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Life Stressors Are an Important Reason for Women Discontinuing Follow-up Care for Cervical Neoplasia

¹ School of Public Health, University of Texas Health Science Center, Houston, Texas; ² College of Nursing, Medical University of South Carolina, Charleston, South Carolina; and ³ Department of Pathology, School of Medicine, University of South Carolina, Columbia, South Carolina

Requests for reprints: Ann L. Coker, School of Public Health, University of Texas, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225. Phone: 713-500-9955; Fax: 713-500-9264. E-mail: ann.l.coker{at}uth.tmc.edu

Although studies have addressed psychosocial factors associated with obtaining follow-up care for an abnormal Pap test, none have explored the effect of stressful life events in predicting the receipt of follow-up care for an abnormal Pap test. Data from a program (1995-2001) that provided free follow-up care for women with low-grade cervical lesions (n = 601) was used to determine whether life stressors increased risk of study discontinuation. Women were interviewed at baseline and offered follow-up at 4- to 6-month intervals for up to 24 months. Of the 556 women recruited and interviewed (92% response rate), 53 were referred out because they had high-grade cervical lesions and 33 had a health condition precluding follow-up. Among 470 women who began follow-up, 175 (37.2%) discontinued before completing three visits. Women who discontinued were significantly more likely to report more stressful life events in the past year [age-adjusted relative risk (aRR), 1.19; 95% confidence interval (95% CI), 1.08-1.30; 17-item scale]. Events most strongly associated with discontinuation included having a problem with a boss (aRR, 1.9; 95% CI, 1.5-2.4), severe physical partner violence (aRR, 1.7; 95% CI, 1.3-2.2), being homeless (aRR, 2.1; 95% CI, 1.6-2.8), and having an unplanned pregnancy (aRR, 1.5, 95% CI, 1.2-2.1). Life stressors may be important predictors of discontinuation of free follow-up care among women in need of immediate follow-up care to prevent lesion progression. (Cancer Epidemiol Biomarkers Prev 2006;15(2):321–5)