C5
Psychosocial impact of alternative management policies for women with low-grade abnormal cervical smears: 3-year follow-up results from TOMBOLA (trial of management of borderline and other low-grade abnormal smears)
Linda Sharp1, Seonaidh Cotton2, Leslie Walker3, Nicola Gray2, Julian Little4
1National Cancer Registry Ireland, Cork, Ireland, 2University of Aberdeen, Aberdeen, UK, 3University of Hull, Hull, UK, 4University of Ottawa, Ottawa, Canada
Background
The adverse psychosocial effect of an abnormal cervical smear result is well documented. Less is known about the impact of different management policies, especially in the longer-term and among women with low-grade smears. TOMBOLA investigated psychosocial effects of alternative management policies over three years in women with low-grade smears.
Method
4439 women aged 20-59 with a low-grade smear were randomised to cytological surveillance in primary care or colposcopy. At colposcopy, women with a visible abnormality were randomised to immediate treatment or biopsy with recall for treatment if necessary. Women completed the Hospital Anxiety and Depression Scale (HADS) and other psychosocial instruments at recruitment, six weeks post-procedure (smear/colposcopy/biopsy/treatment), and 12, 18, 24 and 30 months post-recruitment. Proportions with clinically significant anxiety (≥11) and depression (≥8), and adjusted odds ratios (OR), were calculated at each time-point.
Results
Anxiety declined substantially between recruitment and first HADS administration, particularly in the colposcopy arm (24% to 7.9%; surveillance: 23% to 13.4%; p<0.001). At subsequent time-points the proportions with anxiety or depression were similar between arms; the ORs not differing significantly from unity. There were no significant differences in anxiety or depression between the biopsy and recall and immediate treatment arms at any time-point. Throughout follow-up, considerable proportions of women expressed concerns about having cervical cancer.
Conclusion
Initial colposcopy resulted in lower short-term anxiety than cytological surveillance. However, over three years there was little difference in anxiety or depression. Similarly, there was no difference in the psychosocial impact of alternative management policies at colposcopy.
