Long-term compliance with follow-up after treatment for cervical intra-epithelial neoplasia.
OBJECTIVE
To assess the level of compliance with follow-up over time after treatment for preinvasive and Stage Ia1 lesions of the cervix. To compare the average interval between visits with the interval prescribed by protocol and to evaluate the use of this difference as a measure of compliance.


METHODS
Retrospective observational study. Setting. London university hospital.


METHODS
Women who received treatment for preinvasive (CINI-III, AIS) or Stage Ia1 cervical lesions.


METHODS
Attendance data were obtained from hospital-based colposcopy and community-based databases.


METHODS
The average interval between the appointments attended by each woman was compared with the planned interval between visits. The time that elapsed since the previous appointment attended was calculated for each visit and correlated with the time since treatment.


RESULTS
1013 women attended 4128 follow-up visits in the colposcopy clinic and in the community. Twenty-two (2.2%) women never attended any post-treatment appointment and 209 (21.0%) of the 991 women who attended at least once, did so on average more than 12 months later than specified by the follow-up protocol. There was a highly significant correlation between the interval since the previous appointment and the time since treatment (Kendall's tau b = 0.529614, two-sided p < 0.0001), showing that compliance deteriorates with increasing time since treatment.


CONCLUSIONS
Comparing the average interval between attendances with the planned interval prescribed by protocol is a sensitive measure of compliance. Compliance with follow-up deteriorates significantly with time since treatment. This decline in compliance may contribute to the increased risk of invasive disease after treatment.
Department of Surgery and Cancer, Imperial College NHS Trust, Hammersmith Hospital Campus, Du Cane Road, London, UK.
William Patrick
WP
Soutter
Bronwen
B
Moss
Karen
K
Perryman
Maria
M
Kyrgiou
Katerina
K
Papakonstantinou
Sadaf
S
Ghaem-Maghami
D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000517:prevention & control; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy; D014626:Vaginal Smears / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000628:therapy