Pulmonary nodules and the psychological distress they can cause: A scoping review

Abstract

Abstract Background: More than 1.5 million solitary pulmonary nodules are diagnosed in the United States each year. While the majority prove to be benign, there is evidence to suggest that any incidental and lung cancer screening-detected pulmonary nodules cause patients psychological distress/anxiety. Purpose: To identify the nature and extent of the evidence, we conducted a scoping review of the literature related to patient nodule-specific psychological distress/anxiety. Findings: Of the eight studies identified, five assessed nodule-specific anxiety quantitatively and three qualitatively. Quantitative anxiety constructs included nodule-specific distress (n=3; Impact of Events Scale), anxiety alone (n = 1; Generalized Anxiety Disorder-7 measure); and anxiety and depression combined (n = 2; Hospital Anxiety and Depression Scale). Constructs examined qualitatively included emotional distress (n = 2) and anxiety, fear, and worry (n = 1). Most studies evaluated other factors such as lung cancer risk perceptions and quality of patient/provider communication. Pulmonary nodule-specific anxiety was recorded in >50% of the participants (mild 23%-27%; moderate to severe 16%-24%). Anxiety was associated with financial concerns related to a possible cancer diagnosis, fear/worry about cancer, lack of understanding of pulmonary nodules, and pre-existing depression or PTSD. Anxiety was diffused with better patient/provider communication and active coping strategies and tended to decline to the subclinical level over time. Conclusions: Our review suggests that many patients experience nodule-specific anxiety. These findings serve as a call to action forthe development of interventions to mitigate nodule-specific anxiety andto improve the quality of the patient experience when pulmonary nodules are discovered.