Quality of Life vs Survival in Older Adults With Advanced Cancer Source: JAMA Oncology, March 2026

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.