Sociodemographic and Clinical Determinants of 12-Month Decision Regret for Head and Neck Cancer Patients.

Abstract

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.