Introduction Treatment decisions in advanced cancer often involve a balance between extending survival and preserving quality of life (QoL). Older adults frequently face complex choices because aggressive treatments may prolong life but also increase toxicity, hospitalisations, and functional decline.
Introduction
Treatment decisions in advanced cancer often involve a balance between extending survival and preserving quality of life (QoL). Older adults frequently face complex choices because aggressive treatments may prolong life but also increase toxicity, hospitalisations, and functional decline. Understanding whether patient preferences influence real-world outcomes is essential for patient-centred oncology care.
Summary
This secondary analysis evaluated 706 adults aged ≥70 years with advanced incurable cancers enrolled in the GAP70+ trial. Patients were categorised based on whether they prioritised maintaining quality of life or prolonging survival when starting systemic therapy.
71.7% (506 patients) prioritised quality of life
8.4% (59 patients) prioritised survival
The most common cancers were gastrointestinal (34.6%), lung (24.8%), and genitourinary (15.4%)
Despite differing priorities, clinical outcomes were similar between groups:
No difference in treatment modifications
No difference in grade 3–5 treatment-related adverse effects
No difference in hospitalisation rates
No difference in survival at 6 months or 1 year
Key Message
Most older adults with advanced cancer prefer maintaining quality of life over extending survival, yet this preference did not translate into different treatment approaches or outcomes, suggesting that current oncology care systems may not adequately align treatment decisions with patient preferences.
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