Decision regret in patients with head-and-neck cancer undergoing radiotherapy

Head-and-neck cancer patients often face decisions between treatment options with similar oncological outcomes. In this context, decision regret becomes a central concern, particularly within the framework of shared decision-making. This study aims to assess the prevalence of decision regret and identify associated risk factors among head-and-neck cancer patients.

This cross-sectional observational study included patients who underwent curative radiotherapy for head-and-neck cancer. Decision regret was assessed using the Decision Regret Scale (DRS). Additional patient-reported outcomes included health-related quality of life (HRQoL), psychological distress, anxiety, depression, and fear of cancer progression (FoP).

Of 300 eligible patients, 192 participated and filled out the DRS. The median age was 59 years (IQR, 45-65), and the median time between the end of radiotherapy and study participation was 45.5 months (IQR, 24-68.5). No decision regret (0 points) in terms of radiotherapy was reported by 27 %, mild regret (1-25 points) by 34 %, and high regret (>25 points) by 39 %. The mean (SD) DRS score regarding radiotherapy, systemic treatment, and surgery was 23.6 (22.4), 20.8 (19.3), and 20.9 (22.2), respectively. Decision regret was associated with HRQoL (r = -0.34, p < 0.001), distress (r = 0.25, p < 0.001), anxiety (r = 0.20, p < 0.01), depression (r = 0.19, p < 0.01), and FoP (r = 0.29, p < 0.001). In the multiple regression, a poorer ECOG status (β = 0.18, p < 0.01), lower HRQoL (β = -0.22, p < 0.01), and higher FoP (β = 0.19, p < 0.05) were associated with decision regret.

More than one-third of head-and-neck cancer patients report high decision regret. These findings highlight the need for enhanced shared decision-making to mitigate decision regret in head-and-neck oncology.