Introduction/Background International guidelines recommend symptom-triggered testing to detect ovarian cancer (OC). In the UK, symptomatic women are referred if they have an abnormal CA125 and/or ultrasound. Some women will experience adverse psychological responses to testing and be less motivated to attend further investigations. We analysed data from the ROCkeTS prospective test accuracy study to investigate psychological morbidity in diagnostic testing and identify women most at risk.
Methodology Participants completed a questionnaire at enrolment and, if not diagnosed with OC at 12 months. Anxiety and post-traumatic stress disorder (PTSD) were measured using the State-Trait Anxiety Inventory (STAI) and Revised Impact of Event Scale (IES-r). Their association with variables was explored using Wilcoxon Rank-Sum and Kruskal-Wallis tests. The effect on scores at 12 months was explored using the Wilcoxon signed-rank test.
Results Responses from 2574 women were analysed. Women experienced ‘moderate’ anxiety and ‘severe’ PTSD’ at enrolment with median (IQR) STAI and IES scores of 43 (40–50) and 41 (29–62) respectively. Age, employment status, educational level, smoking history, route of presentation and a change in menstruation were associated with PTSD (table 1). None of the variables were associated with anxiety (table 1). Anxiety levels in those without an OC diagnosis increased to ‘high’ at 12 months (n=487), 47 (40–50) but this change was not statistically significant (p=0.197). IES-r scores decreased to 36 (27–55) at 12 months (n=492), which was statistically (p =0.033) and clinically significant resulting in a lowering of IES-r severity categorisation.
Conclusion To our knowledge, this is the first study investigating psychological morbidity after diagnostic testing for OC. Women experience significant anxiety and distress with certain groups more predisposed to PTSD. Distress was highest in emergency admissions, reinforcing the need for earlier diagnosis through improved diagnostic pathways. Psychological support may improve patient experience, especially for younger, less educated unemployed women.
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