title: Impact of alternative management policies on health-related quality of life in women with low-grade abnormal cervical cytology referred for colposcopy.
abstract: OBJECTIVE
  To assess the health-related quality of life (HRQoL) over 30 months among women who received colposcopy following low-grade abnormal cervical cytology.
  
  
  METHODS
  751 women with low-grade abnormal cytology were seen for colposcopy. Of these, 350 additionally underwent either immediate treatment by large loop excision of the transformation zone (LLETZ) or investigation by punch biopsy followed by treatment of high-grade cervical intraepithelial neoplasia if present. The HRQoL of the women was assessed on seven separate occasions over 30 months by means of the EQ-5D instrument. Outcomes for women receiving colposcopy only, colposcopy with biopsy and colposcopy with LLETZ were compared.
  
  
  RESULTS
  Women experienced modest short-term increases in HRQoL, statistically significant for the colposcopy only and biopsy groups but not for the LLETZ group. HRQoL in all three groups thereafter fell until 12 months following recruitment, significantly so for the LLETZ group. Changes in EQ-5D index score arose primarily from changes in severities in the "pain and discomfort" and "anxiety and depression" domains. Changes in the visual analogue scale (VAS) representations of quality of life corresponded closely to those of the index scores and most of the VAS scores themselves did not differ from VAS population norms. All inter-assessment changes in index scores were smaller than the minimum important difference for the instrument. Beyond 18 months from recruitment, HRQoL stabilised in all three groups.
  
  
  CONCLUSIONS
  Women referred to colposcopy following a low-grade abnormal smear test result experienced a short-term improvement in their health-related quality of life, but the long-term effect was insubstantial. HRQoL over the post-recruitment follow-up period did not vary by intervention.
authors.affiliation: School of Economics, University of Nottingham, Nottingham, England, United Kingdom. david.whynes@nottingham.ac.uk
authors.forename: David K
authors.initials: DK
authors.lastname: Whynes
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Seonaidh C
authors.initials: SC
authors.lastname: Cotton
authors.forename: Margaret
authors.initials: M
authors.lastname: Cruickshank
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Gray
authors.forename: Julian
authors.initials: J
authors.lastname: Little
authors.forename: Norman
authors.initials: N
authors.lastname: Waugh
mesh_terms: D000328:Adult; D001007:Anxiety; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003127:Colposcopy; D003863:Depression; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery