The Psychological Impact of a Colorectal Cancer Diagnosis Following a Negative Fecal Occult Blood Test Result
The Psychological Impact of a Colorectal Cancer Diagnosis Following a Negative Fecal Occult Blood Test Result
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DOI：
10.1158/1055-9965.epi-15-0004
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发表时间：
2015-07-01
影响因子：
3.8
通讯作者：
Wardle, Jane
中科院分区：
文献类型：
--
作者：
Miles, Anne;McClements, Paula L.;Wardle, Jane
背景：使用粪便潜血试验（FOBt）筛查可降低结直肠癌死亡率，但该试验的敏感性较低。“漏诊”的癌症可能会对筛查人群造成心理伤害，部分抵消早期发现的好处。方法：311人在阴性FOBt结果后被诊断为结直肠癌（i）（ii）阳性结果（筛查发现的癌症），或（iii）在未提供筛查的地区，完成生活质量（FACT-C）、抑郁症（CES-D）、感知诊断延迟，以及对FOBt筛查结果的信任。结果：在控制人口统计学和临床变量后，与筛查发现的疾病相比，间隔期癌症患者的生活质量较差（平均差异= 6.16，P = 0.03），诊断延迟（OR = 0.37，P = 0.02），抑郁无差异。间隔癌症组和未提供筛查的组在这些指标上没有观察到差异。与间隔癌症患者报告的最低水平的信任FOBt.Conclusions：间隔癌症有不利影响的信任FOBt，但不会导致更糟糕的心理结果相比，在没有筛查计划的地区诊断的人。间隔期癌症患者报告的生活质量比筛查发现的疾病患者差。影响：测试灵敏度的提高可以提高完成FOB测试的人的生活质量，超过早期检测所带来的任何好处。(C)2015年AACR。
Background: Screening using fecal occult blood testing (FOBt) reduces colorectal cancer mortality, but the test has low sensitivity. A "missed" cancer may cause psychologic harms in the screened population that partially counteract the benefits of early detection.Methods: Three hundred and eleven people diagnosed with colorectal cancer (i) after a negative FOBt result (interval cancer), (ii) a positive result (screen-detected cancer), or (iii) in regions where screening was not offered, completed questions on quality of life (FACT-C), depression (CES-D), perceived diagnostic delay, and trust in the results of FOBt screening. Fifteen withheld consent to data matching with medical records, leaving a sample size of 296.Results: Controlling for demographic and clinical variables, patients with an interval cancer reported poorer quality of life (difference in means = 6.16, P = 0.03) and more diagnostic delay (OR, 0.37; P = 0.02) than patients with screen-detected disease, with no differences in depression. No differences were observed between the interval cancer group and the group not offered screening on these measures. Patients with an interval cancer reported the lowest levels of trust in FOBt.Conclusions: An interval cancer has adverse effects on trust in FOBt, but does not result in worse psychologic outcomes compared with people diagnosed in areas with no screening program. People with an interval cancer report poorer quality of life than people with screen-detected disease.Impact: Improvements in test sensitivity could improve quality of life among people who complete an FOB test over and above any benefits already conferred by earlier detection. (C) 2015 AACR.