Psychologic morbidities prior to loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia

Abstract

The objective of this study was to assess and compare anxiety and distress in patients undergoing colposcopic examinations and loop electrosurgical excision procedure (LEEP). Patients seen for evaluation of cervical intraepithelial neoplasia (CIN) and LEEP were recruited. All patients received further teaching with respect to their abnormality right after the colposcopic evaluation by nursing staff. The Hospital anxiety and Depression Scale (HADS) and the Psychosocial Effects of Abnormal Pap Smears (PEAPS) questionnaires were used to measure and compare distress between the two groups. Linear regression models were built to identify significant predictive variables for psychologic morbidities. Twenty-one colposcopy and 20 LEEP patients participated in this study. No significant demographic differences were noted. Eighty-one percent of patients having colposcopy and 65% of those undergoing LEEP can be classified as having significant anxiety and depression based on the HADS questionnaire. Patients undergoing LEEP scored significantly better than colposcopy patients on the mean total PEAPS score and on the self-belief/cancer concern and effects on sexual relationship dimension scores. Significant psychologic morbidities exist in patients diagnosed with CIN. Face-to-face individualized education and support after colposcopy can decrease patients' distress at subsequent treatment visits.

Patients’ psychological reactions to colposcopy and LLETZ treatment for cervical intraepithelial neoplasia

“…These results differ from a prospective study of colposcopy and LLETZ patients, which found greater anxiety and psychosocial distress in colposcopy rather than LLETZ patients [17]. However, in that study, all LLETZ patients had previously undergone colposcopy, and there are suggestions that anxiety levels are reduced with repeat colposcopy visits [8].…”

Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy

“…Overall, the demographics of the sample were similar to those described in other studies (e.g. Le et al, 2006). Thirty-three women were smokers (38%); the distribution of smokers and non-smokers across interventions groups was balanced, χ 2 (2) = 3.03, p = .22.…”

Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ)

“…Another explanation might be that anxious women are less likely to attend for a repeat cervical smear within the recommended time frame [19]. If the last explanation is true, anxiety for follow-up visits should be decreased by face-to-face education and supportive care after colposcopy [20]. Although our follow-up was mainly performed by the same medical doctor who also performed the LLETZ, compliance was still disappointing.…”