Psychosocial impact of alternative management policies for low-grade cervical abnormalities: results from the TOMBOLA randomised controlled trial

Linda Sharp*, Seonaidh Cotton, Julian Little, Nicola M. Gray, Margaret Cruickshank, Louise Smart, Alison Jane Thornton, Norman Waugh, Leslie Walker, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

*Corresponding author for this work

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Abstract

BACKGROUND: Large numbers of women who participate in cervical screening require follow-up for minor cytological abnormalities. Little is known about the psychological consequences of alternative management policies for these women. We compared, over 30-months, psychosocial outcomes of two policies: cytological surveillance (repeat cervical cytology tests in primary care) and a hospital-based colposcopy examination.

METHODS: Women attending for a routine cytology test within the UK NHS Cervical Screening Programmes were eligible to participate. 3399 women, aged 20-59 years, with low-grade abnormal cytology, were randomised to cytological surveillance (six-monthly tests; n = 1703) or initial colposcopy with biopsies and/or subsequent treatment based on colposcopic and histological findings (n = 1696). At 12, 18, 24 and 30-months post-recruitment, women completed the Hospital Anxiety and Depression Scale (HADS). A subgroup (n = 2354) completed the Impact of Event Scale (IES) six weeks after the colposcopy episode or first surveillance cytology test. Primary outcomes were percentages over the entire follow-up period of significant depression (≥ 8) and significant anxiety (≥ 11; "30-month percentages"). Secondary outcomes were point prevalences of significant depression, significant anxiety and procedure-related distress (≥ 9). Outcomes were compared between arms by calculating fully-adjusted odds ratios (ORs) for initial colposcopy versus cytological surveillance.

RESULTS: There was no significant difference in 30-month percentages of significant depression (OR = 0.99, 95% CI 0.80-1.21) or anxiety (OR = 0.97, 95% CI 0.81-1.16) between arms. At the six-week assessment, anxiety and distress, but not depression, were significantly less common in the initial colposcopy arm (anxiety: 7.9% vs 13.4%; OR = 0.55, 95% CI 0.38-0.81; distress: 30.6% vs 39.3%, OR = 0.67 95% CI 0.54-0.84). Neither anxiety nor depression differed between arms at subsequent time-points.

CONCLUSIONS: There was no difference in the longer-term psychosocial impact of management policies based on cytological surveillance or initial colposcopy. Policy-makers, clinicians, and women themselves can be reassured that neither management policy has a significantly greater psychosocial cost.

TRIAL REGISTRATION: Controlled-Trials.com ISRCTN 34841617.

Original languageEnglish
Article numbere80092
Number of pages13
JournalPloS ONE
Volume8
Issue number12
DOIs
Publication statusPublished - 30 Dec 2013

Keywords

  • 5-year follow-up
  • depression scale
  • hospital anxiety
  • event scale
  • psychological impact
  • long-term
  • colposcopy
  • women
  • borderline
  • cytology

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    Sharp, L., Cotton, S., Little, J., Gray, N. M., Cruickshank, M., Smart, L., Thornton, A. J., Waugh, N., Walker, L., & The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group (2013). Psychosocial impact of alternative management policies for low-grade cervical abnormalities: results from the TOMBOLA randomised controlled trial. PloS ONE, 8(12), [e80092]. https://doi.org/10.1371/journal.pone.0080092