title: Quality of life and trial adherence among participants in the prostate, lung, colorectal, and ovarian cancer screening trial.
abstract: BACKGROUND
  The National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was designed to examine whether annual screening tests for these four tumor sites result in reduced disease-related mortality. We assessed the impact of trial participation on both health-related quality of life (HRQL) and trial adherence.
  
  
  METHODS
  Participants (N = 432; 217 in the control arm and 215 in screening arm) were accrued from the Georgetown University PLCO site from May through December 1998. Screening-arm participants were interviewed by telephone at baseline (prescreening), shortly after notification of screening results (short-term follow-up), and 9 months after notification of screening results (intermediate-term follow up). Control-arm participants completed a baseline and 1-year follow-up assessment. Logistic regression analyses were conducted.
  
  
  RESULTS
  Participants reported high levels of HRQL and satisfaction with their decision to participate. Screening-arm participants with abnormal screening results had a higher level of intrusive thoughts about cancer than those with all normal results (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.3 to 6.3) at the short-term follow-up but not at the intermediate-term follow-up (when abnormal test results were known to be false positive; OR = 1.9, 95% CI = 0.89 to 4.2). Trial adherence was statistically significantly better among participants who had received all normal results in the previous year's screening tests (93.7% versus 78.7%; OR = 3.7, CI = 1.1 to 12.0) than in those who received at least one abnormal result. In the control arm, adherence (defined as returning annual questionnaires) was positively associated with education (OR = 3.4, 95% CI = 1.4 to 8.4) and sex, with women being more likely to return questionnaires than men (OR = 2.1, 95% CI = 1.05 to 4.4).
  
  
  CONCLUSIONS
  It is feasible to collect HRQL measures as part of a large cancer screening trial. Prior abnormal screening results were related to short-term HRQL but not to intermediate-term HRQL. Trial adherence was poorer among those who had received previous false-positive results. These results suggest several methods for improving adherence in this and other subgroups.
authors.affiliation: Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, 2233 Wisconsin Ave., NW, Ste. 317, Washington, DC 20007, USA. taylorkl@georgetown.edu
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Taylor
authors.forename: Rebecca
authors.initials: R
authors.lastname: Shelby
authors.forename: Edward
authors.initials: E
authors.lastname: Gelmann
authors.forename: Colleen
authors.initials: C
authors.lastname: McGuire
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control* / Q000523:psychology; D005189:False Positive Reactions; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000517:prevention & control* / Q000523:psychology; D010349:Patient Compliance; D011471:Prostatic Neoplasms / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D013850:Thinking