The Psychological Impact of a Colorectal Cancer Diagnosis Following a Negative Fecal Occult Blood Test Result.
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.


CONCLUSIONS
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.
Department of Psychological Sciences, Birkbeck, University of London, London, England. ae.miles@bbk.ac.uk.
Anne
A
Miles
Information Services Division, NHS National Services Scotland, Edinburgh, Scotland.
Paula L
PL
McClements
Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, Scotland.
Robert J C
RJ
Steele
Department of Psychological Sciences, Birkbeck, University of London, London, England.
Claudia
C
Redeker
Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, St. Mary's Campus, Norfolk Place, London, England. Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England.
Nick
N
Sevdalis
Health Behaviour Research Centre, Institute of Epidemiology and Public Health, University College London, London, England.
Jane
J
Wardle
D000368:Aged; D001007:Anxiety / Q000209:etiology*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010865:Pilot Projects; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires