As reported in JAMA Oncology by Richardson et al, a secondary analysis of the GAP70+ trial showed that treatment modifications and outcomes did not differ between older patients with advanced cancer who prioritized quality of life (QOL) vs those who preferred prolonging survival.
Study Details
This was a secondary analysis of the GAP70+ trial conducted at National Cancer Institute Community Oncology Research Program centers. Eligible patients were those aged 70 years or older with incurable solid tumors or lymphoma and one or more impaired geriatric assessment domain(s) who were starting a new systemic cancer treatment as part of the trial. As stated by the investigators, the aim of the analysis was: “To describe treatment outcome preferences among older adults with advanced cancer and explore differences in outcomes between patients prioritizing survival vs …[QOL], testing the hypothesis that patients prioritizing survival would live longer, while those prioritizing QOL would have fewer treatment-related adverse effects and hospitalizations.” The primary trial took place between July 2014 and March 2019, with all secondary analyses performed between January and May 2025. Main outcome measures were treatment outcome preferences, hospitalization, treatment-related adverse events, and survival at 6 months and 1 year.
Key Findings
A total of 706 patients were included in the analysis. Mean age was 77.2 years, and 43.3% were female. The most common cancers were gastrointestinal (34.6%), lung (24.8%), and genitourinary (15.4%) cancers.
Among 706 patients, 59 (8.4%) preferred to prioritize extending survival vs maintaining QOL, and 506 (71.7%) preferred to prioritize maintaining QOL. No significant differences were found between patients prioritizing survival vs QOL for treatment modifications (risk ratio = 1.03, 95% confidence interval [CI] = 0.84–1.27), grade 3 to 5 treatment-related adverse events (hazard ratio [HR] = 0.84, 95% CI = 0.57–1.23), hospitalization (HR = 0.74, 95% CI = 0.39–1.41), or survival at 6 months (HR = 0.72, 95% CI = 0.40–1.29) or at 1 year (HR = 1.18, 95% CI = 0.81–1.72).
The investigators concluded: “In this secondary analysis of a randomized clinical trial, fewer than 1 in 10 older adults with advanced cancer participating in the trial prioritized extending survival over maintaining QOL. Patient preference for extending survival or maintaining QOL was not associated with upfront treatment modifications or downstream outcomes, suggesting a possible lack of responsiveness of the current oncology care delivery system to patient preference."
Daniel R. Richardson, MD, MSc, of University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
