Psychosocial consequences of receiving a lung cancer diagnosis by telephone versus in an outpatient clinic. A pragmatic randomized trial

Abstract

Background: Workup of suspected lung cancer is associated with severe psychosocial distress, and breaking bad news is challenging. Providing the result of cancer workup by telephone is generally not recommended, yet several studies support the use of telephone in cancer follow-up, palliation and counselling. We wanted to investigate whether psychosocial consequences of receiving a final result of diagnostic lung cancer workup were affected by type of disclosure, ie. telephone versus in-person. Material and methods: A single-center, randomized, controlled trial: 1:1 allocation to receiving the result of diagnostic workup by Telephone vs. in an Outpatient clinic. Patients were enrolled prior to invasive workup (baseline). Patient-centered information flow from first cancer suspicion to final visit was used. Primary outcome: change in psychosocial consequences from baseline to 4 weeks after receiving the result, using a validated, sensitive questionnaire (ΔCOS-LC, Consequences of Screening in Lung Cancer). Results: Totally 260 patient were eligible, 255 randomized (Telephone group: n=129), and 89 (71%) patients in the outpatient group (Telephone: 85; 66%) completed the study. Malignancy was found in 68%. Groups were comparable, and we found no statistically significant between-groups differences in mean ΔCOS-LC scores neither in the total cohort nor in the subgroup with cancer. One patient (Telephone) requested an in-person meeting. Conclusion: Disclosing a diagnosis of malignancy (or benign result) by telephone is not psychosocially harmful when using a patient-centered information flow ensuring the patient understands aim and consequence of workup.