Nearly half of adults with new small lung nodules feel distressed, anxious

Key takeaways:

• A survey revealed some adults feel distressed or anxious after hearing about a small lung nodule.
• Compared with their counterparts, female, Black, Hispanic and younger patients may have higher distress scores.

Among adults with newly identified small pulmonary nodules, 48.8% reported emotional distress and 42.3% reported general anxiety, according to results published in CHEST.

“Prior studies of patients with incidentally detected nodules have suggested that nodule-related emotional distress occurs in a substantial number of patients; although this distress is usually mild and transient, it can occasionally be more severe and protracted,” Michael K. Gould, MD, MS, professor and faculty director of research at Kaiser Permanente Bernard J. Tyson School of Medicine, and colleagues wrote.

Using survey responses, Gould and colleagues evaluated 2,049 adults (mean age, 65 years; 52.4% women; 86.1% white) with small pulmonary nodules (≤ 15 mm) from the Watch the Spot Trial to determine the prevalence of anxiety and distress in this population 6 to 8 weeks after knowledge of the nodule.

Researchers collected information on general anxiety using the Six-Item State Anxiety Inventory (score range, 6-24 points), whereas the Impact of Event Scale-Revised questionnaire was used to obtain information on nodule-related emotional distress (score range, 0-88 points). On both scales, a higher score signaled a worse outcome.

The most frequent nodule size within the limits was 4 mm or less (39.6%), followed by greater than 4 mm to 6 mm (31.7%), greater than 6 mm to 8 mm (15.5%) and greater than 8 mm to 15 mm (13.2%).

Further, over half of individuals (60.4%) learned about their nodule through incidental detection.

When assessing scores from the Impact of Event Scale-Revised questionnaire, researchers found that 48.8% of adults experienced nodule-related distress, including 32.2% with mild distress (8-23 points). Moderate distress (24-36 points) and severe distress (> 36 points) occurred less frequently (9.4%; 7.2%).

Results from the Six-Item State Anxiety Inventory part of the survey showed that 27.4% of adults had more severe anxiety (> 13 points) and 14.9% of adults had moderate anxiety (> 11-13 points).

In terms of general health, a response of poor or fair was given by 26.4% of the study population.

Researchers also asked individuals about cancer and found that one-third (33.2%) worried “a lot” about this possibility.

To determine factors linked to higher nodule-related emotional distress and anxiety scores, researchers used a model adjusted for age, sex, race, ethnicity, smoking history and nodule attenuation as fixed-effects.

Lack of timely notification about the nodule from a clinician raised both emotional distress scores (absolute difference, 2 points) and anxiety scores (absolute difference, 0.9 points). Additionally, having a nodule with a diameter larger than 8 mm vs. 4 mm or less increased the emotional distress score by 3.3 points, according to researchers.

This adjusted model also revealed a higher likelihood for good, very good or excellent general health status among those who had nodules detected by screening vs. incidentally and those with a primary care provider vs. a specialist as the ordering clinician.

In terms of demographics, several raised nodule-related emotional distress scores: younger age (absolute difference per 10-year increase, –1.8 points), female sex (vs. male sex; absolute difference, 3.5 points), Black race (vs. white race; 4.7 points) and Hispanic ethnicity (vs. non-Hispanic ethnicity: 4.4 points).

Researchers also found that former smokers and never smokers had reduced emotional distress scores vs. current smokers.

Similar to the above characteristics, higher anxiety scores were found in women vs. men (absolute difference, 1.2 points) and younger vs. older individuals (absolute difference per 10-year increase, –0.7 points). Never smokers had lower anxiety scores than current smokers, according to researchers.

“Strategies are needed to mitigate the burden of distress, especially in younger, female, ever smoking and minoritized patients, and in those with larger nodules,” Gould and colleagues wrote.