Many Patients With Advanced Cancer Report Care Misaligned With Their Goals

Nearly 4 in 10 patients with advanced cancer who preferred comfort-focused care reported receiving treatment that prioritized extending life instead, according to a study published in Cancer.1

The cross-sectional analysis of 1099 patients found this discordance was significantly higher among individuals with advanced cancer (37%) compared with those with other serious illnesses (19%). Importantly, receiving life-extending care did not appear to improve survival in patients who expressed a preference for comfort.

Two-year mortality was 24% for patients with advanced cancer who reported receiving life-extending care against their wishes for comfort, compared with 15% among those who felt their care was aligned with comfort-focused goals. This difference was not statistically significant.

It's important for doctors and patients to be aligned on care goals and treatment intent. | Image credit: RFBSIP – stock.adobe.com

A Disconnect in Oncology Care

Overall, 49% of patients with advanced cancer and 48% of patients with other serious illnesses preferred comfort-focused care, while about one-quarter in both groups preferred life-extending care. Despite these similarities, more than half (51%) of patients with advanced cancer perceived their treatment as life-extending, compared with 35% of those with other advanced illnesses.

“When treating advanced cancer, the goal is to help patients live as long and as well as possible,” Manan P. Shah, MD, medical oncologist at UCLA Health and lead author of the study, said in a statement.2 “But sometimes, patients and oncologists face tough choices, especially when the goals of living longer and staying comfortable begin to compete with one another.”

Patients with advanced cancer were also younger on average than those with other illnesses (62 years vs 71 years) and reported slightly better baseline physical and mental health.1 The authors noted these factors may influence oncologists to pursue more aggressive treatments, potentially exacerbating the gap between patient goals and perceived care.

“In this scenario, it is plausible that treatment toxicity may bias patients to characterize their medical care as focusing on longevity over comfort,” the authors said. “Nonetheless, such patient-reported discrepancies between goals and perceived treatment should be explicitly discussed and reconciled. Perhaps some patients in this group would benefit from treatment modifications to prioritize quality of life over longevity.”

Communication Gaps and Clinical Implications

The study found no difference in physician communication scores between patients with advanced cancer and those with other illnesses, suggesting that discordance may stem from other dynamics. Oncologists may hesitate to initiate goals-of-care discussions if patients appear well or still have treatment options available, according to a nationwide survey of more than 4000 oncologists, but prior research suggests most patients expect clinicians to lead these conversations.

“The results of our study and more recent literature raise another question: Are clinicians to blame for the relatively high patient-reported care discordance in advanced cancer?” the authors posed.

They suggested that hesitancy to address palliative treatment goals may help explain why patients with advanced cancer reported higher rates of goal-discordant care compared with those facing other serious illnesses. They stressed that even as treatment options improve, explicitly discussing care goals and treatment intent remains essential to ensuring care aligns with patient priorities.

“This disconnect between what patients want and what they feel they’re getting is an important issue,” Shah said.2 “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.”

References

1. Shah MP, Wenger NS, Glaspy J, et al. Patient-reported discordance between care goals and treatment intent in advanced cancer. Cancer. 2025;131(17):e35976. doi:10.1002/cncr.35976
2. Are patients with advanced cancer receiving treatment aligned with their goals? News release. Wiley. August 25, 2025. Accessed August 25, 2025. https://newsroom.wiley.com/press-releases/press-release-details/2025/Are-patients-with-advanced-cancer-receiving-treatment-aligned-with-their-goals/default.aspx