Haack Lars, Krug David, Rodler Severin, Nuhn Philipp, van der Horst Christof, Schulz Christian, Wittenstein Olaf, Schmalz Claudia, Blanck Oliver, Siebert Frank-André, Fabian Alexander
Department of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str.3, 24105, Kiel, Germany.
Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
World J Urol. 2025 Apr 9;43(1):220. doi: 10.1007/s00345-025-05615-3.
Patients with localized prostate cancer have various treatment options. Decision regret from a patient's view is an unpleasant feeling concerning a decision in health care. We aimed to explore regret and its determinants after external beam radiotherapy (EBRT) with a high dose-rate brachytherapy (HDR-BT) boost as traditional method of treatment intensification.
We conducted a secondary analysis of a cross-sectional study. Patients were enrolled at least two years after EBRT + HDR-BT. Decision regret was measured using the Decision Regret Scale (0-100). Covariables included patient characteristics, dose to organs at risk and patient-reported outcomes (PRO) including EPIC- 26, EORTC QLQ-C30, and PSCC. We used Pearson's correlation and one-way ANOVA analyses.
Among 108 patients, the median age was 73 and the median interval since treatment was 4 years. The mean score of decision regret was 11 (SD: 14). No (0), mild (1-25), or strong (> 25) decision regret was present in 49% (53/108), 39% (42/108), and 12% (13/108) of the patients, respectively. PRO were associated with stronger decision regret including worse urinary incontinence (r = - 0.198; p = 0.046), worse urinary irritative/obstructive symptoms (r = - 0.203; p = 0.045), worse bowel function (r = - 0.312; p = 0.001), worse hormonal function (r = - 0.289; p = 0.003), lower levels of shared-decision making (r = - 0.292; p = 0.002), and lower patient satisfaction (r = - 0.326; p < 0.001).
Long-term decision regret is mild among patients with prostate cancer treated with EBRT + HDR-BT. PRO were associated with decision regret which should be respected in clinical practice.
The study protocol was registered prior to patient accrual on the Open Science Framework (doi.org/10.17605/OSF.IO/A6DC3).
局限性前列腺癌患者有多种治疗选择。从患者角度来看，决策后悔是一种关于医疗保健决策的不愉快情绪。我们旨在探讨在采用高剂量率近距离放射治疗（HDR - BT）增强的外照射放疗（EBRT）作为传统治疗强化方法后，后悔情绪及其决定因素。
我们对一项横断面研究进行了二次分析。患者在接受EBRT + HDR - BT至少两年后入组。使用决策后悔量表（0 - 100）测量决策后悔程度。协变量包括患者特征、危及器官的剂量以及患者报告的结局（PRO），包括EPIC - 26、欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ - C30）和前列腺癌症状困扰量表（PSCC）。我们采用了Pearson相关性分析和单因素方差分析。
108例患者中，年龄中位数为73岁，治疗后间隔时间中位数为4年。决策后悔的平均得分为11分（标准差：14）。分别有49%（53/108）、39%（42/108）和12%（13/108）的患者不存在（0分）、有轻度（1 - 25分）或强烈（> 25分）的决策后悔。PRO与更强的决策后悔相关，包括更严重的尿失禁（r = - 0.198；p = 0.046）、更严重的尿路刺激/梗阻症状（r = - 0.203；p = 0.045）、更差的肠道功能（r = - 0.312；p = 0.001）、更差的激素功能（r = - 0.289；p = 0.003）、更低的共同决策水平（r = - 0.29
