Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective
To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology.
Methods
Women aged 20–59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity.
Results
On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI −3.6 to −1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (−2.4; −3.3 to −1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education.
Conclusions
Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women.
To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology.
Methods
Women aged 20–59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity.
Results
On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI −3.6 to −1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (−2.4; −3.3 to −1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education.
Conclusions
Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women.
Date Issued
2016-06-14
Date Acceptance
2016-04-21
Citation
Psycho-Oncology, 2016, 26 (4), pp.476-483
ISSN
1099-1611
Publisher
Wiley
Start Page
476
End Page
483
Journal / Book Title
Psycho-Oncology
Volume
26
Issue
4
Copyright Statement
© 2016 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,provided the original work is properly cited
License URL
Subjects
Science & Technology
Social Sciences
Life Sciences & Biomedicine
Oncology
Psychology
Psychology, Multidisciplinary
Social Sciences, Biomedical
Biomedical Social Sciences
cancer
oncology
colposcopy
cytology
psychosocial morbidity
INTRAEPITHELIAL NEOPLASIA
PSYCHOLOGICAL REACTIONS
EVERY WOMAN
CANCER
SMEARS
IMPACT
PREFERENCES
BORDERLINE
QUALITY
DEBATE
In association with the TOMBOLA group
1112 Oncology And Carcinogenesis
1701 Psychology
1103 Clinical Sciences
Oncology & Carcinogenesis
Publication Status
Published