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Martinez-Gutierrez J, Chima S, Boyd L, Sherwani A, Drosdowsky A, Karnchanachari N, Luong V, Reece JC, Emery J. Failure to follow up abnormal test results associated with cervical cancer in primary and ambulatory care: a systematic review. BMC Cancer 2023; 23:653. [PMID: 37438686 DOI: 10.1186/s12885-023-11082-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/17/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cervical cancer is a preventable and treatable form of cancer yet continues to be the fourth most common cancer among women globally. Primary care is the first point of contact most patients have with health services and is where most cancer prevention and early detection occur. Inadequate follow-up of abnormal test results for cervical abnormalities in primary care can lead to suboptimal patient outcomes including higher mortality and decreased quality of life. AIMS To explore the magnitude of and factors associated with, inadequate follow-up of test results for cervical abnormalities in primary and ambulatory care. METHODS MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer-reviewed literature from 2000-2022, excluding case-studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A segregated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research. RESULTS We included 27 publications reporting on 26 studies in our review; all were conducted in high-income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women's services, and colposcopy clinics. Rates of inadequate follow-up ranged from 4 to 75%. Studies reported 41 different factors associated with inadequate follow-up. Personal factors associated with inadequate follow-up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results. DISCUSSION This review describes inadequate follow-up of abnormal cervical abnormalities in primary care. Prevalence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreasing inadequate follow-up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self-sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow-up in primary care and ambulatory settings, particularly in low and middle-income countries. This information is crucial if we are to achieve WHO's interim targets by 2030, and hope to avert 62 million cervical cancer deaths by 2120. TRIAL REGISTRATION PROSPERO ID CRD42021250136.
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Affiliation(s)
- Javiera Martinez-Gutierrez
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
- Department of Family Medicine. Pontificia, Universidad Católica de Chile, Santiago, Chile.
| | - Sophie Chima
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Lucy Boyd
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
- Melbourne School of Population and Global Health, Centre for Health Policy, The University of Melbourne, Melbourne, Australia
| | - Asma Sherwani
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Allison Drosdowsky
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Vivien Luong
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
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Jørgensen SF, Andersen B, Petersen LK, Rebolj M, Njor SH. Adherence to follow-up after the exit cervical cancer screening test at age 60-64: A nationwide register-based study. Cancer Med 2022; 11:224-237. [PMID: 34766466 PMCID: PMC8704149 DOI: 10.1002/cam4.4420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In Denmark, human papillomavirus (HPV) testing has replaced cytology in primary cervical cancer screening for women aged 60-64; at this age, women are invited for the last (exit) screening test within the national organized program. AIM We investigated the adherence of these women to the recommended follow-up after a non-negative (positive or inadequate) HPV test and the overall resource use during that follow-up. MATERIALS & METHODS We included all 2926 women aged 60-64 years with nonnegative HPV screening tests between March 2012 and December 2016. All relevant follow-up tests and procedures were retrieved until the end of 2020 from the highly complete Danish administrative health registers, and the data were linked at the individual level. We determined the extent to which the adherence patterns followed the national recommendations for follow-up and estimated the total numbers of tests and diagnostic procedures utilized during the entire process. RESULTS In total, only 26% of women had follow-up in accordance with the recommendations; 4% had no follow-up, 46% had insufficient follow-up, and 24% had more follow-up than recommended. We estimated that 17% of women remained in follow-up for longer than 4 years. The average numbers of diagnostic tests and procedures used after positive HPV screening were higher than expected, even among women who had insufficient follow-up, that is, those who received less invasive procedures than recommended, or experienced delays in receiving those procedures. CONCLUSION To conclude, we found that the patterns of follow-up of women with nonnegative primary HPV screening tests at 60-64 often diverged from the recommendations. Addressing these inconsistencies in follow-up by providing evidence for optimal clinical management should help improve the quality of screening programs and secure an equal and reliable follow-up care service for all women.
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Affiliation(s)
- Susanne F. Jørgensen
- University Research Clinic for Cancer ScreeningDepartment of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Berit Andersen
- University Research Clinic for Cancer ScreeningDepartment of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lone Kjeld Petersen
- Department of Gynaecology and ObstetricsOdense University HospitalOdenseDenmark
- Open Patient Data Explorative Network (OPEN)University of Southern DenmarkOdenseDenmark
| | - Matejka Rebolj
- Cancer Prevention GroupSchool of Cancer & Pharmaceutical SciencesFaculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Sisse H. Njor
- University Research Clinic for Cancer ScreeningDepartment of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
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Manley KM, Simms RA, Platt S, Patel A, Bahl R. Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty. BMC Med Inform Decis Mak 2017; 17:125. [PMID: 28830493 PMCID: PMC5567663 DOI: 10.1186/s12911-017-0516-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unsatisfactory colposcopy, where the cells of interest are not visible in women with a positive cervical screening test, is a common area of clinical uncertainty due to the lack of clear evidence and guidance. Colposcopists' opinions and experiences are likely to have a significant influence on service provision and the development of national policy. The aim of this study was to analyse decision-making when applied to women with unsatisfactory colposcopy. METHODS A multi-centre qualitative study utilizing a series of focus groups in an English healthcare region. Sampling aimed to ensure heterogeneity of experience and healthcare provider demographics. A topic guide covered a range of clinical and cytological variables and was compiled by the researchers and three expert Colposcopists. Using an iterative approach, thematic analysis was selected as the most appropriate method to identify factors affecting decision-making. RESULTS Twenty-three Colposcopists from four units participated. The decision to treat was easier in women with high-grade cytology and high risk women with low-grade cytology such as heavy smokers, poor attenders, older women, those who had completed their families and women opting for treatment. Where decision-making was more complex, intuition and a multi-disciplinary approach were used to guide management. Areas of dissonance, which are affected by paucity of evidence and emotive factors, included cytological collection device, clinical setting and length of conservative follow-up and depth of excision in women at high risk of treatment-related morbidity. CONCLUSIONS Anxiety of missing a cancer deters long-term cytological follow-up, resulting in heterogeneity of care and higher than anticipated excisional treatments in women with low-grade screening and unsatisfactory colposcopy. In areas of clinical uncertainty when decisions are dominated by affect, clinical guidance can reduce the difficulty and anxiety of decision-making.
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Affiliation(s)
- Kristyn M. Manley
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
- University of Bristol, Bristol, UK
| | - Rebecca A. Simms
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
- University of Bristol, Bristol, UK
| | - Sarah Platt
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
| | - Amit Patel
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
| | - Rachna Bahl
- Department of Women’s Health, University Hospitals Bristol NHS Foundation Trust, St. Michael’s Hospital, Level D, St. Michaels Hospital, Bristol, BS2 8EG UK
- University of Bristol, Bristol, UK
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Yepes-Nuñez JJ, Zhang Y, Xie F, Alonso-Coello P, Selva A, Schünemann H, Guyatt G. Forty-two systematic reviews generated 23 items for assessing the risk of bias in values and preferences' studies. J Clin Epidemiol 2017; 85:21-31. [DOI: 10.1016/j.jclinepi.2017.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/23/2017] [Accepted: 04/14/2017] [Indexed: 11/29/2022]
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Fielding S, Rothnie K, Gray NM, Little J, Cruickshank ME, Neal K, Walker LG, Whynes D, Cotton SC, Sharp L. Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial. Psychooncology 2017; 26:476-483. [PMID: 27297097 PMCID: PMC5412834 DOI: 10.1002/pon.4163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology. METHODS Women aged 20-59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity. RESULTS On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI -3.6 to -1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (-2.4; -3.3 to -1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education. CONCLUSIONS Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women. © 2016 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.
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Affiliation(s)
- S. Fielding
- Medical Statistics Team, Division of Applied Health SciencesUniversity of AberdeenAberdeenScotland
| | - K. Rothnie
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine and Faculty of MedicineImperial College LondonLondonUK
| | - N. M. Gray
- Scottish Improvement Science Collaborating Centre, School of Nursing and Health SciencesUniversity of DundeeDundeeScotland
| | - J. Little
- School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada
| | - M. E. Cruickshank
- Division of Medical and Dental EducationUniversity of AberdeenAberdeenScotland
| | - K. Neal
- Consultant EpidemiologistLondon and South East PHE CentresLondonUK
| | | | - D. Whynes
- School of EconomicsUniversity of NottinghamNottinghamUK
| | - S. C. Cotton
- Division of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - L. Sharp
- Institute of Health & SocietyNewcastle UniversityNewcastleUK
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Wood B, Van Katwyk SR, El-Khatib Z, McFaul S, Taljaard M, Wright E, Graham ID, Little J. Eliciting women's cervical screening preferences: a mixed methods systematic review protocol. Syst Rev 2016; 5:136. [PMID: 27516072 PMCID: PMC4982264 DOI: 10.1186/s13643-016-0310-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the accumulation of evidence regarding potential harms of cancer screening in recent years, researchers, policy-makers, and the public are becoming more critical of population-based cancer screening. Consequently, a high-quality cancer screening program should consider individuals' values and preferences when determining recommendations. In cervical cancer screening, offering women autonomy is considered a "person-centered" approach to health care services; however, it may impact the effectiveness of the program should women choose to not participate. As part of a larger project to investigate women's cervical screening preferences and correlates of these preferences, this systematic review will capture quantitative and qualitative investigations of women's cervical screening preferences and the methods used to elicit them. DESIGN AND METHODS This mixed methods synthesis will use a thematic analysis approach to synthesize qualitative, quantitative, and mixed methods evidence. This protocol describes the methods that will be used in this investigation. A search strategy has been developed with a health librarian and peer reviewed using PRESS. Based on this strategy, five databases and the gray literature will be searched for studies that meet the inclusion criteria. The quality of the included individual studies will be examined using the Mixed Methods Appraisal Tool. Three reviewers will extract data from the primary studies on the tools or instruments used to elicit women's preferences regarding cervical cancer screening, theoretical frameworks used, outcomes measured, the outstanding themes from quantitative and qualitative evidence, and the identified preferences for cervical cancer screening. We will describe the relationships between study results and the study population, "intervention" (e.g., tool or instrument), and context. We will follow the PRISMA reporting guideline. We will compare findings across studies and between study methods (e.g., qualitative versus quantitative study designs). The strength of the synthesized findings will be assessed using the validated GRADE and CERQual tool. DISCUSSION This review will inform the development of a tool to elicit women's cervical screening preferences. Understanding the methods used to elicit women's preferences and what is known about women's cervical screening preferences will be useful for guideline developers who wish to incorporate a woman-centered approach specifically for cervical screening guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016035737.
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Affiliation(s)
- Brianne Wood
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Roger-Guindon Hall, Room 3105, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada.
| | - Susan Rogers Van Katwyk
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Roger-Guindon Hall, Room 3105, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada
| | - Ziad El-Khatib
- Department of Public Health Sciences, K9, Karolinska Institutet, Tomtebodavägen 18A; Widerströmska huset, 171 77, Stockholm, Sweden.,World Health Programme, Université du Québec en Abitibi-Témiscamingue, 79, rue Côté Notre-Dame-du-Nord, Québec, J0Z 3B0, Canada
| | - Susan McFaul
- Department of Obstetrics and Gynecology, University of Ottawa, 1919 Riverside Dr., Suite 201, Ottawa, K1H 1A2, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Roger-Guindon Hall, Room 3105, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, K1Y 4E9, Ontario, Canada
| | - Erica Wright
- Health Sciences Library, University of Ottawa, Roger-Guindon Hall, Room 1020, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada
| | - Ian D Graham
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Roger-Guindon Hall, Room 3105, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada
| | - Julian Little
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Roger-Guindon Hall, Room 3105, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada
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Santesso N, Mustafa RA, Schünemann HJ, Arbyn M, Blumenthal PD, Cain J, Chirenje M, Denny L, De Vuyst H, Eckert LO, Forhan SE, Franco EL, Gage JC, Garcia F, Herrero R, Jeronimo J, Lu ER, Luciani S, Quek SC, Sankaranarayanan R, Tsu V, Broutet N. World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer. Int J Gynaecol Obstet 2015; 132:252-8. [PMID: 26868062 DOI: 10.1016/j.ijgo.2015.07.038] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/15/2015] [Accepted: 11/26/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is estimated that 1%-2% of women develop cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) annually worldwide. The prevalence among women living with HIV is higher, at 10%. If left untreated, CIN 2-3 can progress to cervical cancer. WHO has previously published guidelines for strategies to screen and treat precancerous cervical lesions and for treatment of histologically confirmed CIN 2-3. METHODS Guidelines were developed using the WHO Handbook for Guideline Development and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. A multidisciplinary guideline panel was created. Systematic reviews of randomized controlled trials and observational studies were conducted. Evidence tables and Evidence to Recommendations Tables were prepared and presented to the panel. RESULTS There are nine recommendations for screen-and-treat strategies to prevent cervical cancer, including the HPV test, cytology, and visual inspection with acetic acid. There are seven for treatment of CIN with cryotherapy, loop electrosurgical excision procedure, and cold knife conization. CONCLUSION Recommendations have been produced on the basis of the best available evidence. However, high-quality evidence was not available. Such evidence is needed, in particular for screen-and-treat strategies that are relevant to low- and middle-income countries.
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Affiliation(s)
- Nancy Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Reem A Mustafa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Departments of Internal Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Joanna Cain
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Lynette Denny
- University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hugo De Vuyst
- International Agency for Research on Cancer, Lyon, France
| | - Linda O'Neal Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Sara E Forhan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | - Nathalie Broutet
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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WHAT IS THE ROLE OF COMMUNITY PREFERENCE INFORMATION IN HEALTH TECHNOLOGY ASSESSMENT DECISION MAKING? A CASE STUDY OF COLORECTAL CANCER SCREENING. Int J Technol Assess Health Care 2015; 31:241-8. [PMID: 26376934 DOI: 10.1017/s0266462315000367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to determine the role of community preference information from discrete choice studies of colorectal cancer (CRC) screening in health technology assessment (HTA) reports and subsequent policy decisions. METHODS We undertook a systematic review of discrete choice studies of CRC screening. Included studies were reviewed to assess the policy context of the research. For those studies that cited a recent or pending review of CRC screening, further searches were undertaken to determine the extent to which community preference information was incorporated into the HTA decision-making process. RESULTS Eight discrete choice studies that evaluated preferences for CRC screening were identified. Four of these studies referred to a national or local review of CRC screening in three countries: Australia, Canada, and the Netherlands. Our review of subsequently released health policy documents showed that while consideration was given to community views on CRC, policy was not informed by discrete choice evidence. CONCLUSIONS Preferences and values of patients are increasingly being considered "evidence" to be incorporated into HTA reports. Discrete choice methodology is a rigorous quantitative method for eliciting preferences and while as a methodology it is growing in profile, it would appear that the results of such research are not being systematically translated or integrated into HTA reports. A formalized approach is needed to incorporate preference literature into the HTA decision-making process.
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Patient preferences for side effects associated with cervical cancer treatment. Int J Gynecol Cancer 2015; 24:1077-84. [PMID: 24905618 DOI: 10.1097/igc.0000000000000149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess patient preferences regarding side effects associated with cervical cancer treatment. METHODS/MATERIALS The visual analog scale (VAS) and modified standard gamble (SG) were used to elicit preferences of women with no evidence of disease after primary treatment of cervical cancer. Higher scores on VAS and SG indicated more favorable ratings for a given health state. Health states (HS) included vaginal shortening, diarrhea, dietary changes, menopause, moderate nausea/vomiting, rectal bleeding, sexual dysfunction, and urinary self-catheterization. Descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-ranks tests and correlation coefficients were used for statistical analysis. RESULTS Seventy-eight patients participated in the study. Median age was 44.1 years (range, 24.9-67.8 years). Median time since treatment completion was 31.2 months (range, 1.0-113.3 months). The HSs rated as most favorable by VAS were also rated as most favorable by SG. Increasing age was associated with higher VAS scores for menopause and vaginal shortening (P = 0.04 and 0.036). African Americans had higher VAS scores for dietary changes (P = 0.05), sexual dysfunction (P = 0.028), and diarrhea (P = 0.05) when compared with Hispanic and non-Hispanic white patients. Women receiving radiation had more favorable VAS scores for menopause compared with women undergoing radical hysterectomy (P = 0.05). Women receiving chemotherapy rated urinary self-catheterization less favorably by VAS score compared with those not receiving chemotherapy (P = 0.045). CONCLUSIONS Multiple demographic and clinical factors influence the severity of treatment-related adverse effects perceived by women surviving cervical cancer. A better understanding of factors influencing patient preferences regarding treatment side effects will allow providers to formulate care better tailored to the individual desires of each patient.
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Liverani CA. The four steps in the prevention of human papillomavirus-associated neoplasia: considerations for preventive measures, screening, disease impact, and potential overtreatments in HPV-related pathology. Arch Gynecol Obstet 2013; 288:979-88. [PMID: 23974280 DOI: 10.1007/s00404-013-3011-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 08/09/2013] [Indexed: 12/26/2022]
Abstract
There is no cure currently available for HPV infections, although ablative and excisional treatments of some dysplasias often result in a clinical and virological cure. Effective control measures of HPV-associated cancers rely on the prevention at four different levels. Apart from sexual abstinence, primary prevention is realized through vaccines targeting the most frequent HPV types: negative attitudes towards HPV vaccination and high costs are the main obstacles. The aim of secondary prevention is to detect precancerous changes before they develop into invasive cancer, while tertiary prevention involves actual treatment of high-grade lesions: in many countries routine screening with cytology is being challenged with HPV DNA testing. Quaternary prevention comprehends those actions adopted to mitigate or avoid unnecessary or excessive medical interventions, and may well be addressed in avoiding treatments for low-grade intraepithelial neoplasia. Though some gynecologists commonly recommend treatment for low-grade disease and women tend to prefer active management if not properly informed, harms arising from unnecessary treatments, increased costs, work overload for second-level health services, and induced psychosocial distress are causing on-going problems. Prevention efforts of genital HPV-associated cancers should concentrate in: (1) enhancing primary prevention through vaccination of all eligible subjects, (2) achieving high levels of adherence to routine screening programs, (3) treating precancerous lesions, and (4) monitoring current guidelines recommendations to avoid overtreatments. Novel research projects should be designed to study the delicate mechanisms of immune response to HPV.
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Affiliation(s)
- Carlo A Liverani
- Gynecologic Oncology Unit, Department of Mother and Infant Sciences, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,
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Saccardi C, Gizzo S, Noventa M, Anis O, Di Gangi S, Patrelli TS, D'Antona D, Nardelli GB. High-risk human papillomavirus DNA test: could it be useful in low-grade cervical lesion triage? Five-year follow-up. Reprod Sci 2013; 21:198-203. [PMID: 23744882 DOI: 10.1177/1933719113492214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a retrospective, observational study in order to evaluate the role of high-risk human papillomavirus (hrHPV)-DNA test in patients with first diagnosis of low-grade squamous intraepithelial lesions (L-SILs).Patients were divided into group A, annual Papanicolaou test and hrHPV-DNA tests (167 patients) and group B, immediate colposcopy, followed by annual papanicolaou test and hrHPV-DNA tests (164 patients). We assessed sensitivity, specificity, negative predictive value (NPV), positive predictive value, positive-negative likelihood ratio of hrHPV-DNA test, and 5-year relative risk of cervical intraepithelial neoplasia grade 2 in hrHPV-DNA+. Colposcopy is still considered the best choice for women with L-SIL and hrHPV-DNA+ test. High sensitivity and NPV of hrHPV-DNA test permit to use it in the follow-up of L-SIL with a HPV-negative status, without necessity of referring to colposcopy.
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Affiliation(s)
- Carlo Saccardi
- 1Department of Woman and Child Health, University of Padua, Padua, Italy
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Lee YY, Song SY, Do IG, Kim TJ, Kim BG, Lee JW, Bae DS. Dynamin 2 expression as a biomarker in grading of cervical intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol 2012; 164:180-4. [PMID: 22959143 DOI: 10.1016/j.ejogrb.2012.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/17/2012] [Accepted: 05/15/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Dynamin 2, which plays a role in endocytosis, is known to be required for HPV infection on host cells. We investigated dynamin 2 as a biomarker in grading of cervical intraepithelial neoplasia (CIN) by comparing with Ki-67 expression and the type of HPV infection (low-risk vs. high-risk). STUDY DESIGN We performed immunohistochemical stains of dynamin 2 and Ki-67 on tumor samples of patients with CIN and the type of HPV infection was investigated. RESULTS All the patients with reactive changes (n=7) or normal (n=4) did not show dynamin 2 expression. There were 33, 14, and 12 cases with CIN I, II, and III, respectively, and there was a negative correlation between the degree of dynamin 2 expression and the severity of CIN lesions with statistical significance (P<0.001). Negative expression of dynamin 2 was more sensitive for the detection of CIN II/III than high expression (2+) of Ki-67 (96.2% vs. 73.1%, P=0.041). Among patients in whom HPV infection was detected, the degrees of dynamin 2 expression were not associated with the type of HPV infection (low-risk vs. high-risk). Overall, there was a negative correlation between the expression patterns of Ki-67 and dynamin 2. CONCLUSION We found that dynamin 2 may be a helpful biomarker in grading of CIN lesions and a candidate biomarker for detecting low grade CIN with high sensitivity.
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Affiliation(s)
- Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
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Davies P. Public awareness and cervical cancer screening. Cytopathology 2012; 23:143-5. [DOI: 10.1111/j.1365-2303.2012.00984.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Frederiksen ME, Lynge E, Rebolj M. Women's preferences regarding options for management of atypical, borderline and low-grade cervical abnormalities. Cytopathology 2012; 23:201. [DOI: 10.1111/j.1365-2303.2012.00967.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- H C Kitchener
- Department of Gynaecological Oncology, St Mary's Hospital, University of Manchester, Oxford Road, Manchester, UK
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