Decision regret in older adults with advanced cancer receiving systemic therapy: Associations with patient-reported and clinician-rated tolerability metrics.
Decision regret (DR) (distress or remorse after a treatment decision) has received limited examination in older adults with advanced cancer. The authors hypothesized that DR would change over time and be associated with worse patient-reported outcomes (PRO) and clinician-rated tolerability metrics over 6 months.
Adults aged 70+ with advanced cancer planning to receive systemic treatment were recruited from a national trial (GAP70+, NCT02054741). DR level (none (0), mild [1-25], and moderate/severe [>25]) and PROs (symptoms, functional status, and satisfaction with treatment) were assessed at 4-6 weeks, 3 months, and 6 months after treatment initiation and compared with ANOVA. Associations between clinician-rated grade >3 toxicities, and treatment-related hospitalizations and DR were examined with longitudinal linear mixed modeling.
Data from 623 patients (M = 77 years, 43% female, mixed diagnoses) who completed the DR scale at least once were analyzed. At 4-6 weeks, mean DR was 17.1 (SD = 15.7), with 50% reporting mild DR and 21% moderate/severe DR. Patients experiencing higher DR reported significantly higher concurrent symptom severity, lower functional scores, and lower treatment satisfaction (all p < .05). At 6 months, mean DR was 3.9 points higher (95% confidence interval [CI], 1.1-6.7, p = .006) in patients with any grade >3 toxicities and 6.8 points higher (95% CI, 3.4-10.2, p < .001) in patients with treatment-related hospitalization.
DR changes over time and is associated with worse PROs and clinician-rated toxicity. Clinicians can discuss DR and poor tolerability in conversations about high-risk cancer treatment with older adults who have advanced cancer.
NCT02054741.
Adults aged 70+ with advanced cancer planning to receive systemic treatment were recruited from a national trial (GAP70+, NCT02054741). DR level (none (0), mild [1-25], and moderate/severe [>25]) and PROs (symptoms, functional status, and satisfaction with treatment) were assessed at 4-6 weeks, 3 months, and 6 months after treatment initiation and compared with ANOVA. Associations between clinician-rated grade >3 toxicities, and treatment-related hospitalizations and DR were examined with longitudinal linear mixed modeling.
Data from 623 patients (M = 77 years, 43% female, mixed diagnoses) who completed the DR scale at least once were analyzed. At 4-6 weeks, mean DR was 17.1 (SD = 15.7), with 50% reporting mild DR and 21% moderate/severe DR. Patients experiencing higher DR reported significantly higher concurrent symptom severity, lower functional scores, and lower treatment satisfaction (all p < .05). At 6 months, mean DR was 3.9 points higher (95% confidence interval [CI], 1.1-6.7, p = .006) in patients with any grade >3 toxicities and 6.8 points higher (95% CI, 3.4-10.2, p < .001) in patients with treatment-related hospitalization.
DR changes over time and is associated with worse PROs and clinician-rated toxicity. Clinicians can discuss DR and poor tolerability in conversations about high-risk cancer treatment with older adults who have advanced cancer.
NCT02054741.
Authors
Flannery Flannery, Zhang Zhang, Culakova Culakova, Loh Loh, Canin Canin, Tylock Tylock, Stauffer Stauffer, Mohamed Mohamed, Sun Sun, Mohile Mohile
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