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PSM

PSM Abstract Session 1

8: Decision Regret in Appendiceal Cancer Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Saturday, February 17, 2024
10:25 AM - 10:35 AM AST
Location: Miramar I & II
Disclosure(s):
Alissa Greenbaum, MD: No financial relationships to disclose
Divya Sood, MD: No financial relationships to disclose
Introduction: Decision regret is an emerging patient reported outcome and has not been previously measured in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).  The aim of this study was to assess the incidence of regret in patients with appendiceal cancer (AC) who underwent CRS-HIPEC and correlation to clinical outcomes.


Methods:

An anonymous, IRB-exempt survey was distributed to patients through the Appendix Cancer and Pseudomyxoma Peritonei (ACPMP) Research Foundation.  The Decision Regret Scale (DRS) is a validated clinical tool, with scores ranging from 0 (no regret) to 100 (high regret).  In this study, DRS > 25 signified regret.  Patients with incomplete DRS or did not undergo CRS-HIPEC were excluded. Patient demographics, tumor characteristics, postoperative outcomes and gastrointestinal specific symptoms assessed by the Colorectal Cancer Subscale (CSS) Score were compared between patients who regretted or did not regret (NO-REG) the procedure.


Results:

A total of 122 patients met inclusion criteria.  DRS responses for the entire cohort are shown in Figure 1. The majority of patients had no regret about undergoing CRS-HIPEC (n=104, 85.2%) and 18 patients expressed regret (14.8%).  Patients with income in the lower 3 quartiles (≤ $74,062) had higher regret (72.2 vs. 44.2% NO-REG; p=0.028).  There were no differences between histology types, travel distance from the CRS-HIPEC center, or synchronicity of metastases.  Patients had higher regret if they had major complications within 30 days of surgery (55.6 vs. 15.4% NO-REG; p< 0.001), spent > 30 days in the hospital (38.9 vs. 4.8% NO-REG; p< 0.001), required an ostomy (27.8 vs. 7.7% NO-REG; p=0.03), or had more than 1 CRS-HIPEC procedure (56.3 vs. 12.6% NO-REG; p< 0.001).  The mean CSS score was lower, demonstrating worse symptoms, in patients with regret (14.0 +/- 4.2; p< 0.001) vs. NO-REG (19.9 +/- 4.36).  In preliminary multivariable analysis, >30 days in the hospital (p=0.005) and >1 CRS-HIPEC procedure (p=0.044) was associated with regret.


Conclusions:

The vast majority of patients with AC undergoing CRS-HIPEC do not regret undergoing the procedure. Patients with lower income, postoperative complications, an ostomy, or who underwent 2 or more procedures, and have worse long-term gastrointestinal symptoms experience increased levels of regret.  Improved preoperative counseling, postoperative psychologic support and symptom management may assist to ameliorate regret. Future studies will examine the relationship of regret to financial toxicity after CRS-HIPEC. 

Learning Objectives:

  • Define the intent and calculation of the Decision Regret Scale clinical tool
  • List the clinical outcomes that are associated with regret after CRS-HIPEC
  • Identify areas of improvement and possible interventions for patients prior to and after CRS-HIPEC