Short-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON)

Abstract

Background: In lung cancer CT screening, participants often have an indeterminate screening result at baseline requiring a follow-up CT. In subjects with either an indeterminate or a negative result after screening, we investigated whether health-related quality of life (HRQoL) changed over time and differed between groups in the short term.

Methods: A total of 733 participants in the NELSON trial received four questionnaires: T0, before randomisation; T1, 1 week before the baseline screening; T2, 1 day after the screening; and T3, 2 months after the screening results but before the 3-month follow-up CT. HRQoL was measured as generic HRQoL (the 12-item Short Form, SF-12; the EuroQol questionnaire, EQ-5D), anxiety (the Spielberger State-Trait Anxiety Inventory, STAI-6), and lung-cancer-specific distress (the Impact of Event Scale, IES). For analyses, repeated-measures analysis of variance was used, adjusted for covariates.

Results: Response to each questionnaire was 88% or higher. Scores on SF-12, EQ-5D, and STAI-6 showed no clinically relevant changes over time. At T3, IES scores that were clinically relevant increased after an indeterminate result, whereas these scores showed a significant decrease after a negative result. At T3, differences in IES scores between the two baseline result groups were both significant and clinically relevant (P<0.01).

Conclusion: This longitudinal study among participants of a lung cancer screening programme showed that in the short term recipients of an indeterminate result experienced increased lung-cancer-specific distress, whereas the HRQoL changes after a negative baseline screening result may be interpreted as a relief.

Figure 1

Flow chart of the HRQoL study. 41 subjects out of 733 of the screen group were excluded from the HRQoL study: 30 had no baseline CT scan, and 11 had a positive CT result at baseline. At T1, T2, and T3 a total of 7, 25, and 8 questionnaires, respectively, were not sent due to administrative failures. Responses at T1, T2, and T3 were excluded for 1, 2, and 2 questionnaires, respectively, due to more than 50% missing items. Also excluded were T1 questionnaires (n=10) completed after the baseline CT scan, T2 questionnaires (n=6) completed after the baseline CT scan result, and T3 questionnaires (n=1) completed after the follow-up scan result.

Figure 2

(A–G) Average scale scores and 95% confidence intervals per result group (negative or indeterminate baseline result) adjusted for gender, age, education, smoking status, and smoking pack-years: SF-12 (PCS and MCS) (A and B); EQ-5D VAS (C), STAI-6 (D), and IES (total, intrusive, avoidance) (E–G) T0, before trial randomisation; T1, just before baseline CT scan; T2, 1 day after baseline CT scan; and T3, about 2 months after baseline CT scan. ^aSignificant difference. ^bClinically relevant difference. (A–C) A higher score indicates better HRQoL. (D–G) A lower score indicates better HRQoL.