Factors influencing surgical choice and surgerical anxiety in patients with pulmonary nodules smaller than 8mm

Background: The detection of pulmonary nodules has a great impact on people's lives and mental health. The 2018 NCCN guidelines recommend follow-up treatment for nodules ≤8mm, but many patients with small nodules choose surgery. We wanted to explore why these patients had surgery and what caused their anxiety. Methods: : We cross-sectionally surveyed patients with small nodules who decided to undergo surgery in a local grade 3 hospital, using a questionnaire. Results: : 338 patients responded, but only 234 were included in the final analysis. 68.81% of patients reported clinically significant anxiety about pulmonary nodules, as measured by the IES-R. Poor performance in activities of daily living (ADL) (P=0.022, 95% CI: 1.237-15.857) was associated with the highest positive rate (92.31%). Other factors such as presence of solid nodules (P=0.015, 95% CI: 1.26-8.335), multifocal disease (P=0.006, 95% CI: 1.317-5.373) and family history of lung cancer (P=0.048, 95% CI: 1.015-21.307) were also associated with distress. Conclusion: Current ability to perform activities of daily living, presence of solid and multiple nodules, and a family history of lung cancer make patients who choose surgery more likely to experience pain.