Article Text

Download PDFPDF

Original article
Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial
  1. Kate Brain1,
  2. Kate J Lifford1,
  3. Ben Carter1,
  4. Olivia Burke1,
  5. Fiona McRonald2,
  6. Anand Devaraj3,
  7. David M Hansell3,
  8. David Baldwin4,
  9. Stephen W Duffy5,
  10. John K Field6
  1. 1Cardiff University School of Medicine, Cardiff, UK
  2. 2Public Health England, Liverpool, UK
  3. 3Royal Brompton and Harefield NHS Foundation Trust, London, UK
  4. 4Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
  5. 5Queen Mary University of London, London, UK
  6. 6University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Kate Brain, Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4YS, UK: brainke{at}cardiff.ac.uk

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.

  • Lung Cancer
  • Imaging/CT MRI etc
  • Psychology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

View Full Text

Statistics from Altmetric.com

Footnotes

  • Work was conducted by FM at the University of Liverpool and Cardiff University.

  • Twitter Follow Kate Brain at @Katebrain

  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles