DISTRESS AND DECISIONAL REGRET AFTER THE SURGICAL DECISION FOR EARLY STAGE BREAST CANCER

PURPOSE  Breast cancer and the associated surgical treatment decisions are stressful.  To help women newly diagnosed with breast cancer, an integrated decision support program was developed.  As patients become more involved in their treatment decisions, the potential for decision regret may increase. The purpose of this study was 2-fold: to monitor patient distress over time and to assess decisional regret for the surgery decision for women with early stage breast cancer.       

METHODS  From March 2004 – January 2008, we followed a prospective cohort of women diagnosed with early stage breast cancer. Study participants: 1) completed a baseline questionnaire capturing clinical and decision making data, 2) viewed a video-based decision aid (DA) about surgical treatment options, 3) proceeded to their surgical consultation, and 4) completed follow-up questionnaires at 4 weeks and 1 year post surgery. Screening instruments: Distress thermometer, Decisional Regret scale, and SF-8.

RESULTS  119 women (81 breast conserving surgery [BCS], 38 mastectomy) completed questionnaires at the 3 time points.  Almost all (98%) had low decisional regret regarding their surgery choices - (1 BCS and 1 mastectomy participant indicated regret). Distress thermometer scores were significantly lower at 4 weeks and at 1 year (p < .01).  SF-8 mental summary scores (MCS) also improved over time (p < .01).  SF-8 physical summary scores (PCS) were lower at 4 weeks (p < .01), likely due to surgical recovery;  PCS scores at 1 year improved, but were still below baseline levels (p < .01).

CONCLUSIONS  Distress in this cohort was moderate at the time of diagnosis. At follow-up these participants showed improvement in distress and SF-8 MCS scores and had low levels of decisional regret.  These results suggest that when offered a decision support program that provides current, comprehensive information about the risks and benefits of their surgery options for early stage breast cancer, women are likely to be comfortable with their surgery decision up to 1 year later.

Screening N=119  mean(sd)	Baseline	4 week follow-up	1 year  follow-up * (p < .01)
Distress thermometer	4.4 (2.5)	3.0 (2.7)*	2.0 (2.5)*
SF-8 Mental summary	49.8 (8.7)	51.5 (8.2)	52.1 (8.3)*
SF-8 Physical summary	54.9 (6.9)	48.2 (8.5)*	52.0 (7.3)*