Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
University Cancer Center Mainz, Mainz, Germany.
JAMA Otolaryngol Head Neck Surg. 2024 Aug 1;150(8):666-676. doi: 10.1001/jamaoto.2024.1422.
Clinicians should understand how patients who were treated with laryngeal cancer surgery think about this later on and what factors may be related with regretting surgery.
To assess variables associated with a positive attitude toward laryngeal cancer surgery.
DESIGN, SETTING, AND PARTICIPANTS: This combination of 2 cohorts, based on patient interviews and questionnaires, was studied in 16 hospitals in Germany. Participants scheduled for laryngeal cancer surgery were enrolled before surgery and followed up until 1 year after surgery. Data collection began on November 28, 2001, and ended on March 15, 2015. Statistical analysis was performed from August 21, 2023, to January 19, 2024.
The attitude toward surgery was measured with the Psychosocial Adjustment After Laryngectomy Questionnaire (scores range from 0 to 100, with high scores representing a positive attitude toward the surgery) at 1 year after surgery. In multivariate regression analysis, the following variables were investigated: type of surgery, number of surgeries to the larynx, receipt of radiotherapy and chemotherapy, quality of life, speech intelligibility (objectively measured), age, sex, educational level, employment status, having a partner or not, counseling by patient association, and shared decision-making.
Patients (n = 780; mean [SD] age, 60.6 [10.4] years; 701 [90%] male) who had received counseling from the patient association reported a more positive attitude toward surgery (adjusted B = 8.8; 95% CI, 1.0-16.6). Among patients after total laryngectomy, those with a university degree had a less positive attitude toward their surgery (adjusted B = -50.8; 95% CI, -84.0 to -17.6); this result was not observed in patients after partial laryngectomy (adjusted B = -4.8; 95% CI, -15.1 to 5.4). Among patients after partial laryngectomy, the attitude toward surgery was most positive in those who had experienced shared decision-making (mean [SD] questionnaire score, 84 [20] in those without a wish and 83 [20] in those with a wish for shared decision-making). Those who had wished they could decide together with the physician but where this eventually was not experienced expressed the most regret toward surgery (mean [SD] score, 71 [22]). There was no association between attitudes toward surgery and type of surgery (total vs partial laryngectomy) and all other variables tested.
In this cohort study, most patients with head and neck cancer reported a positive attitude toward surgery, suggesting low levels of decision regret. Counseling by members of patient associations as well as individualized shared decision-making prior to surgery may have a positive impact on decision regret and is advisable in daily practice.
临床医生应该了解接受喉癌手术治疗的患者对此的看法，以及哪些因素可能与对手术的后悔有关。
评估与对喉癌手术的积极态度相关的变量。
设计、地点和参与者：本研究基于患者访谈和问卷调查，由德国 16 家医院的两个队列组成。在接受喉癌手术前，对计划接受手术的患者进行了招募，并随访至术后 1 年。数据收集始于 2001 年 11 月 28 日，结束于 2015 年 3 月 15 日。统计分析于 2023 年 8 月 21 日至 2024 年 1 月 19 日进行。
术后 1 年采用喉切除术患者心理社会适应量表（得分范围为 0 至 100，得分越高表示对手术的态度越积极）评估手术态度。在多变量回归分析中，调查了以下变量：手术类型、喉手术次数、放疗和化疗、生活质量、言语可懂度（客观测量）、年龄、性别、教育水平、就业状况、是否有伴侣、患者协会咨询以及共同决策。
接受患者协会咨询的患者（n=780；平均[标准差]年龄为 60.6[10.4]岁；701[90%]为男性）对手术的态度更为积极（调整后的 B=8.8；95%CI，1.0-16.6）。全喉切除术患者中，具有大学学历的患者对手术的态度不那么积极（调整后的 B=-50.8；95%CI，-84.0 至-17.6）；而部分喉切除术患者则未观察到这种结果（调整后的 B=-4.8；95%CI，-15.1 至 5.4）。在接受部分喉切除术的患者中，最积极的手术态度出现在那些经历过共同决策的患者中（无意愿的患者平均（SD）问卷得分为 84（20），有共同决策意愿的患者平均（SD）问卷得分为 83（20））。那些希望能够与医生共同决策但最终未能如愿的患者对手术的后悔程度最高（平均[SD]评分，71[22]有此意愿和 71[22]无此意愿）。手术态度与手术类型（全喉切除术与部分喉切除术）和所有其他测试变量之间没有关联。
在这项队列研究中，大多数头颈部癌症患者对手术的态度为积极，这表明决策后悔的程度较低。在手术前接受患者协会成员的咨询以及个体化的共同决策可能对决策后悔产生积极影响，在日常实践中是明智的。
