Decision regret 3 and 6 months after treatment for head and neck cancer: Observational study of associations with clinicodemographics, anxiety, and quality of life

Nallani, Rohit; Smith, Jane Kapler; Penn, Joseph; Bur, Andrés M.; Kakarala, Kiran; Shnayder, Yelizaveta; Villwock, Mark R.; Sykes, Kevin J.

doi:10.1002/hed.26911

Cited by 15 publications

(46 citation statements)

References 56 publications

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“…Adult patients eligible for enrollment into the KUMC Head and Neck Registry were those receiving primary evaluation and treatment for HNSCC at KUMC, a tertiary care referral center. This registry has been described in detail in prior work . Patients who completed radiation therapy between September 2018 and June 2022 were included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy

Sawaf

Virgen

Renslo

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceTimely initiation of postoperative radiation therapy (PORT) is associated with reduced recurrence rates and improved overall survival in patients with head and neck squamous cell carcinoma (HNSCC). Measurement of the association of social-ecological variables with PORT delays is lacking.ObjectiveTo assess individual and community-level factors associated with PORT delay among patients with HNSCC.Design, Setting, and ParticipantsThis prospective cohort study carried out between September 2018 and June 2022 included adults with untreated HNSCC who were enrolled in a prospective registry at a single academic tertiary medical center. Demographic information and validated self-reported measures of health literacy were obtained at baseline visits. Clinical data were recorded, and participant addresses were used to calculate the area deprivation index (ADI), a measure of community-level social vulnerability. Participants receiving primary surgery and PORT were analyzed. Univariable and multivariable regression analysis was performed to identify risk factors for PORT delays.ExposuresSurgical treatment and PORT.Main Outcomes and MeasuresThe primary outcome was PORT initiation delay (&gt;42 days from surgery). Risk of PORT initiation delay was evaluated using individual-level (demographic, health literacy, and clinical data) and community-level information (ADI and rural-urban continuum codes).ResultsOf 171 patients, 104 patients (60.8%) had PORT delays. Mean (SD) age of participants was 61.0 (11.2) years, 161 were White (94.2%), and 105 were men (61.4%). Insurance was employer-based or public among 65 (38.5%) and 75 (44.4%) participants, respectively. Mean (SD) ADI (national percentile) was 60.2 (24.4), and 71 (41.8%) resided in rural communities. Tumor sites were most commonly oral cavity (123 [71.9%]), with 108 (63.5%) classified as stage 4 at presentation. On multivariable analysis, a model incorporating individual-level factors with health literacy in addition to community-level factors was most predictive of PORT delay (AOC= 0.78; R2, 0.18).Conclusions and RelevanceThis cohort study provides a more comprehensive assessment of predictors of PORT delays that include health literacy and community-level measures. Predictive models that incorporate multilevel measures outperform models with individual-level factors alone and may guide precise interventions to decrease PORT delay for at-risk patients with HNSCC.

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Section: Methodsmentioning

confidence: 99%

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy

Sawaf

Virgen

Renslo

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…Further details from the registry have previously been published. 17 Participants included in the analysis were enrolled in the registry between June 2018 and January 2022. This study was approved by the KUMC Institutional Review Board (IRB), IRB #1732.…”

Section: Methodsmentioning

confidence: 99%

Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys

Renslo

Sawaf

Virgen

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveIn patients with head and neck squamous cell carcinoma (HNSCC), initiating postoperative radiotherapy (PORT) greater than 42 days after surgery is associated with a higher risk of poor survival outcomes. Social support has been shown to modulate behaviors related to care‐seeking and treatment adherence. In this study, we sought to determine the relationship between social support metrics and PORT delays.Study DesignProspective cohort study.SettingSingle tertiary medical center.MethodsPatients with HNSCC who underwent primary surgical excision requiring PORT were prospectively enrolled. Patient‐perceived social support metrics were assessed using the Medical Outcomes Study Social Support Survey (MOS‐SSS) at initial presurgical evaluation. Associations with PORT delays were evaluated via univariable and multivariable logistic regression analysis.ResultsA total of 111 patients met the inclusion criteria for the study. An additional 28 patients were recommended to receive PORT but did not initiate treatment and were included for secondary analysis. All four subscales of the MOS‐SSS (positive social interaction, affectionate support, tangible support, and emotional/informational support) were significantly associated with PORT initiation delays on univariable analysis. On multivariable analysis, the overall MOS‐SSS score (odds ratio [OR] 2.08, 1.15‐4.35, p = .028) was significantly associated with PORT initiation delays. On secondary analysis, lower tangible support was associated with a lack of PORT initiation (OR 1.63, 1.05‐2.54, p = .028).ConclusionSocial support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high‐risk patients.

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“…(IQR) time since surgery was 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) months. Participant characteristics are presented in Table 1.…”

Section: Key Pointsmentioning

confidence: 99%

“…Nearly half of patients with HNC experience clinically significant decisional conflict during this time . Posttreatment decision regret (DR) is associated with lower quality of life and higher anxiety …”

Section: Introductionmentioning

confidence: 99%

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Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

Dattilo,

Russell,

Warinner

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceMajor head and neck surgery with microvascular free tissue transfer reconstruction is complex, with considerable risk of morbidity. Little is known about patients’ experiences, including decision-making prior to, and regret following, free flap surgery.ObjectiveTo characterize patient experiences and decision regret of patients undergoing head and neck reconstructive free flap surgery.Design, Setting, and ParticipantsThis mixed-methods cohort study comprising semistructured interviews was conducted June to August 2021 at a single tertiary academic cancer center. Participants underwent head and neck reconstructive surgery with microvascular free tissue transfer (flap) more than 3 months before recruitment (range, 3 months to 4 years). Interview transcripts were qualitatively analyzed for themes. Participants also completed a Decision Regret Scale questionnaire.ExposureMicrovascular free flap surgery for head and neck reconstruction.Main Outcomes and MeasuresThematic analysis of interviews, decision regret score.ResultsSeventeen participants were interviewed. Median (IQR) age was 61 (52-70) years. Overall, 7 participants were women (49%), and 10 of 17 were men (59%). The most common free flap was fibula (8/17, 47%). Three major themes with 9 subthemes were identified: theme 1 was the tremendous effect of preoperative counseling on surgical decision-making and satisfaction, with subthemes including (1) importance of clinical care team counseling on decision to have surgery; (2) emotional context colors preoperative understanding and retention of information; (3) expectation-setting affects satisfaction with preoperative counseling; and (4) desire for diversified delivery of preoperative information. Theme 2 was coexisting and often conflicting priorities, including (1) desire to survive above all else, and (2) desire for quality of life. Theme 3 was perception of surgery as momentous and distressing, including (1) surgery as a traumatic event; (2) centrality of mental health, emotional resolve, and gratitude to enduring surgery and recovery; and (3) sense of accomplishment in recovery. On the Decision Regret Scale, most participants had no regret (n = 8, 47%) or mild regret (n = 5, 29%); 4 had moderate-to-severe regret (24%).Conclusions and RelevanceIn this mixed-methods cohort study, patient experiences surrounding major head and neck reconstructive free flap surgery were described. Opportunities to improve support for this complex and vulnerable population, and to mitigate decision regret, were identified.

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Decision regret 3 and 6 months after treatment for head and neck cancer: Observational study of associations with clinicodemographics, anxiety, and quality of life

Cited by 15 publications

References 56 publications

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy

Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys

Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

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