programs.
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11
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Cooper GC, Harvie MN, French DP. Do negative screening test results cause false reassurance? A systematic review. Br J Health Psychol 2017; 22:958-977. [PMID: 28895257 DOI: 10.1111/bjhp.12265] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE It has been suggested that receiving a negative screening test result may cause false reassurance or have a 'certificate of health effect'. False reassurance in those receiving a negative screening test result may result in them wrongly believing themselves to be at lower risk of the disease, and consequently less likely to engage in health-related behaviours that would lower their risk. METHODS The present systematic review aimed to identify the evidence regarding false reassurance effects due to negative screening test results in adults (over 18 years) screened for the presence of a disease or its precursors, where disease or precursors are linked to lifestyle behaviours. MEDLINE and PsycINFO were searched for trials that compared a group who had received negative screening results to an unscreened control group. The following outcomes were considered as markers of false reassurance: perceived risk of disease; anxiety and worry about disease; health-related behaviours or intention to change health-related behaviours (i.e., smoking, diet, physical activity, and alcohol consumption); self-rated health status. RESULTS Nine unique studies were identified, reporting 55 measures in relation to the outcomes considered. Outcomes were measured at various time points from immediately following screening to up to 11 years after screening. Despite considerable variation in outcome measures used and timing of measurements, effect sizes for comparisons between participants who received negative screening test results and control participants were typically small with few statistically significant differences. There was evidence of high risk of bias, and measures of behaviours employed were often not valid. CONCLUSIONS The limited evidence base provided little evidence of false reassurance following a negative screening test results on any of four outcomes examined. False reassurance should not be considered a significant harm of screening, but further research is warranted. Statement of contribution What is already known on this subject? It has been argued that screening for disease may cause 'false reassurance' whereby those who receive a negative screening test result wrongly interpret their result as indicating they are less likely to develop the disease in future. There is some evidence for false reassurance, but the relevant studies consider a range of diseases and possible indicators of false reassurance (i.e., risk perceptions, lifestyle behaviours, emotional outcomes, and quality of life). For these reasons, it is currently unclear that the extent to receive negative screening test results is likely to impact on participants' lifestyle behaviours, or other possible indicators of false reassurance. What does this study add? Current available evidence shows that negative screening test results are unlikely to cause false reassurance and, in particular, are unlikely to have a negative impact on lifestyle behaviours. Given the limitations of the current evidence base in terms of number of studies and study quality, future research should continue to explore this issue, where this can be done at low cost.
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Affiliation(s)
- Grace C Cooper
- The Nightingale and Prevent Breast Cancer Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, UK
| | - Michelle N Harvie
- The Nightingale and Prevent Breast Cancer Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, UK
| | - David P French
- Manchester Centre of Health Psychology, School of Health Sciences, The University of Manchester, UK
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12
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Hofmann B. Ethical issues with colorectal cancer screening-a systematic review. J Eval Clin Pract 2017; 23:631-641. [PMID: 28026076 DOI: 10.1111/jep.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Colorectal cancer (CRC) screening is widely recommended and implemented. However, sometimes CRC screening is not implemented despite good evidence, and some types of CRC screening are implemented despite lack of evidence. The objective of this article is to expose and elucidate relevant ethical issues in the literature on CRC screening that are important for open and transparent deliberation on CRC screening. METHODS An axiological question-based method is used for exposing and elucidating ethical issues relevant in HTA. A literature search in MEDLINE, Embase, PsycINFO, PubMed Bioethics subset, ISI Web of Knowledge, Bioethics Literature Database (BELIT), Ethics in Medicine (ETHMED), SIBIL Base dati di bioetica, LEWI Bibliographic Database on Ethics in the Sciences and Humanities, and EUROETHICS identified 870 references of which 114 were found relevant according to title and abstract. The content of the included papers were subject to ethical analysis to highlight the ethical issues, concerns, and arguments. RESULTS A wide range of important ethical issues were identified. The main benefits are reduced relative CRC mortality rate, and potentially incidence rate, but there is no evidence of reduced absolute mortality rate. Potential harms are bleeding, perforation, false test results, overdetection, overdiagnosis, overtreatment (including unnecessary removal of polyps), and (rarely) death. Other important issues are related to autonomy and informed choice equity, justice, medicalization, and expanding disease. CONCLUSION A series of important ethical issues have been identified and need to be addressed in open and transparent deliberation on CRC screening.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Science, the Norwegian University for Science and Technology, Gjøvik, Norway.,The Centre of Medical Ethics at the University of Oslo, Norway
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13
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Lange TD, Randel KR, Schult AL, Knudsen MD, Kirkøen B, Botteri E, Berstad P, Jørgensen A, Ursin G, Bretthauer M, Hoff G. Sigmoidoscopy and faecal occult blood test - a comparative screening trial. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:727-730. [PMID: 28551972 DOI: 10.4045/tidsskr.16.1031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
| | | | | | | | | | - Edoardo Botteri
- Kreftregisteret og Nasjonal kompetansetjeneste for kvinnehelse
| | | | | | - Giske Ursin
- Kreftregisteret og Institutt for medisinske basalfag Universitetet i Oslo
| | - Michael Bretthauer
- Institutt for helse og samfunn Universitetet i Oslo og Oslo universitetssykehus
| | - Geir Hoff
- Sykehuset Telemark og Kreftregisteret og Universitetet i Oslo
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14
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Affective, cognitive and behavioral outcomes associated with a false positive ovarian cancer screening test result. J Behav Med 2017; 40:803-813. [PMID: 28432546 DOI: 10.1007/s10865-017-9851-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 04/13/2017] [Indexed: 12/19/2022]
Abstract
While participation in cancer screening can facilitate early detection and improved prognosis, all screening tests yield some proportion of abnormal test results which are later determined benign. These false positive (FP) results can negatively impact affective, cognitive, and behavioral outcomes. Women participating in an ovarian cancer (OC) screening program receiving an abnormal screening test result (n = 375) were matched with women receiving normal results (n = 375). Both groups completed a baseline and 1- and 4-month follow-up assessments. FP test results were clearly associated with increased cancer-specific distress and increased perceptions of OC risk with more limited evidence for increased perceived positive consequences of screening and increased intentions to participate in future OC screening. FP OC screening test results negatively impact both affective and cognitive outcomes which may serve to reduce motivation to participate in future routine screening. The development and testing of brief, timely interventions to minimize this negative impact is warranted.
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15
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Psychological and Behavioral Impact of Participation in Ovarian Cancer Screening. Diagnostics (Basel) 2017; 7:diagnostics7010015. [PMID: 28282847 PMCID: PMC5373024 DOI: 10.3390/diagnostics7010015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022] Open
Abstract
Evaluation of costs and benefits associated with cancer screening should include consideration of any psychological and behavioral impact associated with screening participation. Research examining the psychological and behavioral impact of screening asymptomatic women for ovarian cancer (OC) was considered. Research has focused upon potential negative psychological (e.g., distress) and behavioral (e.g., reduced future screening participation) impact of false positive (FP) OC test results. Results suggest FP OC screening results are associated with greater short-term OC-specific distress. While distress dissipates over time it may remain elevated relative to pre-screening levels for several weeks or months even after clinical follow-up has ruled out malignancy. The likelihood of participation in future OC screening may also be reduced. Research focused upon identification of any beneficial impact of participation in OC screening associated with receipt of “normal” results was also considered. This research suggests that a “normal” screening test result can have psychological benefits, including increased positive affect and beliefs in the efficacy of screening. It is concluded that any psychological or behavioral harms attributable to OC screening are generally very modest in severity and duration and might be counterbalanced by psychological benefits accruing to women who participate in routine OC screening and receive normal test results.
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16
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Kirkøen B, Berstad P, Botteri E, Bernklev L, El-Safadi B, Hoff G, de Lange T, Bernklev T. Psychological effects of colorectal cancer screening: Participants vs individuals not invited. World J Gastroenterol 2016; 22:9631-9641. [PMID: 27920484 PMCID: PMC5116607 DOI: 10.3748/wjg.v22.i43.9631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/19/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the possible long-term psychological harm of participating in colorectal cancer (CRC) screening in Norway.
METHODS In a prospective, randomized trial, 14294 participants (aged 50-74 years) were invited to either flexible sigmoidoscopy (FS) screening, or a faecal immunochemical test (FIT) (1:1). In total, 4422 screening participants (32%) completed the questionnaire, which consisted of the Hospital Anxiety and Depression Scale and the SF-12, a generic health-related quality of life (HRQOL) measurement, when invited to screening and one year after the invitation. A control group of 7650 individuals was invited to complete the questionnaire only, at baseline and one year after, and 1911 (25%) completed the questionnaires.
RESULTS Receiving a positive or negative screening result and participating in the two different screening modalities did not cause clinically relevant mean changes in anxiety, depression or HRQOL after one year. FS screening, but not FIT, was associated with an increased probability of being an anxiety case (score ≥ 8) at the one-year follow-up (5.6% of FS participants transitioned from being not anxious to anxious, while 3.0% experienced the reverse). This increase was moderately significantly different from the changes in the control group (in which the corresponding numbers were 4.8% and 4.5%, respectively), P = 0.06.
CONCLUSION Most individuals do not experience psychological effects of CRC screening participation after one year, while FS participation is associated with increased anxiety for a smaller group.
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17
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Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment. J Am Coll Radiol 2016; 13:R89-R97. [PMID: 27814821 DOI: 10.1016/j.jacr.2016.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Anxiety has been called a "harm" of screening mammography. The authors provided direct, interactive education to lay audiences and measured these sessions' impact on anxiety and any increased understanding of breast cancer screening. METHODS Academic breast radiologist provided seven 1-hour sessions of structured lectures and question-and-answer periods. Lay language and radiologic images were used to discuss disease background, screening guidelines, and areas of debate. One hundred seventeen participants (mean age, 45 ± 15 years) completed voluntary, anonymous, institutional review board-approved pre and postsession questionnaires relaying their attitudes regarding screening and the impact of the sessions. Results are summarized descriptively. RESULTS Mean reported anxiety regarding screening (on a scale ranging from 1-5; 1 = no anxiety) was 2.5 ± 1.3. Anxiety was attributed to unknown results (56.4%), anticipation of pain (21.8%), known risk factors (14.5%), general uncertainty (12.7%), waiting for results (9.1%), possibility of more procedures (3.6%), and personal breast cancer history (3.6%). Ninety-seven percent reported that immediate results would lower anxiety (78% of those women indicated a 75%-100% decrease in anxiety); 93% reported that radiologist consultation with images would lower anxiety (75.6% indicated a 75%-100% decrease in anxiety). After the lecture, women reported (on a scale ranging from 1-5) increased understanding of the topic (4.7 ± 0.6), encouragement to screen (4.6 ± 0.7), and reduced anxiety (4.0 ± 1.1). Ninety-seven percent to 100% provided correct responses to these questions: rationale for screening in the absence of family history, recall does not equate to cancer diagnosis, benefit of prior films, and continued importance of physical examination. CONCLUSION Attendees of radiologist-provided direct public lectures reported decreased anxiety and improved knowledge regarding screening mammography. The resultant reduced anxiety ("harm") and educational empowerment help enable informed decision making and may promote screening attendance.
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Affiliation(s)
- Samantha L Quaife
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, London, UK
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19
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Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening. Int J Gynecol Cancer 2016. [PMID: 26222482 DOI: 10.1097/igc.0000000000000507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) aims to establish the efficacy of 2 different ovarian cancer screening schedules. The psychosocial substudy examines the psychological factors associated with the screening program. METHODS Women aged 50 to 75 years from 16 UK gynecologic centers randomized to annual multimodal screening or ultrasound screening (US) groups were followed up for 7 years. Psychosocial data from women who withdrew from the study after a repeat screen were examined. RESULTS Sixteen percent (3499/21,733) of women requiring a repeat screening test in addition to annual screen withdrew from the study: 12.9% (1560/12,073) from the multimodal group and 20.1% (1939/9660) from the US group. An estimated relative risk of withdrawal is 1.46 (95% confidence interval, 1.36-1.56; P ≤ 0.001) for the US arm. High anxiety trait and increased psychological morbidity significantly influenced withdrawal, even when age, screening center, and group were taken into account (P < 0.001). The risk of withdrawal decreased significantly the longer a woman stayed in UKCTOCS, irrespective of the number of screens and intensity in the preceding year. CONCLUSIONS Withdrawal rate was greater in women undergoing US screening and in those who had repeats earlier in UKCTOCS. Having a high predisposition to anxiety, high current state anxiety, and above threshold general psychological morbidity all increased the withdrawal rate.
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20
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Brain K, Lifford KJ, Carter B, Burke O, McRonald F, Devaraj A, Hansell DM, Baldwin D, Duffy SW, Field JK. Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial. Thorax 2016; 71:996-1005. [PMID: 27471048 PMCID: PMC5099188 DOI: 10.1136/thoraxjnl-2016-208283] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/23/2016] [Indexed: 11/13/2022]
Abstract
Background The UK Lung Cancer Screening (UKLS) trial is a randomised pilot trial of low-dose CT (LDCT) screening for individuals at high risk of lung cancer. We assessed the long-term psychosocial impact on individuals participating in the UKLS trial. Methods A random sample of individuals aged 50–75 years was contacted via primary care. High-risk individuals who completed T0 questionnaires (baseline) were randomised to LDCT screening (intervention) or usual care (no screening control). T1 questionnaires were sent 2 weeks after baseline scan results or control assignment. T2 questionnaires were sent up to 2 years after recruitment. Measures included cancer distress, anxiety, depression and decision satisfaction. Results A total of 4037 high-risk individuals were randomised and they completed T0 questionnaires (n=2018 intervention, n=2019 control). Cancer distress was higher at T1 in intervention arm participants who received positive screening results (p≤0.001), but not at T2 (p=0.04). T2 anxiety (p≤0.001) and depression (p≤0.01) were higher in the control arm, but the absolute differences were small and not clinically relevant. At both time points, fewer control than screened participants were satisfied with their decision to participate in UKLS (p≤0.001). Regardless of trial allocation, cancer distress was higher in women (p≤0.01), participants aged ≤65 years (p≤0.001), current smokers (p≤0.001), those with lung cancer experience (p≤0.001) and those recruited from the Liverpool area (p≤0.001). Conclusion Lung cancer screening using LDCT appears to have no clinically significant long-term psychosocial impact on high-risk participants. Strategies for engaging and supporting underserved groups are the key to implement routine lung cancer screening in the UK. Trial registration number ISRCTN 78513845; results.
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Affiliation(s)
- Kate Brain
- Cardiff University School of Medicine, Cardiff, UK
| | | | - Ben Carter
- Cardiff University School of Medicine, Cardiff, UK
| | - Olivia Burke
- Cardiff University School of Medicine, Cardiff, UK
| | | | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - David M Hansell
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - David Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
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Abstract
Background Randomized trials evaluating new cancer screening technologies may underestimate the efficacy of screening to reduce cancer mortality if study participants are noncompliant. Participants may fail to comply with the screening itself or fail to obtain appropriate diagnostic follow-up and treatment. Noncompliance with screening has drawn wide attention, but little attention has been paid to noncompliance with diagnostic follow-up and treatment. Purpose To examine the importance of noncompliance with screening, follow-up, and treatment in cancer screening trials. Methods The unique problems associated with noncompliance in screening trials are described and provide an example illustrating the potential impact of noncompliance in a screening trial. I discuss issues that arise with measurement of follow-up and therapeutic noncompliance, and the benefit of collecting information on health system and participant characteristics associated with noncompliance. Results The estimate of the efficacy of a screening program on cancer mortality can be adjusted for screening, follow-up, and treatment noncompliance. Noncompliance needs to be measured in a rigorous, systematic manner across all arms of the trial. Information on health system and participant characteristics associated with compliance may also be incorporated into statistical models to estimate screening effects with full compliance, plan interventions to increase compliance, and extrapolate results of screening trials from one population to another. Limitations Measuring compliance with follow-up and treatment can be difficult when these occur outside the trial, and when there is variation among providers in follow-up and treatment practices. Conclusions Noncompliance may alter the estimate of a screening effect on cancer mortality in clinical trials. It is possible to adjust screening efficacy estimates for noncompliance using existing statistical techniques. It is important that data describing compliance with screening, follow-up, and treatment are collected as part of standard data collection in cancer screening trials. Clinical Trials 2007; 4: 341—349. http://ctj.sagepub.com
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Affiliation(s)
- Ilana F Gareen
- Center for Statistical Sciences and the Department of Community Health, Brown University School of Medicine, Providence, RI 02912, USA.
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22
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Field JK, Duffy SW, Baldwin DR, Brain KE, Devaraj A, Eisen T, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MK, Rintoul RC, Screaton N, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Hansell DM. The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer. Health Technol Assess 2016; 20:1-146. [PMID: 27224642 PMCID: PMC4904185 DOI: 10.3310/hta20400] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects. OBJECTIVES To (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening. DESIGN A pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years). SETTING Thoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire. PARTICIPANTS Individuals aged 50-75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres. INTERVENTIONS A thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria. MAIN OUTCOME MEASURES Population-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling. RESULTS A total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality. CONCLUSIONS The UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60-75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols. FUTURE WORK The UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch-Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation. TRIAL REGISTRATION Current Controlled Trials ISRCTN78513845. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John K Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate E Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Beverley A Green
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John A Holemans
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kate J Lifford
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona E McRonald
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Arjun Nair
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard D Page
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas Screaton
- Department of Radiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J Wald
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David Weller
- School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
| | - David K Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | - Paula R Williamson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ghasem Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David M Hansell
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Burden of waiting for surveillance CT colonography in patients with screen-detected 6-9 mm polyps. Eur Radiol 2016; 26:4000-4010. [PMID: 27059859 PMCID: PMC5052316 DOI: 10.1007/s00330-016-4251-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 01/23/2023]
Abstract
Purpose We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6–9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC. Materials and methods In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6–9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar’s test was used for comparison after dichotomization. Results Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as ‘never’ or ‘only sometimes’ burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012). Conclusion Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable. Key points • Waiting for surveillance CTC within a CRC screening caused little burden • The vast majority never or only sometimes thought about their polyp(s) • In general, the burden of index and surveillance CTC were comparable • Awaiting results was more burdensome for surveillance than for index CTC
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Freiman MR, Clark JA, Slatore CG, Gould MK, Woloshin S, Schwartz LM, Wiener RS. Patients' Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey. J Thorac Oncol 2016; 11:700-708. [PMID: 26961390 DOI: 10.1016/j.jtho.2016.01.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Pulmonary nodules are detected in more than 1 million Americans each year. Prior qualitative work suggests that the detection of incidental pulmonary nodules can be burdensome for patients, but whether these findings generalize to a broader sample of patients is unknown. We categorized patients' knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, as well as their impressions of clinician communication. METHODS We administered a cross-sectional survey to adults with an incidental pulmonary nodule who were recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital. RESULTS Of the 490 individuals mailed surveys, 244 (50%) responded. Median nodule size was 7 mm, mean patient age was 67 years, 29% of respondents were female, and 86% were white. A quarter of the respondents (26%) reported clinically significant distress related to their nodule, our primary outcome, as measured by the Impact of Event Scale. Patients reported multiple concerns, including uncertainty about the nodule's cause (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall, there was no correlation between perceived and actual risk (r = -0.007, p = 0.93). The 23% of patients who did receive information on cancer risk from their provider were more likely to find this information reassuring (16%) than scary (7%). CONCLUSION A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.
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Affiliation(s)
- Marc R Freiman
- Pulmonary Center, Boston University Medical Center, Boston, Massachusetts
| | - Jack A Clark
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford, Massachusetts; Boston University School of Public Health, Boston, Massachusetts
| | - Christopher G Slatore
- Center to Improve Veteran Involvement and Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven Woloshin
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Lisa M Schwartz
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Renda Soylemez Wiener
- Pulmonary Center, Boston University Medical Center, Boston, Massachusetts; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford, Massachusetts.
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Kirkøen B, Berstad P, Botteri E, Åvitsland TL, Ossum AM, de Lange T, Hoff G, Bernklev T. Do no harm: no psychological harm from colorectal cancer screening. Br J Cancer 2016; 114:497-504. [PMID: 26867161 PMCID: PMC4782205 DOI: 10.1038/bjc.2016.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/21/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality. The present study aimed to investigate possible psychological harm of participation in a colorectal cancer (CRC) screening pilot in Norway. Methods: In a prospective, randomised trial participants (aged 50–74 years) were invited to either flexible sigmoidoscopy (FS) screening, faecal immunochemical test (FIT), or no screening (the control group; 1 : 1: 1). Three thousand two hundred and thirteen screening participants (42% of screened individuals) completed the Hospital Anxiety and Depression Scale questionnaire as well as the SF-12—a health-related quality of life (HRQOL) questionnaire when invited to screening and when receiving the screening result. A control group was invited to complete the questionnaires only. Two thousand six hundred and eighteen control participants (35% of invited individuals) completed the questionnaire. Results: A positive screening result did not increase participants' level of anxiety or depression, or decrease participants' level of HRQOL. Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions. However, no change was considered to be of clinical relevance. Conclusion: The current study showed no clinically relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening, in a Norwegian population.
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Affiliation(s)
- Benedicte Kirkøen
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. box 1171 Blindern, 0318 Oslo, Norway
| | - Paula Berstad
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway
| | - Edoardo Botteri
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Tone Lise Åvitsland
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, P.O. box 800, 3004 Drammen, Norway
| | - Alvilde Maria Ossum
- Department of Gastroenterology, Østfold Hospital Trust, P.O. box 300, 1714 Grålum, Norway
| | - Thomas de Lange
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, P.O. box 800, 3004 Drammen, Norway
| | - Geir Hoff
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. box 1089 Blindern, 0318 Oslo, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, P.O. box 1171 Blindern, 0318 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway
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Lee J, Hardesty LA, Kunzler NM, Rosenkrantz AB. Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment. J Am Coll Radiol 2016; 13:12-20. [DOI: 10.1016/j.jacr.2015.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022]
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Reid AE, Tanoue L, Detterbeck F, Michaud GC, McCorkle R. The Role of the Advanced Practitioner in a Comprehensive Lung Cancer Screening and Pulmonary Nodule Program. J Adv Pract Oncol 2015; 5:440-6. [PMID: 26328217 PMCID: PMC4530114 DOI: 10.6004/jadpro.2014.5.6.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Amanda E Reid
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Lynn Tanoue
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Frank Detterbeck
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Gaetane Celine Michaud
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Ruth McCorkle
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
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Ebbert JA, Donovan KA, Lengacher CA, Fabri D, Reich R, Daley E, Thompson EL, Wenham RM. Right Place, Right Time: Preferences of Women with Ovarian Cancer for Delivery of CAM Education. MEDICINES 2015; 2:236-250. [PMID: 28930210 PMCID: PMC5456219 DOI: 10.3390/medicines2030236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/05/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022]
Abstract
The purpose of this pilot study was to assess the feasibility of on-site complementary and alternative medicine (CAM) education sessions to maximize quality of life for women with ovarian cancer. The pilot intervention consisted of four weekly sessions, each focusing the techniques and benefits of a particular CAM topic (e.g., nutrition, massage, relaxation). Participants were recruited from the Center for Women’s Oncology at H. Lee Moffitt Cancer Center from 2010 to 2012. Eligible participants had an ovarian cancer diagnosis with a life expectancy of at least 12 months, and were 18 years or older. The Gynecologic Oncology research nurse invited women in the outpatient clinic who matched the eligibility criteria. The research nurse explained the study and provided an informed consent form and return envelope. Because ovarian cancer is not only a rare cancer but, also, most patients seen at Moffitt have recurrent or advanced disease, many women did not have an adequate ECOG score. Many women who consented had rapid changes in health status, with morbidity and mortality outpacing recruitment of the 20 needed to proceed with the four education sessions. Baseline and follow-up surveys were conducted to assess changes in QOL, knowledge, and satisfaction with the intervention. While 27 women consented and 24 women completed the baseline survey, only five women participated in the intervention. The five women who participated were all white, and at time of consenting had a mean age of 60 (SD 9.08) and an average of 102 months (SD 120.65) since diagnosis, and were all on active treatment, except for one. The intervention pilot did not encounter difficulties with regard to recruitment, but suffered problems in achieving an adequate number of women to launch the on-site sessions because of rapidly changing morbidity and significant mortality. The team recognized that a larger-scaled intervention comprised of on-site sessions was impractical and compared attendance rates with a more convenient format currently underway in the Women’s Oncology program at Moffitt. While low participation prevented an intervention analysis of scientific merit, the study data is informative with regard to barriers, facilitators, and alternative methods for sharing useful information to women with advanced ovarian cancer. The comparison strongly suggested that CAM education for women compromised by the disease and treatment associated with ovarian cancer would best be delivered in the convenient-access format that allowed remote access to live and recorded discussions of specific topics.
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Affiliation(s)
- Judith Ann Ebbert
- Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
- University of Florida Health, College of Nursing, 12901 Bruce B. Downs Blvd., Tampa, FL 33612 USA.
| | - Kristine A Donovan
- Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Cecile A Lengacher
- University of Florida Health, College of Nursing, 12901 Bruce B. Downs Blvd., Tampa, FL 33612 USA.
| | - Donna Fabri
- Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Richard Reich
- Division of Psychology, College of Arts and Sciences, University of South Florida Sarasota-Manatee, Tamiami Trail Sarasota, FL 34243, USA.
| | - Ellen Daley
- University of Florida College of Public Health, 13201 Bruce B. Downs Blvd., Tampa, FL 33612 USA.
| | - Erika Lynne Thompson
- University of Florida College of Public Health, 13201 Bruce B. Downs Blvd., Tampa, FL 33612 USA.
| | - Robert M Wenham
- Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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Sexual Activity and Function in Patients With Gynecological Malignancies After Completed Treatment. Int J Gynecol Cancer 2015; 25:1134-41. [DOI: 10.1097/igc.0000000000000468] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveSexual activity (SA) and sexual function (SF) after completion of treatment are central for quality of life (QoL) in women affected by gynecological cancer (GC). The aim of this study was to analyze the sexual outcome and overall QoL of women after treatment for primary GC compared with a healthy control group (CG).MethodsIn a multicenter cross-sectional study, 77 women aged 28 to 67 years were surveyed at least 12 months after completion of primary therapy for cervical, endometrial, or vulvar cancer [gynecological cancer group (GCG)]. Data were collected through validated questionnaires (Female Sexual Function Index-d, EORTC Quality of Life Questionnaire-C30, and Sexual Activity Questionnaire) and compared to a control of 60 healthy women (CG).ResultsIn the GCG, 41.3% were sexually active compared to 78.0% in the CG. Twelve women of the CG and 42 women of the GCG indicated the reasons for their sexual inactivity. The most common reason for sexual inactivity in the GCG was “the-presence-of-a-physical-problem” [18/42 (42.9%) vs 2/12 (16.7%) in the CG], whereas in the CG, “because-I-do-not-have-a-partner” was most common [6/12 (50.0%) vs 11/42 (26.2%) in the GCG]. Sexually active patients in the GCG had an SF comparable to the CG. In multivariate analysis of the total cohort (n = 137), relationship status [solid partnership vs living alone; odds ratio (OR), 33.82; 95% confidence interval (CI), 4.83–236.70], smoking (OR, 0.25; 95% CI, 0.06–1.03), and age (OR, 0.87; 95% CI, 0.79–0.94) influenced SA significantly. The probability of SA thereby decreased with increasing age. Quality of life and subjective general health status were not significantly different between the GCG and the CG (EORTC Quality of Life Questionnaire-C30 score 68.25 vs 69.67).ConclusionsA high number of patients with GC remain sexually inactive after treatment, indicating that women experience persistent functional problems. However, women who regain SA after completed treatment have a good overall SF and vice versa.
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Psychosocial consequences in the Danish randomised controlled lung cancer screening trial (DLCST). Lung Cancer 2015; 87:65-72. [DOI: 10.1016/j.lungcan.2014.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 11/19/2022]
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Huijbers A, Mesker WE, Mertens BJ, Bladergroen MR, Deelder AM, van der Burgt YEM, Tollenaar RAEM. Case-controlled identification of colorectal cancer based on proteomic profiles and the potential for screening. Colorectal Dis 2014; 16:907-13. [PMID: 25243779 DOI: 10.1111/codi.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/17/2014] [Indexed: 01/25/2023]
Abstract
AIM Colorectal cancer (CRC) screening programmes detect early cancers but unfortunately have limited sensitivity and specificity. Mass spectrometry-based determination of serum peptide and protein profiles provides a new approach for improved screening. METHOD Serum samples were obtained from 126 CRC patients before treatment and 277 control individuals. An additional group of samples from 50 CRC patients and 82 controls was used for validation. Peptide and protein enrichments were carried out using reverse-phase C18 and weak-cation exchange magnetic beads in an automated solid-phase extraction and spotting procedure. Profiles were acquired on a matrix-assisted laser desorption/ionization time-of-flight system. Discriminant rules using logistic regression were calibrated for the peptide and protein signatures separately, followed by combining the classifications to obtain double cross-validated predicted class probabilities. Results were validated on an identical patient set. RESULTS A discriminative power was found for patients with CRC representative for all histopathological stages compared with controls with an area under the curve of 0.95 in the test set (0.93 for the validation set) and with a high specificity (94-95%). CONCLUSION The study has shown that a serum peptide and protein biomarker signature can be used to distinguish CRC patients from healthy controls with high discriminative power. This relatively simple and cheap test is promising for CRC screening.
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Affiliation(s)
- A Huijbers
- Department of Surgery, Leiden Universal Medical Center, Leiden, The Netherlands
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Gritz ER, Arnold KB, Moinpour CM, Burton-Chase AM, Tangen CM, Probstfield JF, See WA, Lieber MM, Caggiano V, Moody-Thomas S, Szczepanek C, Ryan A, Carlin S, Hill S, Goodman PJ, Padberg RM, Minasian LM, Meyskens FL, Thompson IM. Factors associated with adherence to an end-of-study biopsy: lessons from the prostate cancer prevention trial (SWOG-Coordinated Intergroup Study S9217). Cancer Epidemiol Biomarkers Prev 2014; 23:1638-48. [PMID: 25028457 PMCID: PMC4119542 DOI: 10.1158/1055-9965.epi-14-0202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Prostate Cancer Prevention Trial (PCPT) was a 7-year randomized, double-blind, placebo-controlled trial of the efficacy of finasteride for the prevention of prostate cancer with a primary outcome of histologically determined prevalence of prostate cancer at the end of 7 years. METHODS A systematic modeling process using logistic regression identified factors available at year 6 that are associated with end-of-study (EOS) biopsy adherence at year 7, stratified by whether participants were ever prompted for a prostate biopsy by year 6. Final models were evaluated for discrimination. At year 6, 13,590 men were available for analysis. RESULTS Participants were more likely to have the EOS biopsy if they were adherent to study visit schedules and procedures and/or were in good health (P < 0.01). Participants at larger sites and/or sites that received retention and adherence grants were also more likely to have the EOS biopsy (P < 0.05). CONCLUSIONS Our results show good adherence to study requirements 1 year before the EOS biopsy was associated with greater odds that a participant would comply with the invasive EOS requirement. IMPACT Monitoring adherence behaviors may identify participants at risk of nonadherence to more demanding study end points. Such information could help frame adherence intervention strategies in future trials.
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Affiliation(s)
- Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Carol M Moinpour
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
| | - Allison M Burton-Chase
- Department of Basic and Social Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York;
| | | | | | - William A See
- Division of Urology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | | | | | - Sarah Moody-Thomas
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Anne Ryan
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland; and
| | | | | | | | | | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland; and
| | - Frank L Meyskens
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California
| | - Ian M Thompson
- Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Ostroff JS. Quality lung cancer screening protects quality of life: no harm, no foul. Cancer 2014; 120:3275-6. [PMID: 25065840 DOI: 10.1002/cncr.28835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
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Barrett J, Jenkins V, Farewell V, Menon U, Jacobs I, Kilkerr J, Ryan A, Langridge C, Fallowfield L. Psychological morbidity associated with ovarian cancer screening: results from more than 23 000 women in the randomised trial of ovarian cancer screening (UKCTOCS). BJOG 2014; 121:1071-9. [DOI: 10.1111/1471-0528.12870] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J Barrett
- Cardiovascular Epidemiology Unit; Department of Public Health & Primary Care; University of Cambridge; Cambridge UK
| | - V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - V Farewell
- Medical Research Council Biostatistics Unit; Institute of Public Health; Cambridge UK
| | - U Menon
- EGA Institute for Women's Health; University College London; London UK
| | - I Jacobs
- Faculty of Medical & Human Sciences; University of Manchester; Manchester UK
| | - J Kilkerr
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - A Ryan
- EGA Institute for Women's Health; University College London; London UK
| | - C Langridge
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
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van Dam L, Bretthauer M. Ethical issues in colorectal cancer screening. Best Pract Res Clin Gastroenterol 2014; 28:315-26. [PMID: 24810192 DOI: 10.1016/j.bpg.2014.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/02/2014] [Indexed: 02/07/2023]
Abstract
In many countries, colorectal cancer screening is currently an established population screening program due to the evidence on its reduction of colorectal cancer mortality. There is general consensus that colorectal cancer screening meets the screening criteria as proposed by Wilson and Jungner. However, as for all population screening programs, colorectal cancer screening also has disadvantages and thereby entails ethical issues. There are the general issues concerning the introduction of screening programs (e.g. medicalization, overdiagnosis and overtreatment, information provision to screenees), evaluation of cancer screening programs (e.g. lead time and length bias), chosen screening method (e.g. false-positive and false-negative test results, reduction of all-cause mortality, choice between different screening methods). The different colorectal cancer screening methods and the ethical issues concerning colorectal cancer screening will be discussed in this review.
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Affiliation(s)
- Leonie van Dam
- Department of Gastroenterology and Hepatology, University Medical Centre Rotterdam, The Netherlands; Department of Medical Ethics and Philosophy, University Medical Centre Rotterdam, The Netherlands.
| | - Michael Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Oslo, Norway.
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Oyama H, Sakashita T. Differences in specific depressive symptoms among community-dwelling middle-aged Japanese adults before and after a universal screening intervention. Soc Psychiatry Psychiatr Epidemiol 2014; 49:251-8. [PMID: 23824236 DOI: 10.1007/s00127-013-0735-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated changes in depressive symptoms after the implementation of a universal screening for depression and subsequent care support. METHODS A cluster-randomized study design used 10 subdistricts (2,400 inhabitants aged 40-64 years) in northern Japan randomly assigned in a 2:3 ratio to intervention and control conditions. All 900 residents aged 40-64 in the intervention districts were invited to participate in a 2-year depressive screening program, with a participation rate of 49.2%. A 4-year ongoing education program occurred in both intervention and control districts. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptomatology. Repeated cross-sectional samples were surveyed before (n = 1,516, response rate 63.6%) and after (n = 1,596, 66.4%) intervention, and the data, clustered according to district, were analyzed at the individual level using a mixed-effects model. RESULTS Significant changes in mean scores between baseline and 5-year follow-up in the intervention group were observed in the Depressive Affect, Somatic Symptoms, and Interpersonal Problems subscales. The difference between the changes over time in the two groups was significant for the three subscales and marginally for the CES-D total scale, but not for the Positive Affect subscale. CONCLUSIONS Universal depression screening and subsequent support can be effective in preventing general depressive symptoms, but may not influence psychological well-being, among middle-aged adults in a community setting.
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Affiliation(s)
- Hirofumi Oyama
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase Hamadate, Aomori, 030-8505, Japan,
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Jeffers CD, Pandey T, Jambhekar K, Meek M. Effective Use of Low-Dose Computed Tomography Lung Cancer Screening. Curr Probl Diagn Radiol 2013; 42:220-30. [DOI: 10.1067/j.cpradiol.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening asymptomatic women for ovarian cancer: a systematic review and meta-analysis. Gynecol Oncol 2013; 130:674-81. [PMID: 23822892 DOI: 10.1016/j.ygyno.2013.06.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/16/2013] [Accepted: 06/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to quantify risks and benefits of screening asymptomatic women for ovarian cancer. METHODS We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL, without language restrictions, from January 1, 1979 to February 5, 2012. Eligible studies randomly assigned asymptomatic women to screening or usual care. Two reviewers independently screened studies for eligibility, extracted data using a standardized, piloted extraction form, and assessed bias and strength of inference for each outcome using the GRADE framework. Chance-corrected agreement was calculated at each step, and disagreements were resolved through consensus. RESULTS Ten randomized trials proved eligible. Screening did not reduce all-cause mortality (relative risk (RR)=1.0, 95% confidence interval (CI) 0.96-1.06), ovarian cancer specific mortality (RR=1.08, 95% CI 0.84-1.38), or risk of diagnosis at an advanced stage (RR of diagnosis at FIGO stages III-IV=0.86, 95% CI 0.68-1.11). Transvaginal ultrasound resulted in a mean of 38 surgeries per ovarian cancer detected (95% CI 15.7-178.1) while screening with CA-125 led to 4 surgeries per ovarian cancer detected (95% CI 2.7-4.5). Surgery was associated with severe complications in 6% of women (95% CI 1%-11%). Quality of life was not affected by screening; however, women with false-positive results had increased cancer-specific distress compared to those with normal results (odds ratio (OR)=2.22, 95% CI 1.23-3.99). CONCLUSIONS Screening asymptomatic women for ovarian cancer does not reduce mortality or diagnosis at an advanced stage and is associated with unnecessary surgery.
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Affiliation(s)
- Clare J Reade
- Division of Gynecologic Oncology, University of Toronto, Toronto, Canada.
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Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA. What do you mean, a spot?: A qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules. Chest 2013; 143:672-677. [PMID: 22814873 PMCID: PMC3590883 DOI: 10.1378/chest.12-1095] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/26/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND More than 150,000 Americans each year are found to have a pulmonary nodule. Even more will be affected following the publication of the National Lung Screening Trial. Patient-doctor communication about pulmonary nodules can be challenging. Although most nodules are benign, it may take 2 to 3 years to rule out cancer. We sought to characterize patients’ perceptions of communication with their providers about pulmonary nodules. METHODS We conducted four focus groups at two sites with 22 adults with an indeterminate pulmonary nodule. Transcripts were analyzed using principles of grounded theory. RESULTS Patients described conversations with 53 different providers about the pulmonary nodule. Almost all patients immediately assumed that they had cancer when first told about the nodule. Some whose providers did not discuss the actual cancer risk or explain the evaluation plan experienced confusion and distress that sometimes lasted for months. Patients were frustrated when their providers did not address their concerns about cancer or potential adverse effects of surveillance (eg, prolonged uncertainty, radiation exposure), which in some cases led to poor adherence to evaluation plans. Patients found it helpful when physicians used lay terms, showed the CT image, and quantified cancer risk. By contrast, patients resented medical jargon and dismissive language. CONCLUSIONS Patients commonly assume that a pulmonary nodule means cancer. What providers tell (or do not tell) patients about their cancer risk and the evaluation plan can strongly influence patients’ perceptions of the nodule and related distress. We describe simple communication strategies that may help patients to come to terms with an indeterminate pulmonary nodule.
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Affiliation(s)
- Renda Soylemez Wiener
- Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Steven Woloshin
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Lisa M Schwartz
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Jack A Clark
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
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Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA. 'The thing is not knowing': patients' perspectives on surveillance of an indeterminate pulmonary nodule. Health Expect 2012; 18:355-65. [PMID: 23252477 DOI: 10.1111/hex.12036] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The hundreds of thousands of patients found to have a potentially malignant pulmonary nodule each year are faced with tremendous uncertainty regarding what the nodule is and how it should be evaluated. OBJECTIVE To explore patients' responses to the detection and evaluation of a pulmonary nodule. DESIGN Qualitative study based on four focus-group discussions. We performed inductive analysis using principles of grounded theory to identify themes relating to responses to the nodule and strategies to manage uncertainty. SETTING AND PARTICIPANTS Twenty-two patients from two medical centres who were undergoing surveillance for an indeterminate pulmonary nodule. RESULTS Patient responses to an indeterminate pulmonary nodule were varied and evolved over time. Although almost all patients reported an initial fear about cancer, subsequent depictions of the nodule diverged into four types defined on two dimensions: cognitive ('it's cancer' vs. 'I don't know what it is' vs. 'it's nothing serious') and emotional (anxiety vs. equanimity). Most eventually accepted that the nodule was unlikely to be malignant; however, some remained anxious, convinced the nodule could turn into cancer at any time and should be aggressively monitored for life. Patients used results of surveillance tests as well as their own strategies (e.g. vigilance for symptoms, information-seeking, contemplating and controlling modifiable risk factors, avoidance, faith) to manage uncertainty. CONCLUSIONS Surveillance for a pulmonary nodule can weigh heavily on some patients for months or years. Our findings may help clinicians prepare patients with a newly detected pulmonary nodule for the burden of the prolonged uncertainty of surveillance.
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Affiliation(s)
- Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; Center for Health Quality, Outcomes and Economic Research, ENRM VA Hospital, Bedford, MA, USA
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The sensitivity and specificity of guaiac and immunochemical fecal occult blood tests for the detection of advanced colonic adenomas and cancer. Int J Colorectal Dis 2012; 27:1657-64. [PMID: 22696204 DOI: 10.1007/s00384-012-1518-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Fecal immunochemical tests (FITs) have been developed to address analytical problems inherent in the older guaiac-based fecal occult blood tests (g-FOBTs). Our aim was to compare the performance characteristics of one g-FOBT (Hemoccult II) and two FITs (the Hemoccult ICT and MagStream HemSp) relative to colonoscopy for the detection of colorectal cancer and significant precursor lesions. We also examined whether a 1-day collection strategy would negatively impact test diagnostic performance. METHODS We used a prospective observational cohort design in a Canadian population eligible for screening. All participants received colonoscopy after performing the occult blood tests. RESULTS One thousand seventy-five individuals were enrolled (mean age 56.3 years, 53.8 % females). Using colonoscopy as the gold standard, the sensitivity for screen-relevant neoplasm was determined for Hemoccult II (7.2, 95 % CI: 1.1-13.4), Hemoccult ICT (23.2 %: 13.2-33.1), and MagStream HemSp using 67 μg/gram stool as the cut-off (23.2 %: 13.2-33.1). The Magstream HemSp, using a cut-off threshold of 30 μg/gram stool, had the lowest specificity at 87.6 % (85.4-89.6), while the Hemoccult II had the highest at 98.8 % (98.1-99.5). Single-day stool testing reduced the false-positive rates of all tests without significantly reducing the sensitivity. CONCLUSION We found that FITs have a significantly increased sensitivity but reduced specificity for screen-relevant neoplasm compared to g-FOBT using colonoscopy as the gold standard. Optimal threshold levels for hemoglobin detection depend on the desired trade off between sensitivity and false-positive rate. Single-day testing with an FIT may be an option to enhance population compliance with screening.
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Abstract
Background: Little is known about the effect of participating in a colorectal cancer (CRC) screening programme on quality of life (QOL), neither for participants with a negative nor for those with a positive test result. These findings, however, are important to evaluate the impact of CRC screening. Methods: Participants from CRC screening trials were sent a questionnaire, which included validated measures on generic health-related QOL, generic anxiety and screen-specific anxiety. Both faecal immunochemical test (FIT) and flexible sigmoidoscopy (FS) participants, either with negative or positive test results, were addressed. Results: The response rate was 73% (1289 out of 1772) for FIT and 78% (536 out of 689) for FS participants, with mean ages varying from 63–66 years. Positive FIT participants had worse physical (PCS-12, 47.1 vs 48.3, P=0.02), but equal mental QOL scores (MCS-12, 51.1 vs 51.6, P=0.26). Positive and negative FS participants had similar QOL scores. Both FIT and FS participants with a positive test result reported more screen-specific anxiety than negative FIT and FS participants. Positive and negative FS participants had similar generic anxiety scores. Conclusion: Our findings indicate that the burden of participating in CRC screening may be limited. Conducting a prospective study to confirm these results is recommended.
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Hafslund B, Espehaug B, Nortvedt MW. Health-related quality of life, anxiety and depression related to mammography screening in Norway. J Clin Nurs 2012; 21:3223-34. [PMID: 22937996 DOI: 10.1111/j.1365-2702.2012.04244.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM AND OBJECTIVES To measure health-related quality of life, anxiety and depression ahead of mammography screening and to assess any differences in health-related quality of life compared to reference population. BACKGROUND The study of health-related quality of life among attendees prior to mammography screening has received little attention, and increased knowledge is needed to better understand the overall health benefits of participation. DESIGN A two-group cross-sectional comparative study was performed. METHODS The samples comprised 4,249 attendees to mammography screening and a comparison group of 943 women. We used the SF-36 Health Survey to assess health-related quality of life. Linear regression was used to study any differences between the groups with adjustment for age, level of education, occupation, having children and smoking status. Other normative data were also used. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. RESULTS Attendees scored statistically significant higher on the SF-36 than the comparison group but were in line with normative data. Attendees had anxiety mean 4·1 and depression mean 2·6. CONCLUSIONS The majority of the attendees have a high health-related quality of life, low anxiety and depression ahead of screening. Anxiety and depression were less than shown in normative data from Norway. Despite a high health-related quality of life, low anxiety and depression among the majority, healthcare workers should pay special attention to the few women who are anxious and depressed, and have a lower health-related quality of life. Omitted from mammography screening may be women who are unemployed, have lower socioeconomic status, are anxious and are depressed. Further research should be performed with non-attendees and subgroups to improve the screening programme. RELEVANCE TO CLINICAL PRACTICE It is important to identify which patients have the greatest need for support and caring in an organised mammography screening and who may be overlooked.
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Affiliation(s)
- Bjorg Hafslund
- Institute of Radiography, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
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Letourneux M, Clin B, Clin-Godard B, Marquignon MF, Gauberti P. [What tools should be used for follow-up post occupational exposure? What should be the frequency?]. Rev Mal Respir 2012; 29:205-12. [PMID: 22405114 DOI: 10.1016/j.rmr.2011.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 07/18/2011] [Indexed: 11/28/2022]
Abstract
As long as the value of screening for cancers related to asbestos is not proven in the population at risk, the medical benefits of follow-up post-professional exposure remain uncertain and the only justification is to answer the questions of anxious retired workers concerning the consequences of their past-exposure and to provide compensation for any abnormalities that are demonstrated. In this country, to answer the questions posed in the title of this contribution in the case of pathologies related to asbestos, it is necessary, after verifying the fact and the level of exposure, to identify the pleural or pulmonary fibrosis and, above all, the pleural plaques, which constitute the essential lesions currently screened for. Thoracic CT scanning without contrast is the examination of choice to achieve this objective. There are, however, two significant problems. On one hand there is a high incidence of pulmonary micronodules, the necessary surveillance of which requires subsequent scans, leading to increased irradiation and anxiety. On the other hand the diagnostic uncertainty concerning discrete lesions is a source of confusion for the persons followed-up. There are, at present, neither scientific criteria to determine the optimum frequency of examination nor any arguments for replacing the pragmatic proposals of the consensus conference of 1999. It is important, therefore, to provide a medical assessment appropriate to the symptoms and anxiety expressed by a person previously exposed to asbestos. Overall it is necessary to question the benefit to the exposed person, in terms of quality of life, of a regular search for lesions that would usually be asymptomatic if not identified. Would it not be more judicious and more equitable to compensate persons whose past-exposure is sufficient to increase significantly their risk of cancer independently of the presence of benign abnormalities.
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Affiliation(s)
- M Letourneux
- ERI3 "cancers et populations", UFR de médecine de Caen, service de santé au travail et pathologie professionnelle, CHU de Caen, avenue de la Côte-de-Nacre, France.
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Wildstein KA, Faustini Y, Yip R, Henschke CI, Ostroff JS. Longitudinal predictors of adherence to annual follow-up in a lung cancer screening programme. J Med Screen 2012; 18:154-9. [PMID: 22045825 DOI: 10.1258/jms.2011.010127] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine rates and factors associated with adherence to annual repeat lung cancer screening in two cohorts. Participants and methods The self-pay cohort (n = 2083) was individuals aged 40 years and older with no prior cancer and a smoking history. Participants had to obtain a prescription from their doctor for the low dose, computerized tomography scan (CT), and were responsible for payment of $300 as these CT scans are not typically covered by insurance. The no-pay cohort (n = 1304) was individuals aged 60 and older with a smoking history, and no prior cancer. The initial and one year repeat CT were provided free of charge. Rates of adherence for each cohort were analyzed by demographic variables, smoking history, family history of lung cancer, smoking status (former/current), perceived risk and worry of getting lung cancer and baseline screening CT. RESULTS Adherence to annual follow-up was lower for the self-pay than for the no-pay cohort (62% vs. 88%). Both the self-pay and no-pay cohorts had higher adherence rates among Caucasians and those who had a college degree. A greater perceived risk of getting lung cancer increased adherence among the self-pay cohort. Non-calcified nodules found on baseline CT increased the adherence for the self-pay cohort, but decreased the adherence for the no-pay cohort. CONCLUSIONS These findings should be used in developing educational materials and targeted retention strategies to increase adherence with repeat lung cancer screening.
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Affiliation(s)
- Kimberly A Wildstein
- Department of Radiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
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Chase DM, Wenzel L. Health-related quality of life in ovarian cancer patients and its impact on clinical management. Expert Rev Pharmacoecon Outcomes Res 2011; 11:421-31. [PMID: 21831023 DOI: 10.1586/erp.11.41] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the incidence of ovarian cancer is less than that of other female cancers, the morbidity and mortality associated with the disease course is high. Because treatment involves radical surgery and intense courses of chemotherapy, health-related quality of life (HRQOL) is often compromised. Most patients recur post-first-line therapy and undergo multiple rounds of chemotherapy. Thus, HRQOL is further disrupted. As the ongoing search for optimal therapies in both the first-line and recurrent setting continues, much attention is paid towards clinical trial design and implementation. Over the last decade, patient-reported outcomes and HRQOL measurement have become an integral part of these trials. HRQOL data are valued in examining the extent of treatment benefit and therefore can aid in decision-making during active treatment and palliative care. HRQOL and patient-reported outcome measurement is also useful in determining symptom prevalence, severity and management. This article highlights the state of the science of HRQOL measurement in clinical trial design and outcomes. In addition, symptom management in ovarian cancer and its ability to modulate quality of life will be explored.
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Affiliation(s)
- Dana M Chase
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Creighton University School of Medicine at St Joseph's Hospital, Catholic Healthcare West, 500 W. Thomas Road, Suite 800, Phoenix, AZ 85013, USA.
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Dalphin JC. Quels sont les objectifs du suivi post-professionnel, les bénéfices attendus et les risques possibles ? Objectifs médicaux en termes de morbidité, mortalité et qualité de vie. Rev Mal Respir 2011; 28:1230-40. [DOI: 10.1016/j.rmr.2011.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/25/2011] [Indexed: 11/25/2022]
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Collins RE, Lopez LM, Marteau TM. Emotional impact of screening: a systematic review and meta-analysis. BMC Public Health 2011; 11:603. [PMID: 21798046 PMCID: PMC3223929 DOI: 10.1186/1471-2458-11-603] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 07/28/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a widely held expectation that screening for disease has adverse emotional impacts. The aim of the current review is to estimate the short (< 4 weeks) and longer term (> 4 weeks) emotional impact of such screening. METHODS Studies selected for inclusion were (a) randomised controlled trials in which (b) participants in one arm underwent screening and received test results, and those in a control arm did not, and (c) emotional outcomes were assessed in both arms. MEDLINE via PubMed (1950 to present), EMBASE (1980 to present), PsycINFO (1985 to present) using OVID SP, and CINAHL (1982 to present) via EBSCO were searched, using strategies developed with keywords and medical subject headings. Data were extracted on emotional outcomes, type of screening test and test results. RESULTS Of the 12 studies that met the inclusion criteria, six involved screening for cancer, two for diabetes, and one each for abdominal aortic aneurysms, peptic ulcer, coronary heart disease and osteoporosis. Five studies reported data on anxiety, five [corrected] on depression, two on general distress and eight on quality of life assessed between one week and 13 years after screening (median = 1.3 years).Meta-analyses revealed no significant impact of screening on longer term anxiety (pooled SMD 0.01, 95% CI -0.10, 0.11), depression (pooled SMD -0.04, 95% CI -.12, 0.20), or quality of life subscales (mental and self-assessed health pooled SMDs, respectively: 0.03; -0.01, (95% CI -.02, 0.04; 0.00, 95% CI -.04, 0.03). CONCLUSION Screening does not appear to have adverse emotional impacts in the longer term (> 4 weeks). Too few studies assessed outcomes before four weeks to comment on the shorter term emotional impact of screening.
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Affiliation(s)
- Ruth E Collins
- Department of Psychology (at Guy's), Kings College London, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
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Pizzo E, Pezzoli A, Stockbrugger R, Bracci E, Vagnoni E, Gullini S. Screenee perception and health-related quality of life in colorectal cancer screening: a review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:152-159. [PMID: 21211497 DOI: 10.1016/j.jval.2010.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Screening for colorectal cancer (CRC) has become established to varying degrees in several Western countries for the past 30 years. Because of its effectiveness, screening has been adopted or is planned in a number of other countries. In most countries, the screening method (e.g., fecal occult blood test [FOBT], sigmoidoscopy) is followed by colonoscopy, for verification. In other countries (e.g., United States, Germany), colonoscopy is the preferred first-line investigation method. However, because colonoscopy is considered to be invasive, might be poorly tolerated, and can be associated with complications, the idea of adopting colonoscopy as the primary screening method suffers. Negative effects of screening methods can reduce participation in programs and thereby negate the desired effect on individual and societal health. At present, there is no generally accepted method either to assess the perception and satisfaction of patients screened or the outcome of the screening procedures in CRC. In this review, we discuss the past development and present availability of instruments to measure health-related quality of life (HRQoL), the scarce studies in which such instruments have been used in screening campaigns, and the findings. We suggest the creation of a specific instrument for the assessment of HRQoL in CRC screening.
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Affiliation(s)
- Elena Pizzo
- Imperial College London, Business School, London, UK.
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Hoff G. Colorectal cancer screening in an expanding panorama of screening programmes. Best Pract Res Clin Gastroenterol 2010; 24:521-7. [PMID: 20833354 DOI: 10.1016/j.bpg.2010.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 04/19/2010] [Indexed: 01/31/2023]
Abstract
Cervical and breast cancer screening programmes have been introduced in times when both the professional requirements for evidence based medicine and public demand for quantification of benefits may have been less explicit. The World Health Organisation has recommended cancer screening only for cervix, breast and colorectal cancer (CRC) - the latter leaving health authorities with a choice between a multitude of screening methods of which the efficacy has been proven only for fecal occult blood testing (FOBT). Although we are far from seeing the perfect screening method and screening programme, cost effectiveness for CRC screening has been estimated at least as cost-effective as established programmes for cervix and breast cancer screening. Established and imminent screening programmes should be considered as natural platforms for randomised trial with commitment and responsibility to continuously improve the quality and effectiveness of the screening service provided.
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Affiliation(s)
- Geir Hoff
- Cancer Registry of Norway, 5313 Majorstuen, 0304 Oslo, Norway.
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