The psychological impact of a colorectal cancer diagnosis following a negative fecal occult blood test result
Menée au Royaume-Uni par questionnaire auprès de 311 participants atteints d'un cancer colorectal, cette étude analyse leur santé psychique suite à un diagnostic de cancer après le résultat négatif d'un test de recherche de sang occulte dans les selles, ainsi que leur qualité de vie et leur confiance dans le dépistage
Background: Screening using fecal occult blood testing (FOBt) reduces colorectal cancer (CRC) mortality, but the test has low sensitivity. A 'missed' cancer may cause psychological harms in the screened population that partially counteract the benefits of early detection. Methods: 311 people diagnosed with CRC: 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. 15 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 FOB testing. Conclusions: An interval cancer has adverse effects on trust in FOBt but does not result in worse psychological outcomes compared with people diagnosed in areas with no screening programme. 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.