Long-term effects of lung cancer computed
tomography screening on health-related
quality of life: the NELSON trial
K.A.M. van den Bergh*, M.L. Essink-Bot*,#, G.J.J.M. Borsboom*, E.T. Scholten",
R.J. van Klaveren+and H.J. de Koning*
health-related quality of life (HRQoL) have not yet been investigated.
In the Dutch–Belgian Randomised Lung Cancer Screening Trial (NELSON trial), 1,466 participants
received questionnaires before randomisation (T0), 2 months after baseline screening (screen
group only; T1) and at 2-yr follow-up (T2). HRQoL was measured as generic HRQoL (12-item short-
form questionnaire and EuroQoL questionnaire), anxiety (Spielberger State-Trait Anxiety Inventory)
and lung cancer-specific distress (impact of event scale (IES)). Repeated measures of ANOVA were
used to analyse differences between the screen and control groups, and between indeterminate
(requiring a follow-up CT) and negative screening result groups.
At T0 and T2 there were no significant differences in HRQoL scores over time between the
screen and control groups, or between the indeterminate or negative second-round screening
result group. There was a temporary increase in IES scores after an indeterminate baseline result
(T0: mean 4.0 (95% CI 2.8–5.3); T1: mean 7.8 (95% CI 6.5–9.0); T2: mean 4.5 (95% CI 3.3–5.8)).
At 2-yr follow-up, the HRQoL of screened subjects was similar to that of control subjects, the
unfavourable short-term effects of an indeterminate baseline screening result had resolved and
an indeterminate result at the second screening round had no impact on HRQoL.
The long-term effects of lung cancer computed tomography (CT) screening on
KEYWORDS: Computed tomography, lung neoplasms, mass screening, quality of life
related quality of life (HRQoL) and their cost-
effectiveness . Few studies have examined the
HRQoL effects of lung cancer screening with
computed tomography (CT) [2–5]. Subjects receiv-
ing an indeterminate or positive result for a
baseline CT screening have reported increased
anxiety or fear of cancer  and more lung cancer-
specific distress than subjects with a negative
result . At short-term follow-up, when all
subjects had negative CT results, these unfavour-
able effects on HRQoL were shown to have
decreased and the differences between subjects
with initially negative or positive/indeterminate
results were no longer observed [2, 4, 5]. CT
scanning caused only a little discomfort and had
no major impact on HRQoL .
ffective policy decisions regarding cancer
screening programmes require data on the
effects of screening on mortality, health-
However,within a screenedcohort,comparisonsof
HRQoL are of limited value due to the possible
effects of reassurance and selection. The best me-
thod to evaluate the long-term impact of screening
is to compare a group of screened participants with
a control group in a randomised controlled trial
(RCT) . The rationale for this is, first, because a
study population is often a selective group that is
healthier than the general population [6, 7] and,
secondly, because subjects invited for lung cancer
screening differ from the general population in that
they are usually heavy current or former smokers.
The Dutch–Belgian Randomised Controlled Lung
Cancer Screening Trial (NELSON trial) evaluates
the long-term impact of screening on HRQoL .
An indeterminate result at baseline (i.e. first or
prevalence screening) has an unfavourable effect
on HRQoL, but it is unknown whether subjects
experience a similar decrease in HRQoL after
second-round screening (i.e. incidence screening).
The aims of the present study were to: 1) compare
HRQoL in a screen and control group over 2 yrs;
*Depts of Public Health,
+Pulmonology, Erasmus MC,
University Medical Centre,
#Dept of Social Medicine, Academic
Medical Centre, University of
Amsterdam, Amsterdam, and
"Dept of Radiology, Kennemer
Gasthuis Haarlem, Haarlem, The
K.A.M. van den Bergh
Dept of Public Health, Erasmus MC
University Medical Centre Rotterdam
P.O. Box 2040
3000 CA Rotterdam
Aug 03 2010
Accepted after revision:
Oct 30 2010
First published online:
Dec 09 2010
European Respiratory Journal
Print ISSN 0903-1936
Online ISSN 1399-3003
This article has supplementary material available from www.erj.ersjournals.com
VOLUME 38 NUMBER 1
EUROPEAN RESPIRATORY JOURNAL
Eur Respir J 2011; 38: 154–161
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EUROPEAN RESPIRATORY JOURNAL
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