Chest. 2023 Jun 23:S0012-3692(23)00924-8. doi: 10.1016/j.chest.2023.06.022. Online ahead of print.

ABSTRACT

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?

METHODS: We surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more versus 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 [IES-R]) and anxiety (State-Trait Anxiety Inventory-6 item [STAI-6]) 6-8 weeks after nodule identification. We used mixed-effects models to compare outcomes between study arms after adjusting for potential confounders and clustering within enrollment site, while also examining a limited number of pre-specified 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 34,701 patients; 2,049 individuals completed the baseline survey (5.9%). Respondents and non-respondents had similar demographic and nodule characteristics, although more respondents were non-Hispanic and White. IES-R 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. After 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 gender, ever smoking, African American race and Hispanic ethnicity. Anxiety was associated with lack of timely notification, ever smoking and female gender.

INTERPRETATION: Almost half of respondents experienced emotional distress 6-8 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 TRIALS REGISTRATION: NCT02623712.

PMID:37356710 | DOI:10.1016/j.chest.2023.06.022