Psychological and utility-based quality of life impact of screening test results for anal precancerous lesions in gay and bisexual men: baseline findings from the Study of the Prevention of Anal Cancer

Abstract

ObjectiveGay, bisexual and other men who have sex with men (GBMSM), particularly HIV-positive GBMSM, are at increased anal cancer risk compared with the general population. This study examined the psychological and quality of life (QoL) impact of receiving abnormal anal cancer screening results during the baseline visit of the Study of the Prevention of Anal Cancer (SPANC).MethodsSPANC was a prospective cohort study of the natural history of anal human papillomavirus (HPV) and associated abnormalities in GBM aged 35 years and over. Participants completed questionnaires including aspects of health-related QoL (HR-QoL) and psychosocial functioning at baseline. Participants underwent procedures including an anal swab for cytology, and high-resolution anoscopy with biopsy of any possibly HPV-related abnormality. Questionnaires were readministered 2 weeks and 3 months after participants were given cytology and histology results. Perceived test result served as the study factor.ResultsParticipants with perceived abnormal results (n=232) reported poorer HR-QoL (mean difference=1.8; p=0.004) and lower utility-based QoL (mean difference=0.02; p=0.018) 2 weeks after screening than individuals with perceived normal results (n=268). These differences did not persist at 3-month follow-up. A greater proportion of participants who perceived their results as abnormal reported feeling worse than usual about their anal health and anal cancer fear (p’s<0.001), experienced more intrusive thoughts about their results (p’s≤0.006) and felt more likely to develop cancer than other gay men their age (p’s≤0.025) at both time points than those with perceived normal results.ConclusionsProviding abnormal results may cause psychological distress and impact HR-QoL, with sustained intrusive thoughts, increased cancer worry and perceived cancer risk. The potential for psychological harm needs to be considered when implementing anal cancer screening programmes.

Patient-reported outcomes associated with cancer screening: a systematic review

“…In some studies, respondents were also asked to rate their own health on the EQ-5D visual analog scale, ranging from 0 (worst imaginable health status) to 100 (best imaginable health status) [72][73][74] as well. Additionally, two studies reported Short-Form Six-Dimension (SF-6D) utility scores, which were either derived from the SF-36 using the UK scoring algorithm [67], or the SF-12 using the University of Sheffield's SF-6D classification for describing health [50]. The SF-6D estimates a preference-based single index measure for health using general population values, and allows utility scores to be obtained with scores covering a range of 0 (worst health state) to 1 (best health state) [40,53].…”

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo papilomavírus humano (HPV)

“…Es deber del profesional de salud orientar a la persona, clara y objetivamente, sobre la transmisión y tratamiento de la enfermedad. 31,32 Cumple considerar, aún, que la presencia de verrugas genitales actúa como "marcador" de ITS, ya que se estima que 20% de las personas con verrugas anogenitales tengan una ITS simultánea, incluyendo clamidia, infección por VIH y sífilis. Por lo tanto, el rastreo de otras ITS debe ser orientado.…”

Quality of life in women with HPV and accurary of direct visual anal inspection with acetic acid and lugol compared to high-resolution anoscopy to diagnose intraepithelial anal lesion

“…A prospective cohort analyzed the psychological impact on patients' life quality when they were informed about the tracking exams abnormality in the reference center to prevent anal cancer in Australia. 25 This aforementioned study included as subjects male bisexuals and other men who had sex with males, particularly HIV positives aged 35 or more. The subjects filled a form on global state of health, psychological aspects of their lives at the first consultation and repeated the same questionnaire 2 weeks and 3 months later.…”

“…After getting the results of the tracking exams, patients that were positive showed significantly lower scores when compared to patients that tested negative, mainly when it came to intrusive thoughts and fear of developing cancer. 25 Another study observed life quality in 118 patients of both genders who had anogenital warts using SF-36 and 2 others questionnaires: Skindex-29 and GHO-12. 26 A significant association between the disease quantified by size (>200mm²), the number of anogenital lesions and the lowering of all scores in SF-36 below the average, signifying a worse state of global health, was observed.…”