TY - JOUR
T1 - Emotional Distress, Anxiety, and General Health Status in Patients With Newly Identified Small Pulmonary Nodules
T2 - Results From the Watch the Spot Trial
AU - Gould, Michael K.
AU - Creekmur, Beth
AU - Qi, Lihong
AU - Golden, Sara E.
AU - Kaplan, Celia P.
AU - Walter, Eric
AU - Mularski, Richard A.
AU - Vaszar, Laszlo T.
AU - Fennig, Kathleen
AU - Steiner, Julie
AU - de Bie, Evan
AU - Musigdilok, Visanee V.
AU - Altman, Danielle A.
AU - Dyer, Debra S.
AU - Kelly, Karen
AU - Miglioretti, Diana L.
AU - Wiener, Renda Soylemez
AU - Slatore, Christopher G.
AU - Smith-Bindman, Rebecca
N1 - Publisher Copyright:
© 2023 American College of Chest Physicians
PY - 2023/12
Y1 - 2023/12
N2 - Background: Anxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules. Research Question: How common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes? Study Design and Methods: This study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vs less intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8 weeks following nodule identification. Mixed-effects models were used to compare outcomes between study arms following adjustment for potential confounders and clustering within enrollment site, while also examining a limited number of prespecified explanatory factors, including nodule size, mode of detection, type of ordering clinician, and lack of timely notification prior to contact by the study team. Results: The trial enrolled 34,699 patients; 2,049 individuals completed the baseline survey (5.9%). Respondents and nonrespondents had similar demographic and nodule characteristics, although more respondents were non-Hispanic and White. Impact of Event Scale-Revised scores indicated mild, moderate, or severe distress in 32.2%, 9.4%, and 7.2% of respondents, respectively, with no difference in scores between study arms. Following adjustment, greater emotional distress was associated with larger nodule size and lack of timely notification by a clinician; distress was also associated with younger age, female sex, ever smoking, Black race, and Hispanic ethnicity. Anxiety was associated with lack of timely notification, ever smoking, and female sex. Interpretation: Almost one-half of respondents experienced emotional distress 6 to 8 weeks following pulmonary nodule identification. Strategies are needed to mitigate the burden of distress, especially in younger, female, ever smoking, and minoritized patients, and those with larger nodules. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02623712; URL: www.clinicaltrials.gov
AB - Background: Anxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules. Research Question: How common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes? Study Design and Methods: This study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vs less intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8 weeks following nodule identification. Mixed-effects models were used to compare outcomes between study arms following adjustment for potential confounders and clustering within enrollment site, while also examining a limited number of prespecified explanatory factors, including nodule size, mode of detection, type of ordering clinician, and lack of timely notification prior to contact by the study team. Results: The trial enrolled 34,699 patients; 2,049 individuals completed the baseline survey (5.9%). Respondents and nonrespondents had similar demographic and nodule characteristics, although more respondents were non-Hispanic and White. Impact of Event Scale-Revised scores indicated mild, moderate, or severe distress in 32.2%, 9.4%, and 7.2% of respondents, respectively, with no difference in scores between study arms. Following adjustment, greater emotional distress was associated with larger nodule size and lack of timely notification by a clinician; distress was also associated with younger age, female sex, ever smoking, Black race, and Hispanic ethnicity. Anxiety was associated with lack of timely notification, ever smoking, and female sex. Interpretation: Almost one-half of respondents experienced emotional distress 6 to 8 weeks following pulmonary nodule identification. Strategies are needed to mitigate the burden of distress, especially in younger, female, ever smoking, and minoritized patients, and those with larger nodules. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02623712; URL: www.clinicaltrials.gov
KW - anxiety
KW - emotional distress
KW - lung cancer
KW - patient-centered outcomes
KW - pulmonary nodule
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U2 - 10.1016/j.chest.2023.06.022
DO - 10.1016/j.chest.2023.06.022
M3 - Article
C2 - 37356710
AN - SCOPUS:85172798260
SN - 0012-3692
VL - 164
SP - 1560
EP - 1571
JO - CHEST
JF - CHEST
IS - 6
ER -