Factors associated with cancer distress in the Asbestos Post-Exposure Survey (APEXS)

Our plain-English summary of Factors associated with cancer distress in the Asbestos Post-Exposure Survey (APEXS), by M. Maurel, A. Stoufflet, L. Thorel, et al (American Journal of Industrial Medicine, 2009).

The study

• Authors: M. Maurel, A. Stoufflet, L. Thorel, V. Berna, A. Gislard, M. Letourneux, J.C. Pairon, National Network of Asbestos Post-Exposure Survey, C. Paris
• Journal: American Journal of Industrial Medicine
• Published: 2009;52(4):288-96
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: CT-scan screening programs for lung cancer detection have been proposed in high-risk subjects, and more recently in former asbestos-exposed subjects. However, to date no data are available on psychological impact of such programs. The aim of this study is to examine the risk factors of psychological distress at baseline of a CT-scan screening program among asbestos-exposed subjects.

Methods: The Asbestos Post-Exposure Survey (APEXS) was carried out in France between October 2003 and December 2005 in order to screen asbestos-related diseases by CT-scan. Volunteers underwent self-administered questionnaires including an asbestos exposure assessment and, for a large sub-sample, a validated psychological distress scale. Non-exposed subjects were used as reference group.

Results: At baseline, a significant higher level of distress was observed in exposed subjects (n = 3,122) relative to the reference group (n = 486) after adjustment on age, sex, and tobacco status. This distress is associated independently with the self-perception of (i) intensity of asbestos exposure and (ii) the risk of current or future disease related to the asbestos exposure. The perception of the cancer risk related to asbestos seems to play a fundamental role in this psychological distress.

Conclusion: In this study, asbestos-exposed subjects experienced a higher significant cancer distress than previously described in literature. These findings may be of potential public health importance. First, the impact of such occupational exposures on quality of life of patients who suffer from cancer related to these exposures has to be appraised. Secondly, the assessment of psychological impact of CT-scan screening programs among asbestos-exposed subjects is also required.

In plain English

This French study examined psychological distress among volunteers in a free CT-scan screening program for asbestos-related diseases (APEXS), run from October 2003 to December 2005. Only people judged occupationally exposed to asbestos were invited for screening; unexposed volunteers served as a comparison group. In two of four regions, volunteers completed a distress questionnaire originally developed for breast cancer screening. Of 3,558 people analysed, 3,122 were judged moderately or highly exposed and 436 non-exposed (no or passive exposure). An abnormal distress score was found in 21.1% of exposed people and 9.2% of non-exposed people. After adjustment for age, gender and smoking, distress was associated with how heavily people believed they had been exposed. It was most strongly associated with believing they already had an asbestos-related disease (final-model odds ratio 14.1, 95% confidence interval 9.5 to 21.0, versus those answering no). Believing that everyone exposed to asbestos will develop a disease was also associated with distress. The authors concluded that exposed subjects showed more distress than earlier studies had described. They noted their volunteer comparison group may not represent the general population.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of questionnaires completed at the start (baseline) of a CT-scan screening program; an ancillary study within the national APEXS screening program, comparing asbestos-exposed and non-exposed volunteers
• Who was studied: 3,558 volunteers with complete questionnaires (3,096 male), living in two of the four APEXS regions of France, recruited between October 2003 and December 2005. By expert assessment, 3,122 had moderate or high exposure and 436 were non-exposed, meaning no or passive exposure. Only subjects with reliable occupational exposure were invited to the free screening; the non-exposed volunteers served as a control group.
• Exposure: Occupational asbestos exposure. Industrial hygienists assessed it from a job history questionnaire using a simplified job-exposure matrix. 'High' exposure meant continuous exposure for at least 1 year or intermittent exposure for at least 10 years; 'low' meant bystander exposure. For analysis, the non-exposed group was defined as no or passive exposure and the exposed group as moderate or high exposure. Participants also rated their own exposure. No fiber types are specified.
• Main results:
  • An abnormal distress (PCQ) score was found in 21.1% of asbestos-exposed subjects and 9.2% of non-exposed subjects (P less than 0.0001).
  • Distress scores were higher in exposed subjects for each domain and for the global score, even after adjustment for age, gender and smoking status. The adjusted mean global score was 9.17 in exposed subjects and 6.92 in non-exposed subjects.
  • In one-by-one analyses, odds of an abnormal score were higher for exposure as assessed by the hygienist, but higher still for participants' own rating of their exposure. For self-rated heavy exposure the OR was 5.40 (95% CI 3.78 to 7.74), compared with null or light exposure.
  • In one-by-one analyses, people who thought they currently had an asbestos-related disease had an OR of 20.4 [14.0 to 29.7] for an abnormal score. The 'possible' group had an OR of 4.7 [3.3 to 6.7]. Both were compared with those answering no.
  • In the final multivariate model, self-reporting a current asbestos-related disease remained associated with an abnormal distress score (OR 14.1 [9.5 to 21.0]). This was self-reported disease status, not a confirmed diagnosis.
  • Agreeing that 'all subjects exposed to asbestos will develop a disease' was associated with an abnormal score (OR 2.3, 95% CI 1.9 to 2.7). About one-third of both groups held this belief (35.0% of exposed and 35.3% of non-exposed subjects; not significant).
• The authors' conclusion: The authors concluded that occupationally asbestos-exposed subjects experienced significantly more distress than previously described in the literature. They found this distress seemed strongly linked to how subjects perceived their health status and to beliefs about asbestos-related diseases, particularly the estimated frequency of fatal diseases such as cancer. They called for further assessment of the psychological impact of screening programs.
• Limitations the authors state:
  • The control group was made up of volunteers who were not exposed, not a random sample of the general population. People responding to media invitations may be more anxious than the general population.
  • The authors state that selection bias in the control group cannot be excluded.
  • The distress scale was developed for mammography breast cancer screening; to the authors' knowledge, no scale specific to asbestos disorders exists.
  • The scale has no established normal score, so the authors defined their own cutoff. As a result, the 21.1% abnormal-score figure cannot easily be compared with other studies.
  • The authors could not exclude that some subjects overestimated their exposure to obtain compensation. They noted, however, that most underestimated their exposure compared with the hygienist's assessment.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Asbestos Exposure, Occupational Exposure, Quality of Life.

Related studies

• CT scan screening is associated with increased distress among subjects of the APExS — C. Paris, M. Maurel, et al. (2010)
• Pleural plaques and asbestosis: dose- and time-response relationships based on HRCT data — C. Paris, S. Thierry, et al. (2009)
• Survey of British pathologists' performance of mesothelioma post-mortems — R. Goldstein, P.S. Hasleton (2010)
• Anxious and depressive symptoms in the French Asbestos-Related Diseases Cohort: risk factors and self-perception of risk — I. Mounchetrou Njoya, C. Paris, et al. (2017)
• An 80-Year-Old Man With Asbestos Exposure Presenting With Respiratory Distress — A. Aron, A.E. Urban, et al. (2017)
• Does asbestos exposure cause airway obstruction, in the absence of confirmed asbestosis? — J. Ameille, M. Letourneux, et al. (2010)

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