{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:13:49Z","timestamp":1790140429860,"version":"4.0.1"},"reference-count":49,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2025,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010reported outcomes (PRO) and clinician\u2010rated tolerability metrics over 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201325], and moderate\/severe [&gt;25]) and PROs (symptoms, functional status, and satisfaction with treatment) were assessed at 4\u20136 weeks, 3 months, and 6 months after treatment initiation and compared with ANOVA. Associations between clinician\u2010rated grade &gt;3 toxicities, and treatment\u2010related hospitalizations and DR were examined with longitudinal linear mixed modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data from 623 patients (M\u00a0=\u00a077 years, 43% female, mixed diagnoses) who completed the DR scale at least once were analyzed. At 4\u20136 weeks, mean DR was 17.1 (SD\u00a0=\u00a015.7), 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\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.05). At 6 months, mean DR was 3.9 points higher (95% confidence interval [CI], 1.1\u20136.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.006) in patients with any grade &gt;3 toxicities and 6.8 points higher (95% CI, 3.4\u201310.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) in patients with treatment\u2010related hospitalization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DR changes over time and is associated with worse PROs and clinician\u2010rated toxicity. Clinicians can discuss DR and poor tolerability in conversations about high\u2010risk cancer treatment with older adults who have advanced cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>NCT02054741<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70023","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T14:41:25Z","timestamp":1761144085000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Decision regret in older adults with advanced cancer receiving systemic therapy: Associations with patient\u2010reported and clinician\u2010rated tolerability metrics"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2957-8482","authenticated-orcid":false,"given":"Marie A.","family":"Flannery","sequence":"first","affiliation":[{"name":"School of Nursing University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Culakova","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center alumni  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kah Poh","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology\/Oncology James P. Wilmot Cancer Institute University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Canin","sequence":"additional","affiliation":[{"name":"Patient Advocate and Board Member University of Rochester Medical Center and NIH Tolerability Consortium  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael G.","family":"Tylock","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology\/Oncology James P. Wilmot Cancer Institute University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5171-2968","authenticated-orcid":false,"given":"Fiona A.","family":"Stauffer","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology\/Oncology James P. Wilmot Cancer Institute University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2936-5794","authenticated-orcid":false,"given":"Mostafa","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Public Health Sciences Department of Medicine University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3144-3544","authenticated-orcid":false,"given":"Hongying","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supriya","family":"Mohile","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology\/Oncology James P. 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