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 by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

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 2 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 2-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.” 

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

Full Citation:
“Patient-reported discordance between care goals and treatment intent in advanced cancer.” Manan P. Shah, Neil S. Wenger, John Glaspy, Ron D. Hays, Rebecca L. Sudore, Maryam Rahimi, Lisa Gibbs, Sidharth Anand, Chi-Hong Tseng, and Anne M. Walling. CANCER; Published Online: August 25, 2025 (DOI: 10.1002/cncr.35976).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35976

Author Contact: Denise Heady, at DHeady@mednet.ucla.edu

About the Journal     
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley      
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