Academic Journal
Beyond tumor response: hope and decision regret during immunotherapy for hepatocellular carcinoma.
| Τίτλος: | Beyond tumor response: hope and decision regret during immunotherapy for hepatocellular carcinoma. |
|---|---|
| Συγγραφείς: | Wang HS; School of Nursing, College of Nursing, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei, 11031, Taiwan.; Department of Nursing, College of Nursing, National Taiwan University Hospital, Taipei, Taiwan., Cheng AL; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan., Chen JH; Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan.; Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan., Huang TW; School of Nursing, College of Nursing, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei, 11031, Taiwan. tsaiwei@tmu.edu.tw.; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. tsaiwei@tmu.edu.tw.; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. tsaiwei@tmu.edu.tw.; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. tsaiwei@tmu.edu.tw. |
| Πηγή: | Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2026 Sep 20; Vol. 34 (10). Date of Electronic Publication: 2026 Sep 20. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Country of Publication: Germany NLM ID: 9302957 Publication Model: Electronic Cited Medium: Internet ISSN: 1433-7339 (Electronic) Linking ISSN: 09414355 NLM ISO Abbreviation: Support Care Cancer Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Berlin : Springer International, c1993- |
| Ιατρικοί όροι (MeSH): | Liver Neoplasms*/psychology , Liver Neoplasms*/therapy , Liver Neoplasms*/drug therapy , Carcinoma, Hepatocellular*/psychology , Carcinoma, Hepatocellular*/therapy , Carcinoma, Hepatocellular*/drug therapy , Immunotherapy*/methods , Immunotherapy*/psychology , Hope*, Fatigue/epidemiology ; Fatigue/etiology ; Humans ; Female ; Male ; Middle Aged ; Quality of Life ; Prospective Studies ; Aged ; Emotions ; Decision Making ; Patient Reported Outcome Measures ; Taiwan ; Longitudinal Studies |
| Περίληψη: | Purpose: Immunotherapy-targeted combination therapy has transformed hepatocellular carcinoma (HCC) treatment, yet longitudinal patient-reported outcome (PRO) trajectories remain poorly characterized. We prospectively examined decision regret, hope, fatigue and quality of life during first-line treatment. Methods: This convergent mixed-methods study enrolled 33 patients initiating first-line immunotherapy-targeted therapy at a Taiwan medical center (December 2022-October 2023). PROs were assessed across six cycles using validated instruments, and all participants were interviewed. Strands were integrated through joint display analysis. Results: Twenty-one patients (63.6%) completed six cycles; 12 (36.4%) discontinued. Completers maintained stable PROs with low regret, whereas discontinuers declined faster in EQ-5D utility (interaction B = - 0.169 per cycle, p = .007) and showed a larger, non-significant rise in regret (+ 9.58, p = .051, d = 0.50; between-group p = .042). Hope declined in both groups (- 1.48, p = .003), correlating negatively with regret (r = - .383, p = .028). Interviews centered on treatment-related discomfort (24/33), sustained hope for disease control (31/33) and financial strain (25/33); where regret was voiced (3/33) it concerned earlier points in the illness course rather than the current treatment decision. Integration yielded four expanded meta-inferences and one discordance, between measured and voiced regret. Conclusion: Treatment completers maintain stable PROs, but more than one-third discontinued and experienced worse fatigue and greater regret, supporting pre-treatment counselling that is honest and informative rather than reassuring. Discontinuation marks a psychologically vulnerable transition, while universal hope decline warrants psychosocial monitoring for all patients. Given the sample size, predictors of regret are hypothesis-generating. (© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Competing Interests: | Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of National Taiwan University Hospital (NTUH-REC No.: 202211075RIND). Consent to participate: Written informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests. |
| References: | Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660. (PMID: 10.3322/caac.2166033538338) Cheng A-L, Qin S, Ikeda M et al (2022) Updated efficacy and safety data from IMbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma. J Hepatol 76:862–873. https://doi.org/10.1016/j.jhep.2021.11.030. (PMID: 10.1016/j.jhep.2021.11.03034902530) Finn RS, Qin S, Ikeda M et al (2020) Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med 382:1894–1905. https://doi.org/10.1056/NEJMoa1915745. (PMID: 10.1056/NEJMoa191574532402160) Abou-Alfa GK, Lau G, Kudo M et al (2022) Tremelimumab plus durvalumab in unresectable hepatocellular carcinoma. NEJM Evid 1:EVIDoa2100070. https://doi.org/10.1056/EVIDoa2100070. (PMID: 10.1056/EVIDoa210007038319892) Gordan JD, Kennedy EB, Abou-Alfa GK et al (2024) Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline update. J Clin Oncol 42:1830–1850. https://doi.org/10.1200/JCO.23.02745. (PMID: 10.1200/JCO.23.0274538502889) Basch E, Deal AM, Dueck AC et al (2017) Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA 318:197–198. https://doi.org/10.1001/jama.2017.7156. (PMID: 10.1001/jama.2017.7156285868215817466) Galle PR, Finn RS, Qin S et al (2021) Patient-reported outcomes with atezolizumab plus bevacizumab versus sorafenib in patients with unresectable hepatocellular carcinoma (IMbrave150): an open-label, randomised, phase 3 trial. Lancet Oncol 22:991–1001. https://doi.org/10.1016/S1470-2045(21)00151-0. (PMID: 10.1016/S1470-2045(21)00151-034051880) Becerra Perez MM, Menear M, Brehaut JC, Legare F (2016) Extent and predictors of decision regret about health care decisions: a systematic review. Med Decis Making 36:777–790. https://doi.org/10.1177/0272989X16636113. (PMID: 10.1177/0272989X1663611326975351) Snyder CR, Irving LM, Anderson JR (1991) Hope and health. Handbook of social and clinical psychology: the health perspective. Pergamon Press, pp 285–305. Herth K (1992) Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs 17:1251–1259. https://doi.org/10.1111/j.1365-2648.1992.tb01843.x. (PMID: 10.1111/j.1365-2648.1992.tb01843.x1430629) Creswell JW, Plano Clark VL (2018) Designing and conducting mixed methods research, 3rd ed. Sage Publications. Gordan JD, Kennedy EB, Abou-Alfa GK et al (2020) Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline. J Clin Oncol 38:4317–4345. https://doi.org/10.1200/JCO.20.02672. (PMID: 10.1200/JCO.20.0267233197225) Brehaut JC, O’Connor AM, Wood TJ et al (2003) Validation of a decision regret scale. Med Decis Making 23:281–292. https://doi.org/10.1177/0272989X03256005. (PMID: 10.1177/0272989X0325600512926578) Chan KS, Li HCW, Chan SW-C, Lopez V (2012) Herth hope index: psychometric testing of the Chinese version. J Adv Nurs 68:2079–2085. https://doi.org/10.1111/j.1365-2648.2011.05887.x. (PMID: 10.1111/j.1365-2648.2011.05887.x22111952) Lin C-C, Chang A-P, Chen M-L et al (2006) Validation of the Taiwanese version of the brief fatigue inventory. J Pain Symptom Manage 32:52–59. https://doi.org/10.1016/j.jpainsymman.2005.12.019. (PMID: 10.1016/j.jpainsymman.2005.12.01916824985) Lin H-W, Li C-I, Lin F-J et al (2018) Valuation of the EQ-5D-5L in Taiwan. PLoS ONE 13:e0209344. https://doi.org/10.1371/journal.pone.0209344. (PMID: 10.1371/journal.pone.0209344305864006306233) Bruera E, Kuehn N, Miller MJ et al (1991) The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9. (PMID: 10.1177/0825859791007002021714502) Zeger SL, Liang K-Y (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130. (PMID: 10.2307/25312483719049) Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 4:863. https://doi.org/10.3389/fpsyg.2013.00863. (PMID: 10.3389/fpsyg.2013.00863243244493840331) Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3:77–101. https://doi.org/10.1191/1478088706qp063oa. (PMID: 10.1191/1478088706qp063oa) Guetterman TC, Fetters MD, Creswell JW (2015) Integrating quantitative and qualitative results in health science mixed methods research through joint displays. Ann Fam Med 13:554–561. https://doi.org/10.1370/afm.1865. (PMID: 10.1370/afm.1865265538954639381) Younas A, Fabregues S, Creswell JW (2023) Generating metainferences in mixed methods research: a worked example in convergent mixed methods designs. Methodol Innov 16:276–291. https://doi.org/10.1177/20597991231188121. (PMID: 10.1177/20597991231188121) Pickard AS, Wilke CT, Lin H-W, Lloyd A (2007) Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics 25:365–384. https://doi.org/10.2165/00019053-200725050-00002. (PMID: 10.2165/00019053-200725050-0000217488136) Connolly T, Zeelenberg M (2002) Regret in decision making. Curr Dir Psychol Sci 11:212–216. https://doi.org/10.1111/1467-8721.00203. (PMID: 10.1111/1467-8721.00203) Hickman RLJ, Pinto MD, Lee E, Daly BJ (2012) Exploratory and confirmatory factor analysis of the decision regret scale in recipients of internal cardioverter defibrillators. J Nurs Meas 20:21–34. https://doi.org/10.1891/1061-3749.20.1.21. (PMID: 10.1891/1061-3749.20.1.21226797075456261) Zafar SY, Peppercorn JM, Schrag D et al (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18:381–390. https://doi.org/10.1634/theoncologist.2012-0279. (PMID: 10.1634/theoncologist.2012-0279234423073639525) Ramsey SD, Bansal A, Fedorenko CR et al (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980–986. https://doi.org/10.1200/JCO.2015.64.6620. (PMID: 10.1200/JCO.2015.64.6620268115214933128) Hasse HT, Kjaer T, Kristensen SR (2025) Trajectory of quality of life among patients with cancer at the end of life: a longitudinal survey study. Qual Life Res 34:1695–1707. https://doi.org/10.1007/s11136-025-03923-0. (PMID: 10.1007/s11136-025-03923-03996619712119717) Ruhle A, Wieland L, Hinz A et al (2024) Decision regret of cancer patients after radiotherapy: results from a cross-sectional observational study at a large tertiary cancer center in Germany. J Cancer Res Clin Oncol 150:167. https://doi.org/10.1007/s00432-024-05638-0. (PMID: 10.1007/s00432-024-05638-03854687310978708) Nicolai J, Buchholz A, Seefried N et al (2016) When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians’ communication styles and the match of decision-making styles on decision regret. Patient Educ Couns 99:739–746. https://doi.org/10.1016/j.pec.2015.11.019. (PMID: 10.1016/j.pec.2015.11.01926658703) Li C, Lu X, Xiao J, Chan CWH (2022) “We can bear it!” Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B: a qualitative study. J Clin Nurs 31:3130–3143. https://doi.org/10.1111/jocn.16140. (PMID: 10.1111/jocn.1614034816510) Kiss I, Kuhn M, Hrusak K, Buchler T (2022) Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis. ESMO Open 7:100474. https://doi.org/10.1016/j.esmoop.2022.100474. (PMID: 10.1016/j.esmoop.2022.100474355766979271472) McLouth LE, Shelton BJ, Bursac V et al (2024) “Pathways”: a hope-enhancing intervention for patients undergoing treatment for advanced lung cancer. Psychooncology 33:e6316. https://doi.org/10.1002/pon.6316. (PMID: 10.1002/pon.63163844654011157457) Taddei TH, Brown DB, Yarchoan M et al (2025) Critical update: AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 82:272–274. https://doi.org/10.1097/HEP.0000000000001269. (PMID: 10.1097/HEP.000000000000126939992051) |
| Contributed Indexing: | Keywords: Decision regret; Hepatocellular carcinoma; Hope; Immunotherapy; Mixed methods; Patient-reported outcomes |
| Entry Date(s): | Date Created: 20260920 Date Completed: 20260920 Latest Revision: 20261015 |
| Update Code: | 20261016 |
| DOI: | 10.1007/s00520-026-11228-2 |
| PMID: | 42763822 |
| Βάση Δεδομένων: | MEDLINE |
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