Patients with advanced cancer reported in survey responses that their treatment often focused on optimizing longevity over maintaining comfort and quality of life, despite their goals that prioritized the opposite, according to study results published in Cancer.
Additionally, the findings highlighted that life-extending care in patients who prioritized comfort over longevity did not result in a survival benefit.
“This disconnect between what patients want and what they feel they’re getting is an important issue,” stated lead study author Manan Prashant Shah, MD, of the University of California, Los Angeles. “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.”
Study Methods and Findings
The study authors conducted a post hoc cross-sectional analysis of baseline survey responses from adult patients with advanced illnesses, including cancer, who were enrolled in a multisite study of advance care planning. In the survey, patients reported on their treatment preferences and realities regarding life-extending care vs comfort-focused care. They compared these relationships for patients with advanced cancer in relation to patients with other advanced illnesses as well as mortality rates.
The survey included 1,099 patients, consisting of 231 patients with advanced cancer and 868 with other serious illnesses. For the patients with advanced cancer, 49% preferred comfort-focused care and had a 2-year mortality rate of 16%. These rates were similar for patients with other serious illnesses at 48% and 13%, respectively.
Patients with cancer who preferred comfort-focused care were more likely to report receiving treatment that did not match their goals than for patients with other serious illnesses (37% vs 19%; P < .001). Among all patients with cancer who prioritized comfort over longevity, no statistically significant difference was observed between those receiving discordant and concordant treatments in 2-year mortality rates (24% vs 15%; P = .31).
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
