Impact of abnormal screening results, pre-cancerous lesions and cervical cancer on quality of life (QoL)

Quality of life (QoL) is defined as an individual’s level of comfort, enjoyment and ability to pursue the daily activities of living. QoL is influenced by a variety of factors, including age, health status, physical and social functioning and psychological well-being (Pearman 2003).

An abnormal cervical screening result, or a diagnosis of cervical cancer and the need for treatment, can have a major psychological impact. This can affect a woman’s QoL, resulting in emotional and relationship problems, including stress and anxiety (Basen-Engquist et al 2003).

Cervical screening programmes, which can detect pre-cancerous changes, allow for the early treatment of cervical abnormalities before the onset of invasive cervical cancer.  However, positive HPV tests, even in the absence of any evidence of pre-cancerous or cancerous changes, can have a significant impact on a woman’s QoL (McCaffery et al 2004).

The impact of cervical cancer on QoL in Europe has been assessed in various studies. A team in Sweden looked at symptom-induced distress in 256 women with stage IB-IIA cervical cancer who were treated with surgery or radiotherapy.  Sexual dysfunction and ano-rectal symptoms were two of the primary causes of distress in these patients (Bergmark et al 2002).

Assessing quality of life

Many generic instruments can be used to assess an individual’s QoL, for example, the Short Form 36 (SF-36) questionnaire.  The QoL of women with cervical cancer can also be assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) scale (Aaronson et al 1993).  This is designed to measure the effects of cancer on a global measure of health and QoL, in terms of specific symptoms, and in greater detail across five functional scales:

• Physical
  
• Role (work or daily activities)
  
• Emotional
  
• Social
  
• Cognitive

However, this instrument is not designed to assess the impact of pre-cancerous lesions, or abnormal screening test results, which also have a considerable impact on a woman’s QoL (Bell et al 1995; Lerman et al 1991).  


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