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Abstract：
Background: It is important to understand cancer survivors\' perceptions about their treatment decisions and quality of life. Methods: We performed a prospective observational cohort study of Canadian patients with small (<2 cm) low-risk papillary thyroid cancer (PTC) who were offered the choice of active surveillance (AS) or surgery (Clinicaltrials.gov NCT03271892). Participants completed a questionnaire one year after their treatment decision. The primary intention-to-treat analysis compared the mean decision regret scale total score between patients who chose AS or surgery. A secondary analysis examined one-year decision regret score according to treatment status. Secondary outcomes included quality of life, mood, fear of disease progression, and body image perception. We adjusted for age, sex, and follow-up duration in linear regression analyses. Results: The overall questionnaire response rate was 95.5% (191/200). The initial treatment choices of respondents were AS 79.1% (151/191) and surgery 20.9% (40/191). The mean age was 53 years (standard deviation [SD] 15 years) and 77% (147/191) were females. In the AS group, 7.3% (11/151) of patients crossed over to definitive treatment (two for disease progression) before the time of questionnaire completion. The mean level of decision regret did not differ significantly between patients who chose AS (mean 22.4, SD 13.9) or surgery (mean 20.9, SD 12.2) in crude (p = 0.730) or adjusted (p = 0.29) analyses. However, the adjusted level of decision regret was significantly higher in patients who initially chose AS and crossed over to surgery (beta coefficient 10.1 [confidence interval; CI 1.3-18.9], p = 0.02), compared with those remaining under AS. In secondary adjusted analyses, respondents who chose surgery reported that symptoms related to their cancer or its treatment interfered with life to a greater extent than those who chose AS (p = 0.02), but there were no significant group differences in the levels of depression, anxiety, fear of disease progression, or overall body image perception. Conclusions: In this study of patients with small, low-risk PTC, the mean level of decision regret pertaining to the initial disease management choice was relatively low after one year and it did not differ significantly for respondents who chose AS or surgery.
摘要：
背景：了解癌症幸存者对其治疗决策和生活质量的看法非常重要。方法：我们对加拿大小（<2cm）低危甲状腺乳头状癌（PTC）患者进行了一项前瞻性观察性队列研究，这些患者接受了主动监测（AS）或手术（Clinicaltrials.govNCT03271892）的选择。参与者在他们的治疗决定后一年完成了问卷调查。主要意向治疗分析比较了选择AS或手术的患者的平均决策后悔量表总分。二次分析根据治疗状态检查了一年的决策后悔评分。次要结果包括生活质量，心情,对疾病进展的恐惧，和身体形象感知。我们调整了年龄，性别,线性回归分析中的随访持续时间。结果:问卷总回复率为95.5%(191/200)。受访者的初始治疗选择为AS79.1%(151/191)和手术20.9%(40/191)。平均年龄为53岁（标准差[SD]15岁），77％（147/191）为女性。在AS组中，7.3%(11/151)的患者在问卷完成前接受确定性治疗(2例用于疾病进展)。在粗（p=0.730）或校正（p=0.29）分析中，选择AS（平均22.4，SD13.9）或手术（平均20.9，SD12.2）的患者的平均决策后悔水平没有显着差异。然而,在最初选择AS和交叉手术的患者中，调整后的决策后悔水平明显更高(β系数10.1[置信区间；CI1.3-18.9]，p=0.02),与那些留在AS下的人相比。在二级调整分析中，选择手术的受访者报告说，与癌症或其治疗相关的症状对生活的影响比选择AS的受访者更大（p=0.02），但是抑郁水平没有显著的组间差异，焦虑,对疾病进展的恐惧，或整体身体形象感知。结论:在本研究中,低风险PTC，1年后,与最初的疾病管理选择相关的决策遗憾的平均水平相对较低,对于选择AS或手术的受访者而言,这没有显著差异.
