{"doi":"10.1002/cncr.70023","title":"Decision regret in older adults with advanced cancer receiving systemic therapy: Associations with patient‐reported and clinician‐rated tolerability metrics","abstract":"BACKGROUND: Decision regret (DR) (distress or remorse after a treatment decision) has received limited examination in older adults with advanced cancer. The authors hypothesized that DR would change over time and be associated with worse patient-reported outcomes (PRO) and clinician-rated tolerability metrics over 6 months. METHODS: Adults aged 70+ with advanced cancer planning to receive systemic treatment were recruited from a national trial (GAP70+, NCT02054741). DR level (none (0), mild [1-25], and moderate/severe [>25]) and PROs (symptoms, functional status, and satisfaction with treatment) were assessed at 4-6 weeks, 3 months, and 6 months after treatment initiation and compared with ANOVA. Associations between clinician-rated grade >3 toxicities, and treatment-related hospitalizations and DR were examined with longitudinal linear mixed modeling. RESULTS: Data from 623 patients (M = 77 years, 43% female, mixed diagnoses) who completed the DR scale at least once were analyzed. At 4-6 weeks, mean DR was 17.1 (SD = 15.7), with 50% reporting mild DR and 21% moderate/severe DR. Patients experiencing higher DR reported significantly higher concurrent symptom severity, lower functional scores, and lower treatment satisfaction (all p < .05). At 6 months, mean DR was 3.9 points higher (95% confidence interval [CI], 1.1-6.7, p = .006) in patients with any grade >3 toxicities and 6.8 points higher (95% CI, 3.4-10.2, p < .001) in patients with treatment-related hospitalization. CONCLUSIONS: DR changes over time and is associated with worse PROs and clinician-rated toxicity. Clinicians can discuss DR and poor tolerability in conversations about high-risk cancer treatment with older adults who have advanced cancer. CLINICAL TRIALS REGISTRATION: NCT02054741.","journal":"Cancer","year":2025,"id":542512,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":2,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9518,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02054741"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":845685,"name":"Zhihong Zhang","orcid":"0000-0002-9948-8936","position":1,"is_corresponding":false},{"id":266567,"name":"Eva Culakova","orcid":"0000-0002-9852-6515","position":2,"is_corresponding":false},{"id":266580,"name":"Kah Poh Loh","orcid":"0000-0002-6978-0418","position":3,"is_corresponding":false},{"id":584603,"name":"Beverly Canin","orcid":"0000-0001-7864-1121","position":4,"is_corresponding":false},{"id":996260,"name":"Rachael Tylock","orcid":"0000-0002-5348-4470","position":5,"is_corresponding":false},{"id":1103146,"name":"Fiona Stauffer","orcid":"0009-0009-5171-2968","position":6,"is_corresponding":false},{"id":266571,"name":"Mostafa Mohamed","orcid":"0000-0003-2936-5794","position":7,"is_corresponding":false},{"id":882069,"name":"Hongying Sun","orcid":"0000-0003-3144-3544","position":8,"is_corresponding":false},{"id":266566,"name":"Supriya G. Mohile","orcid":"0000-0003-0867-327X","position":9,"is_corresponding":false},{"id":266574,"name":"Marie Flannery","orcid":"0000-0003-2957-8482","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-19T02:52:55.809501Z","pmid":"41123568","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}