Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes toward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma. Methods: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neoadjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neoadjuvant therapy. Results: The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P < .001). The regret of the commission was diametrically opposite to the regret of omission (P ≤ .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P ≤ .001). The nonsurgeons working in or with lower surgical volume centers (P = .010) and surgeons (P = .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy. Conclusion: Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy.

Regret affects the choice between neoadjuvant therapy and upfront surgery for potentially resectable pancreatic cancer

Cucchetti, Alessandro;Binda, Cecilia;Fabbri, Carlo;Ercolani, Giorgio;Giovanni Brandi;Monica Di Battista;Mariacristina Di Marco;Antonio Facciorusso;Lorenzo Fuccio;Gian Luca Grazi;Elio Jovine;Bruno Nardo;Ilario Giovanni Rapposelli;
2023

Abstract

Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes toward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma. Methods: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neoadjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neoadjuvant therapy. Results: The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P < .001). The regret of the commission was diametrically opposite to the regret of omission (P ≤ .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P ≤ .001). The nonsurgeons working in or with lower surgical volume centers (P = .010) and surgeons (P = .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy. Conclusion: Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy.
2023
Cucchetti, Alessandro; Djulbegovic, Benjamin; Crippa, Stefano; Hozo, Iztok; Sbrancia, Monica; Tsalatsanis, Athanasios; Binda, Cecilia; Fabbri, Carlo; Salvia, Roberto; Falconi, Massimo; Ercolani, Giorgio; Sergio Alfieri, Arnaldo Amato, Marco Amisano, Andrea Anderloni, Antonio Maestri, Chiara Coluccio, Giovanni Brandi, Andrea Casadei-Gardini, Vincenzo Cennamo, Stefano Francesco Crinò, Raffaele Dalla Valle, Claudio De Angelis, Monica Di Battista, Massimo Di Maio, Mariacristina Di Marco, Marco Di Marco, Francesco Di Matteo, Roberto Di Mitri, Giuseppe Maria Ettorre, Antonio Facciorusso, Gabriella Farina, Giovanni Ferrari, Lorenzo Fornaro, Isabella Frigerio, Daniele Frisone, Lorenzo Fuccio, Andrea Gardini, Carlo Garufi, Riccardo Giampieri, Gian Luca Grazi, Elio Jovine, Emanuele Kauffmann, Serena Langella, Alberto Larghi, Mauro Manno, Emanuele Marciano, Marco Marzioni, Alberto Merighi, Massimiliano Mutignani, Bruno Nardo, Monica Niger, Valentina Palmisano, Stefano Partelli, Carmine Pinto, Enrico Piras, Ilario Giovanni Rapposelli, Michele Reni, Claudio Ricci, Lorenza Rimassa, Salvatore Siena, Cristiano Spada, Elisa Sperti, Mariangela Spezzaferro, Carlo Sposito, Stefano Tamberi, Roberto Troisi, Luigi Veneroni, Marco Vivarelli, Alessandro Zerbi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/929574
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