Are patients with advanced cancer receiving treatment aligned with their goals?

New research indicates that many patients with advanced cancer report receiving treatment focusing on longevity over comfort, even when their goal is the opposite. The findings are published in Cancer.

Treatment of serious illnesses generally aims to optimize longevity and quality of life, but in some cases, these goals are at odds with each other. Therefore, clinicians must strive to understand each individual’s objectives so that patients do not receive burdensome treatments that go against their wishes.

“When treating advanced cancer, the goal is to help patients live as long and as well as possible. But sometimes, patients and oncologists face tough choices, especially when the goals of living longer and staying comfortable begin to compete with one another,” said lead author Manan P. Shah, MD, of the University of California, Los Angeles.

To assess the relationship between patients’ preferences and their treatment, Dr. Shah and his colleagues analyzed survey responses from adults with advanced cancer and other serious illnesses who were enrolled in a multi-site trial of advance care planning.

Among 1,099 patients in the study, 49% of the 231 patients with advanced cancer preferred comfort-focused care, and 16% of the 231 patients died within two years.

These proportions were similar to those observed in the 868 patients with other serious illnesses (48% and 13%). Among patients preferring comfort-focused care, patients with cancer were more likely than patients with other illnesses to report receiving discordant life-extending care (37% versus 19%).

Also, life-extending care did not appear to actually extend life in patients who did not wish to receive it. Among patients with cancer preferring comfort-focused care, there was no significant difference in two-year mortality between those who reported receiving discordant life-extending versus concordant comfort-focused care.

“This disconnect between what patients want and what they feel they’re getting is an important issue,” Dr. Shah said.

“One takeaway is that doctors need to have open conversations with patients about their goals, clearly explain the intent of the treatment they are providing, and try to reconcile any real or perceived discordance between goals and treatment.”