Psychosocial outcomes of low-dose computed tomography screening for lung cancer in high-risk populations: A systematic review update

Low dose computed tomography (LDCT) screening programmes for lung cancer are being implemented worldwide, and the psychological impacts of LDCT screening need to be understood. We have updated, and expanded, a systematic review of the health-related quality of life (HRQoL) outcomes associated with LDCT for lung cancer in high-risk individuals which was published in 2018. The original systematic review sought HRQoL from randomised controlled trials (RCTs) only. In this update review, we have expanded the inclusion criteria so that HRQoL data from any study design are relevant. We searched electronic databases from January 2017. Titles and abstracts, and subsequent full-texts, were screened by one person against pre-defined criteria. Data extraction was conducted by one person and checked by a second. After screening 29,097 articles, we did not identify any new HRQoL evidence from RCTs. Thirteen non-RCTs met our inclusion criteria. No statistically significant impacts of LDCT screening were observed in the nine studies measuring general QoL; two out of nine studies reported increases in measures of anxiety (and depression in one study); two out of eleven studies observed short-term negative impacts on psychological cancer-specific outcomes; a further two studies reported statistically significant negative impacts for sub-groups of participants. Our findings suggests that LDCT screening does not markedly impact the psychosocial outcomes of individuals being screened. However, the included studies measured the outcomes at different timepoints and had diverging participant inclusion criteria. Large differences in sample size and loss to follow-up may also affect the validity of the results from the included studies. Although there is limited evidence to indicate that LDCT screening impacts significantly on psychosocial outcomes, it is necessary to ensure that all stages of screening delivery and communication promote wellbeing, motivate positive behaviour change and maximise patient benefit.