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. 2023 Jun;35(6):e352-e361.
doi: 10.1016/j.clon.2023.03.015. Epub 2023 Mar 29.

Decision Regret among Patients with Early-stage Lung Cancer Undergoing Radiation Therapy or Surgical Resection

D R Sullivan  1 , J P Wisnivesky  2 , S M Nugent  3 , K Stone  2 , M K Farris  4 , J A Kern  5 , S Swanson  6 , C B Smith  7 , K Rosenzweig  8 , C G Slatore  9
Affiliations

Decision Regret among Patients with Early-stage Lung Cancer Undergoing Radiation Therapy or Surgical Resection

D R Sullivan et al. Clin Oncol (R Coll Radiol). 2023 Jun.

Abstract

Aims: Clinical equipoise exists regarding early-stage lung cancer treatment among patients as trials comparing stereotactic body radiation therapy (SBRT) and surgical resection are unavailable. Given the potential differences in treatment effectiveness and side-effects, we sought to determine the associations between treatment type, decision regret and depression.

Materials and methods: A multicentre, prospective study of patients with stage IA-IIA non-small cell lung cancer (NSCLC) with planned treatment with SBRT or surgical resection was conducted. Decision regret and depression were measured using the Decision Regret Scale (DRS) and Patient Health Questionnaire-4 (PHQ-4) at 3, 6 and 12 months post-treatment, respectively. Mixed linear regression modelling examined associations between treatment and decision regret adjusting for patient sociodemographics.

Results: Among 211 study participants with early-stage lung cancer, 128 (61%) patients received SBRT and 83 (39%) received surgical resection. The mean age was 73 years (standard deviation = 8); 57% were female; 79% were White non-Hispanic. In the entire cohort at 3 months post-treatment, 72 (34%) and 57 (27%) patients had mild and severe decision regret, respectively. Among patients who received SBRT or surgery, 71% and 46% of patients experienced at least mild decision regret at 3 months, respectively. DRS scores increased at 6 months and decreased slightly at 12 months of follow-up in both groups. Higher DRS scores were associated with SBRT treatment (adjusted mean difference = 4.18, 95% confidence interval 0.82 to 7.54) and depression (adjusted mean difference = 3.49, 95% confidence interval 0.52 to 6.47). Neither patient satisfaction with their provider nor decision-making role concordance was associated with DRS scores.

Conclusions: Most early-stage lung cancer patients experienced at least mild decision regret, which was associated with SBRT treatment and depression symptoms. Findings suggest patients with early-stage lung cancer may not be receiving optimal treatment decision-making support. Therefore, opportunities for improved patient-clinician communication probably exist.

Keywords: Decision making; depression; lung neoplasms; quality of life; radiation; thoracic surgery.

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Conflict of interest statement

Conflicts of Interest

J. Wisnivesky reports financial support was provided by National Institutes of Health. D. Sullivan reports financial support was provided by VA-Portland Health Care System. J. Wisnivesky reports a relationship with Atea Pharmaceuticals that includes: consulting or advisory. J. Wisnivesky reports a relationship with Sanofi that includes: consulting or advisory. J. Wisnivesky reports a relationship with Banook that includes: consulting or advisory. J. Wisnivesky reports a relationship with Regeneron Pharmaceuticals Inc that includes: funding grants. J. Wisnivesky reports a relationship with Sanofi that includes: funding grants. J. Wisnivesky reports a relationship with Arnold Consultants that includes: funding grants.

Figures

Fig 1.
Fig 1.
Longitudinal decision regret at 3, 6 and 12 months by treatment group. Decision Regret Scale (DRS) scores were consistently higher among patients who received stereotactic body radiation therapy (SBRT) compared to surgical resection at every time point (3, 6 and 12 months post-treatment). At 3 months among patients who received SBRT, 37 (29%), 45 (35%) and 46 (36%) patients had no, mild and severe decision regret, respectively. At 3 months among patients who received surgery, 45 (54%), 27 (33%) and 11 (13%) patients had no, mild and severe decision regret, respectively. The mean DRS scores for patients who received SBRT and surgical resection increased at 6 months and then decreased at 12 months. At 12 months post-treatment, 54 (63%) SBRT and 25 (42%) surgical resection patients experienced at least mild decision regret. Error bars = standard error.
Fig 2.
Fig 2.
Consort diagram.
See this image and copyright information in PMC

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