Multicancer early detection test users report high satisfaction, just a ‘blip’ of anxiety
Key takeaways:
- Most people who used multicancer early detection tests reported high levels of satisfaction.
- Increases in anxiety after receipt of test results returned toward baseline at 12 months.
The vast majority of individuals who used multicancer early detection tests reported being satisfied with the test, according to data from a prospective, multicenter cohort study.
Individuals for whom tests indicated a cancer signal experienced small but temporary increases in anxiety, findings from the PATHFINDER study showed.
“This study happened to be conducted during [the COVID-19 pandemic], and some of the same instruments were used in large studies about COVID in the general population,” lead author Donald L. Patrick, PhD, professor emeritus of health systems and population health at University of Washington School of Public Health, told Healio. “The anxiety level in this study was not higher than the general population anxiety level over COVID. Most participants said they were relieved about their test results.”
Anxiety assessment
The PATHFINDER study included healthy ambulatory outpatients treated at seven health networks across the United States between Dec. 12, 2019, and Dec. 4, 2020.
All individuals had been aged 50 years or older at the time of enrollment, with no clinical suspicion of cancer. Those with additional risk factors — such as genetic predisposition, smoking history or prior cancer — could enroll.
The analysis included 6,621 adults (63.5% women; 91.7% white) with analyzable multicancer early detection (MECD) tests.
Time to diagnostic resolution after an MCED result showing a cancer signal, as well as extent of testing pursued, served as the primary outcomes of PATHFINDER.
Objectives of this analysis included patient-reported outcomes and perceptions of MCED testing. Measures related to the impact of MCED test result disclosure, general anxiety symptoms, health-related quality of life and satisfaction with the test.
Researchers used several patient-reported outcomes instruments to assess these outcomes. These included an adapted Multidimensional Impact of Cancer Risk Assessment (MICRA) for distress, uncertainty and positive experience at the disclosure of test results; the PROMIS Anxiety short form for anxiety symptoms; and the Short-Form 12 Health Survey to measure health-related quality of life.
Participants’ intentions to adhere to guideline-recommended screening served as an exploratory objective.
Prior studies that evaluated the impact of results disclosure from individual cancer screenings have showed temporary spikes in anxiety after screening, Patrick said.
“This is particularly true in the case of a positive result,” he said. “So, this was a study to evaluate the effects on patients of a cancer signal or no cancer signal after an MCED test over a 12-month period.”
‘We saw a blip’
Among trial participants who responded to MICRA upon disclosure of their results, the mean total MICRA score was 28.4 (standard deviation ± 14.9) for the 50 patients with a “cancer signal detected” result and 8.8 (standard deviation ± 7.2) for those with no cancer signal detected.
Researchers observed increases in general anxiety scores among those with true-positive and false-positive results at the time of disclosure.
In the true-positive group, PROMIS anxiety scores increased from 46.2 (standard deviation ± 6.5) at baseline to 48.4 (standard deviation ± 7.3) after disclosure of results.
Among those who received a false-positive result, PROMIS anxiety scores increase from 47.3 (standard deviation ± 7.3) at baseline to 49.7 (standard deviation ± 7.7) after disclosure of results.
In both groups, the increases in anxiety had returned toward baseline by the end of the study period (true positive, 46.8 [standard deviation ± 8]; false positive, 46.9 [standard deviation ± 8.1].
“Our key findings were similar to those seen with individual cancers,” Patrick said. “If a signal was detected, anxiety went up. The negative impacts were small, though, and they returned to baseline 12 months later. Basically, we saw a blip.”
Nearly all (97.1%) of participants reported being satisfied, very satisfied or extremely satisfied with the MCED test. Most (95.6%) stated they were likely or very likely to adhere to recommendations their health care providers gave them regarding cancer screening.
“There’s a worry that tests like these could cause patients to change their screening behaviors — that it might cause them to stop their colonoscopies or other screenings,” Patrick said. “We asked them their behavioral intentions, and they said they were very likely to continue to follow screening recommendations.”
Patrick, who spent 10 years working with the FDA on its 2019 guidance on the use of patient-reported outcomes in the evaluation of medical treatments, said much of the skepticism around patient-reported outcomes is not warranted.
“Many have rejected the idea [of PROs] for decades, but we have to have some faith in believing what people say,” he said. “We have a lot of evidence that patient reports have a lot to do with patient attitudes and behaviors.”
For more information:
Donald L. Patrick, PhD, can be reached at donald@uw.edu.
Collapse