DECISION REGRET FOLLOWING TREATMENT FOR LOCALIZED BREAST CANCER: IS REGRET STABLE OVER TIME?

Purpose: Although studies suggest most women have little regret with their breast cancer treatment decisions, few (or no) studies have evaluated whether decision regret changes over time, particularly as women experience disease complications or recurrence.

Method: Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan or Los Angeles County SEER registry completed surveys at two time points: nine months following diagnosis (time 1) and again approximately four years later (time 2). A decision regret scale (adapted from Brehaut, 2003) consisting of 5 items was completed at both time points. Item responses were summed to create a regret score at both nine months and four years (scales of 5 to 25 points; higher values indicate higher regret). We used multivariable linear regression to examine change in regret from nine months to four years. Primary independent variables included surgery type (breast conserving surgery, unilateral mastectomy, bilateral mastectomy), invasive versus non-invasive disease, and recurrence status (yes/no) at follow-up. We included an interaction between surgery type and recurrence status at time 2. The model controlled for patient demographic and clinical factors.

Result: The analytic sample included 1,497 women who responded to both surveys. Mean decision regret at nine months was 9.5 points; mean regret at four years was 10.1 points (range 5-25) (NS). Two-thirds (64%) of respondents had breast conserving surgery, 26% had unilateral mastectomy, and 9% had bilateral mastectomy. We found no impact of surgery type on change in decision regret in the overall sample. However, among the, 86 (6%) women who experienced a recurrence, those who underwent unilateral mastectomy reported significant reduction in decision regret over time relative to recurrent women who underwent breast conserving surgery (d= -6.76, p=0.024). Average change in regret among non-recurrent women was 0.52 points and was 2.7 points for women who recurred. 

Conclusion: Decision regret in breast cancer is generally stable over time, yet changes in regret appear to be associated with disease trajectory and treatment received. Our results suggest that more extensive treatment is associated with a reduction in decision regret only when women experience a recurrence. Understanding patients’ assessment of their own decisions related to treatment may be useful for informing future decision making processes.