title: Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study.
abstract: OBJECTIVE
  Timeliness may influence emotional distress during the diagnostic phase of suspected lung cancer patients. We performed a prospective observational study to compare distress and quality of life (QoL) in two medical centres with a Rapid Outpatient Diagnostic Program (RODP) and two using conventional Stepwise Diagnostic Approach (SDA) on the basis of trained nurse-led care.
  
  
  METHODS
  Outpatients with radiological suspicion of lung cancer completed the Hospital Anxiety and Depression Scale (HADS), European Organization for Research and Treatment of Cancer 30-item Quality of Life Questionnaire (QLQ-C30) and its 13-item Lung Cancer specific module (QLQ-LC13) upon first visit, 2 days later, thereafter weekly for 5 weeks and after 3 months.
  
  
  RESULTS
  The 72 SDA patients and 121 RODP patients had a mean pre-diagnostic HADS-total score of 13.5 (SD 7.6); 63.4% had a score ≥10. Baseline QLQ-C30 global QoL was 61.6 (SD 22.7) exceeding reference values for lung cancer patients. Generalized least square models showed a significant centre by time interaction effect: during the first 6 weeks, HADS-total scores decreased in RODP patients (13.8-11.9) but sustained in SDA patients (13.1-13.6), whereas QoL showed no relevant changes. Times to diagnosis and discussion of therapy plan for RODP patients were 7 and 11 days shorter, respectively.
  
  
  CONCLUSIONS
  Suspected lung cancer patients had high baseline distress levels. A decrease over time was found in RODP compared with SDA patients. QoL did not change relevantly. Albeit observational, these data indicate that patients experience less distress in rapid diagnostic programs than in stepwise diagnostic evaluation.
authors.affiliation: Dept. of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Pepijn
authors.initials: P
authors.lastname: Brocken
authors.forename: Erik H F M
authors.initials: EH
authors.lastname: van der Heijden
authors.forename: Karen T M
authors.initials: KT
authors.lastname: Oud
authors.forename: Gerben
authors.initials: G
authors.lastname: Bootsma
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
authors.forename: A Rogier T
authors.initials: AR
authors.lastname: Donders
authors.forename: P N Richard
authors.initials: PN
authors.lastname: Dekhuijzen
authors.forename: Judith B
authors.initials: JB
authors.lastname: Prins
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D016022:Case-Control Studies; D003863:Depression / Q000523:psychology*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: cancer; distress; lung cancer; oncology; quality of life; rapid diagnosis