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.
- Lung Cancer
- Imaging/CT MRI etc
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Work was conducted by FM at the University of Liverpool and Cardiff University.
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Contributors KB: Trial conception and design, data analysis, data interpretation and manuscript preparation. KJL: Data collection, data analysis, data interpretation and manuscript review. BC: Trial statistician and manuscript review. OB: Data analysis and interpretation and manuscript review. FM: Data collection and manuscript review. AD: Radiological review, data interpretation and manuscript review. DMH: Trial design, radiological review, data interpretation and manuscript review. DB: Trial design, UK Lung Cancer Screening (UKLS) care pathway, data interpretation and manuscript review. SWD: Trial design, statistical analysis, data interpretation and manuscript review. JKF: Trial conception and design, data interpretation and manuscript review.
Funding National Institute for Health Research Health Technology Assessment programme, grant reference no. HTA 09/61/01.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethical approval for the study was given by Liverpool Central Research Ethics Committee in December 2010 (reference number 10/H1005/74). All UKLS participants provided informed consent before taking part. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN) under the reference 78513845.
Provenance and peer review Not commissioned; externally peer reviewed.