Regret concerning treatment decisions in patients with primary or secondary brain tumors - a cross-sectional...

To determine the extent of decisional regret (DR) and contributing factors after treatment of primary and secondary brain tumors (BT).

Patients who received radiotherapy (RT) for a BT between 2010 and 2024 were eligible for this bicentric cross-sectional study. DR was assessed using the 5-item Decision Regret Scale (DRS). Overall and treatment-specific DR was determined. Besides DR, health related quality of life (HRQoL), distress, anxiety, depression, and satisfaction with medical care were determined. Associations between DR and covariates were examined in univariate analyses. Linear regression models were calculated for multivariable analyses.

From 310 eligible contacted patients, 162 were included. Ninety-four patients (58%) suffered from malignant glioma, and 68 (42%) had brain metastases (BM). Median age was 58 years, median interval between the last RT fraction and study participation 22 months. Thirty-two patients (20%) reported no, 85 (53%) mild, and 45 (28%) strong overall DR. Regarding their decision towards specific treatments, 37 patients (23%) expressed strong DR concerning RT, 45 (30%) regarding chemotherapy, and 29 patients (20%) with regard to brain surgery. Global HRQoL was inversely correlated to DR (r = -0.35, p < 0.001). Physical functioning (r = -0.33, p < 0.001) and social functioning (r = -0.32, p < 0.001) demonstrated moderate correlation. As symptoms, fatigue (r = 0.32, p < 0.001), future uncertainty (r = 0.37, p < 0.001), motor dysfunction (r = 0.32, p < 0.001), depression (r = 0.37, p < 0.001) and satisfaction with medical care (r = -0.39, p < 0.001) showed strong correlations with DR. In multivariable linear regression, low satisfaction with medical care, unemployment, future uncertainty and BM stayed associated with DR.

DR is frequent in patients with BT. Rather than treatment-related, low satisfaction with medical care and unemployment/financial uncertainty appear particularly linked to higher DR.