Cancer Screenings Associated With Psychosocial Outcomes Regardless of Findings

Laura Joszt, MA
Laura Joszt, MA

Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

Patients who undergo cancer screenings, even when asymptomatic, experience short-lived psychosocial outcomes, such as anxious symptoms, distress, and worry.

Cancer screening is associated with psychosocial outcomes, such as anxious symptoms, distress, and worry, but these are short lived, according to a poster presented at Virtual ISPOR 2021.

The researchers evaluated the psychological impact of screenings because they are “often offered to individuals who are asymptomatic and ‘healthy.’” They conducted a systematic literature review using MEDLINE and EMBASE between January 2000 and August 2020. A total of 31 studies (12 randomized controlled trials and 19 observation studies) were included.

In the studies, a total of 7 constructs were used to assess the psychosocial impact of cancer screenings:

  1. State-Trait Anxiety Inventory to assess anxious symptoms
  2. Hospital Anxiety and Depression Scale to assess depressive symptoms
  3. Impact of Events Scale to assess distress
  4. Cancer Worry Scale to assess worry
  5. 12-Item Short Form Survey to assess functional status and well-being
  6. EQ-5D to assess preference-weighted health status
  7. Other

They found that within 2 months of screening following positive or false positive results, there was a temporary increase in anxious symptoms, which decreased after 3 months. “More anxious symptoms were reported while waiting for screening results or immediately after screening,” the researchers noted.

While there were minimal changes in levels of depressive symptoms or mood, there was an increase in depressive symptoms directly after positive or false positive results.

Among the indeterminate group, there was an increase in distress even at 2 months from baseline, and at 2 months the higher levels of distress were clinically significant compared with patients who received negative results.

Among patients who received abnormal results, fear of cancer increased shortly after screening, but this returned to baseline levels after 3 months.

They also looked at patients in populations considered at higher risk of cancer:

  • People with a family history of cancer
  • Females
  • People 50 years and older
  • Current smokers
  • Individuals with HIV
  • Certain ethnic groups (eg, Maori and Pacific Island women)

Among these groups, there were more reported anxious symptoms, distress, and worry during the screening process.

Overall, there were minimal changes in functional status and well-being and preference-weighted health status. Patients reported high satisfaction levels and minimal discomfort while waiting for test results.

“As more novel screening tests, including multi-cancer early detection tests, are developed, further research is warranted to assess multiple psychosocial outcomes with validated measures in cancer screening trials, and improve the interpretability of clinical trial results by dichotomizing [patient-reported outcome measure] scores or reporting the minimal important differences,” the authors concluded.

Reference

Kim A, Chung KC, Keir C, Patrick D. Patient-reported outcomes associated with cancer screening: a systematic review. Presented at: Virtual ISPOR 2021; May 17-20, 2021.