Introduction: Little is known regarding regret experienced by older breast cancer survivors surrounding the choice for adjuvant systemic therapy, which limits providers' ability to optimally engage in the shared decision-making process. To address this, we evaluated endocrine therapy and chemotherapy decisional regret in a population-based cohort of older breast cancer survivors.
Materials and methods: Nationally comprehensive Medicare claims identified women age ≥67 living in the US with non-metastatic breast cancer diagnosed in 2009 and still alive in 2015. The Decision Regret Scale, a validated index that assesses regret regarding treatment decisions on a scale of 0 (no regret) to 100, was used to measure regret for endocrine therapy and chemotherapy approximately 6 years after diagnosis and was adjusted for sampling weight. Multivariable logistic regression adjusted for patient, demographic, and treatment characteristics identified predictors of endocrine therapy and chemotherapy decision regret.
Results: Of the 480 respondents, 299 patients (61.1%) reported receiving endocrine therapy and 133 (27%) chemotherapy. The overall weighted decision-regret score was 17.2 (95%CI 13.6-20.8) for endocrine therapy and 17.7 (95%CI 12.1-23.3) for chemotherapy. Risk factors for higher endocrine therapy regret included white race (referent non-white race; estimate 12.8, 95%CI 3.0-22.7; P = 0.01) and post-graduate educational attainment (referent college education; 11.6, 95%CI 1.9-21.3; P = 0.02). The only risk factor for chemotherapy regret, albeit marginal, was age ≥75 (referent age 67-74; 12.0, 95%CI -0.1-24.2; P = 0.05) CONCLUSION: Overall, decision regret levels regarding systemic therapy in older breast cancer survivors are reassuringly low. However, further studies are needed to explore drivers of regret in certain vulnerable subgroups of patients.
Copyright © 2019. Published by Elsevier Ltd.
Local Therapy Decisional Regret in Older Women With Breast Cancer: A Population-Based Study.Int J Radiat Oncol Biol Phys. 2019 Jun 1;104(2):383-391. doi: 10.1016/j.ijrobp.2019.01.089. Epub 2019 Feb 1. Int J Radiat Oncol Biol Phys. 2019. PMID: 30716524 Free PMC article.
Long-term Patient-Reported Outcomes in Older Breast Cancer Survivors: A Population-Based Survey Study.Int J Radiat Oncol Biol Phys. 2018 Mar 15;100(4):882-890. doi: 10.1016/j.ijrobp.2017.11.047. Epub 2017 Dec 9. Int J Radiat Oncol Biol Phys. 2018. PMID: 29485067 Free PMC article.
Treatment Decision Regret Among Long-Term Survivors of Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study.J Clin Oncol. 2017 Jul 10;35(20):2306-2314. doi: 10.1200/JCO.2016.70.6317. Epub 2017 May 11. J Clin Oncol. 2017. PMID: 28493812 Free PMC article.
Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review.Med Decis Making. 2016 Aug;36(6):777-90. doi: 10.1177/0272989X16636113. Epub 2016 Mar 14. Med Decis Making. 2016. PMID: 26975351 Review.
Regret in Surgical Decision Making: A Systematic Review of Patient and Physician Perspectives.World J Surg. 2017 Jun;41(6):1454-1465. doi: 10.1007/s00268-017-3895-9. World J Surg. 2017. PMID: 28243695 Review.