Decision regret in patients with rectal cancer undergoing multimodal therapy

This study examines decision regret (DR) in patients with locally advanced rectal cancer (UICC II/III) after multimodal treatment. We assessed prevalence, risk factors, and the impact of treatment schedules on DR.

In this bicenter cross-sectional observational study, DR was measured using the 5-item Decision Regret Scale. Additional validated questionnaires assessed quality of life (QoL), fear of progression (FoP) and recurrence (FoR), depression and anxiety, social support, and perceived participation in decision-making (PDM). Parametric tests and linear regression were used for group comparisons and predictor analysis.

157 patients were included in the final analysis (mean age 68.8 ± 9.4 years; 67% male). The mean interval between radiotherapy (RT) and survey completion was 35.1 ± 19.8 months; 76.6% underwent surgical resection and 23.4% organ-preserving treatment. DR following RT was reported from 111 patients (70.7%), with 50 patients (31.8%) showing severe DR (>25 points). DR was correlated with FoP (r = 0.26, p < 0.001), FoR (r = 0.29, p < 0.001), and psychological distress (r = 0.28, p < 0.001). Conversely, DR was negatively correlated with PDM (r =  - 0.23, p = 0.004) and QoL (r =  - 0.40, p < 0.001). DR did not differ significantly between organ-preserving and trimodal treatment (p = 0.095) or between treatment modalities (p = 0.821). Multivariable regression analysis revealed lower global QoL (p = 0.026) and PDM (p = 0.019) to be independently associated with DR.

DR was observed in a considerable proportion of patients in our cohort, underscoring its clinical relevance. DR was independently associated with worse QoL and lower PDM. Future studies should examine predictors of DR in larger, longitudinal cohorts and assess interventions to reduce DR.