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. 2019 Nov;10(6):973-979.
doi: 10.1016/j.jgo.2019.03.013. Epub 2019 Mar 30.

Long-term Decision Regret Surrounding Systemic Therapy in Older Breast Cancer Survivors: A Population-Based Survey Study

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Long-term Decision Regret Surrounding Systemic Therapy in Older Breast Cancer Survivors: A Population-Based Survey Study

Meghan Sri Karuturi et al. J Geriatr Oncol. .

Abstract

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.

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