Wang Naomi C, Ramesh Uma R, Feucht Maria, Alapati Rahul, Wagoner Sarah F, Nallani Rohit, Kakarala Kiran, Shnayder Yelizaveta, Hamill Chelsea S, Sykes Kevin J, Bur Andrés M
Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Otolaryngol Head Neck Surg. 2025 Apr;172(4):1318-1327. doi: 10.1002/ohn.1151. Epub 2025 Jan 31.
This study aims to identify factors associated with increased decision regret (DR) 12 months following treatment among head and neck cancer (HNC) patients.
A retrospective observational cohort study.
Patients with newly diagnosed HNC at an academic tertiary care center from 2018 to 2023.
Data from a patient registry assessing quality of life (QOL), DR, social support, and anxiety at initial diagnosis and 12 months post-treatment were analyzed. Only patients who completed the decision regret questionnaire at 12 months were included.
Among 225 participants, 60% experienced mild DR and 28% reported moderate to severe regret. Stronger regret was associated with advanced disease presentation, free flap reconstructive surgery, chemoradiation, and disease recurrence. Patients with more severe regret had lower QOL at baseline and 12 months, higher anxiety at 12 months, and lower social support at 12 months. Multivariable analysis identified multimodal treatment including radiation (adjusted odds ratio [aOR] 3.67, 95% confidence interval [CI] [1.25-10.78], P = .018), lower 12-month social support (aOR 1.03, 95% CI [1.00-1.05], P = .039), and decreases in QOL (aOR 1.03, 95% CI [1.00-1.06], P = .024) as independent predictors of increased DR.
Treatment involving radiation, lower concurrent social support, and diminished QOL are associated with DR 12 months after treatment. This highlights the potential of interventions aimed at enhancing social support, addressing treatment-related sequelae, and strengthening shared decision-making to prevent regret. Further studies are needed to elucidate factors driving regret in HNC patient subgroups and assess the efficacy of proposed mitigative interventions.
本研究旨在确定头颈部癌（HNC）患者治疗后12个月时与决策后悔（DR）增加相关的因素。
一项回顾性观察队列研究。
2018年至2023年在一家学术性三级医疗中心新诊断为HNC的患者。
分析了来自患者登记处的数据，这些数据评估了初始诊断时以及治疗后12个月时的生活质量（QOL）、DR、社会支持和焦虑情况。仅纳入在12个月时完成决策后悔问卷的患者。
在225名参与者中，60%经历了轻度DR，28%报告有中度至重度后悔。更强的后悔与疾病晚期表现、游离皮瓣重建手术、放化疗以及疾病复发相关。后悔程度更严重的患者在基线和12个月时的QOL较低，在12个月时焦虑程度较高，在12个月时社会支持较低。多变量分析确定多模式治疗（包括放疗）（调整后的优势比[aOR]为3.67，95%置信区间[CI][1.25 - 10.78]，P = 0.018）、12个月时较低的社会支持（aOR为1.03，95% CI[1.00 - 1.05]，P = 0.039）以及QOL下降（aOR为1.03，95% CI[1.00 - 1.06]，P = 0.024）是DR增加的独立预测因素。
涉及放疗、同期社会支持较低以及QOL降低的治疗与治疗后12个月的DR相关。这突出了旨在增强社会支持、解决与治疗相关的后遗症以及加强共同决策以预防后悔的干预措施的潜力。需要进一步研究以阐明HNC患者亚组中导致后悔的因素，并评估所提议的缓解干预措施的疗效。
