Psychological distress in patients with detected pulmonary nodules from lung cancer screening

Low-dose computed tomography (LDCT) has improved early detection of lung cancer, but the identification of indeterminate pulmonary nodules (PNs) often triggers psychological distress. Evidence remains limited regarding longitudinal psychological changes following different management approaches and the identification of patients at risk for persistent distress. This study aimed to longitudinally evaluate psychological outcomes and identify predictors of symptom change in patients with LDCT-detected PNs managed by surgical resection/biopsy or radiological surveillance.

A prospective observational study with baseline and 1-month follow-up assessments was conducted. A total of 936 patients with newly detected PNs were consecutively enrolled at a thoracic surgery clinic. Anxiety, depression, and insomnia were assessed using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI) scales. Group differences were analyzed using Wilcoxon signed-rank tests, and multivariate logistic regression with inverse probability of treatment weighting (IPTW) was applied to identify predictors of psychological improvement.

At baseline, clinically significant anxiety, depression, and insomnia were reported in 40.2%, 31.7%, and 24.6% of patients, respectively. After 1 month, symptoms significantly improved across the cohort (P<0.05). Surgical resection was associated with psychological improvement compared with surveillance [anxiety: odds ratio (OR) =15.80, 95% confidence interval (CI): 10.18-25.95; depression: OR =7.38, 95% CI: 4.94-11.46; insomnia: OR =8.58, 95% CI: 5.60-13.77]. Female sex, age <60 years, and mixed ground-glass opacity (GGO) nodules were independently associated with improved distress.

Psychological distress is highly prevalent among patients with LDCT-detected PNs. Surgical resection is significantly associated with anxiety, depression, and insomnia, while surveillance alone offers limited psychological benefit. Early identification of vulnerable subgroups is crucial to guide integrated clinical and psychological care and inform patient-centered management strategies.