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Short-Term Impact of Cancer Prevention and Screening Activities on Quality of Life

From the Cancer Control Program and Cancer Clinical and Economic Outcomes Core, Lombardi Cancer Center, and Departments of Oncology and Medicine, Georgetown University, Washington, DC; Division of Research, Kaiser-Permanente Medical Care Program, Oakland, CA

Address reprint requests to Jennifer Cullen, MPH, PhD, Department of Oncology, Georgetown University, 2233 Wisconsin Ave NW, Suite 440, Washington, DC; e-mail: jc49{at}georgetown.edu

PURPOSE: There are few data on the short-term effects of participating in cancer prevention activities, undergoing genetic risk assessment, or having routine screening. The objective of this article is to systematically review existing research on short-term effects of prevention, genetic counseling and testing, and screening activities on quality of life.

METHODS: We conducted a MEDLINE search for original research studies that were published between January 1, 1985, and December 31, 2002, and conducted in North America or Western Europe. Data were abstracted and summarized using a standardized format.

RESULTS: We reviewed 210 publications. Most studies focused on psychological states (anxiety, depression), symptoms, or general health status. One hundred thirty-one studies used 51 previously validated noncancer instruments. Many researchers (12.6%) also added cancer-specific measures, such as perceived cancer risk or symptom indices. Only one study measured satisfaction or quality of provider-client communication. While one report examined lost workdays, no other economic consequences of short-term outcomes were evaluated. Among seven studies that assessed short-term outcomes preferences, only four specifically used time trade-off or linear rating scale methods. No study used standard gamble or willingness-to-pay methods. The overwhelming majority of research indicated that short-term effects were transient. Only two studies linked short-term effects to long-term cancer-related health behaviors such as repeat screening.

CONCLUSION: There is considerable heterogeneity in short-term outcome measurement. Clinicians need to be aware of potential for short-term, transient adverse effects. The impact of short-term experiences should to be linked to long-term health status and use of services.

Supported, in part, by the National Cancer Institute cooperative agreement No. U01-CA88293A (J.M. and J.C.), and National Cancer Institute Grant No. RO1-CA/HG74861 (M.S.).

Prepared under contract for the National Cancer Institute and the Cancer Outcomes Measurement Working Group. The views in this report represent those of the authors, and not the National Cancer Institute.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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