Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial

S. Fielding, K. Rothnie, N. M. Gray, J. Little, M. E. Cruickshank, K. Neal, L. G. Walker, D. Whynes, S. C. Cotton (Lead / Corresponding author), L. Sharp, The TOMBOLA group

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    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 NHS Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. 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 12 and 18 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.
    Original languageEnglish
    Pages (from-to)476-483
    Number of pages8
    JournalPsycho-Oncology
    Volume26
    Issue number4
    Early online date14 Jun 2016
    DOIs
    Publication statusPublished - 11 Apr 2017

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    Colposcopy
    Cell Biology
    Morbidity
    Linear Models
    Education

    Keywords

    • cancer
    • oncology
    • colposcopy
    • cytology
    • psychosocial morbidity

    Cite this

    Fielding, S. ; Rothnie, K. ; Gray, N. M. ; Little, J. ; Cruickshank, M. E. ; Neal, K. ; Walker, L. G. ; Whynes, D. ; Cotton, S. C. ; Sharp, L. ; The TOMBOLA group. / Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy : longitudinal analysis from the TOMBOLA randomised trial. In: Psycho-Oncology. 2017 ; Vol. 26, No. 4. pp. 476-483.
    @article{e0b1d687992e492a9efdad54f50f69f5,
    title = "Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial",
    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 NHS Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. 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 12 and 18 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.",
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    author = "S. Fielding and K. Rothnie and Gray, {N. M.} and J. Little and Cruickshank, {M. E.} and K. Neal and Walker, {L. G.} and D. Whynes and Cotton, {S. C.} and L. Sharp and {The TOMBOLA group}",
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    language = "English",
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    Fielding, S, Rothnie, K, Gray, NM, Little, J, Cruickshank, ME, Neal, K, Walker, LG, Whynes, D, Cotton, SC, Sharp, L & The TOMBOLA group 2017, 'Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial', Psycho-Oncology, vol. 26, no. 4, pp. 476-483. https://doi.org/10.1002/pon.4163

    Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy : longitudinal analysis from the TOMBOLA randomised trial. / Fielding, S.; Rothnie, K.; Gray, N. M.; Little, J.; Cruickshank, M. E.; Neal, K.; Walker, L. G.; Whynes, D.; Cotton, S. C. (Lead / Corresponding author); Sharp, L.; The TOMBOLA group.

    In: Psycho-Oncology, Vol. 26, No. 4, 11.04.2017, p. 476-483.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy

    T2 - longitudinal analysis from the TOMBOLA randomised trial

    AU - Fielding, S.

    AU - Rothnie, K.

    AU - Gray, N. M.

    AU - Little, J.

    AU - Cruickshank, M. E.

    AU - Neal, K.

    AU - Walker, L. G.

    AU - Whynes, D.

    AU - Cotton, S. C.

    AU - Sharp, L.

    AU - The TOMBOLA group

    PY - 2017/4/11

    Y1 - 2017/4/11

    N2 - 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 NHS Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. 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 12 and 18 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.

    AB - 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 NHS Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. 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 12 and 18 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.

    KW - cancer

    KW - oncology

    KW - colposcopy

    KW - cytology

    KW - psychosocial morbidity

    U2 - 10.1002/pon.4163

    DO - 10.1002/pon.4163

    M3 - Article

    C2 - 27297097

    VL - 26

    SP - 476

    EP - 483

    JO - Psycho-Oncology

    JF - Psycho-Oncology

    SN - 1057-9249

    IS - 4

    ER -