New research published in the peer-reviewed journal CANCER, a flagship publication from the American Cancer Society, reveals a striking disconnect between the care goals expressed by patients with advanced cancer and the treatments they actually receive. The investigation, led by Dr. Manan P. Shah of the University of California, Los Angeles, utilized survey data from a multi-site advance care planning trial, uncovering that many patients who prioritize comfort over longevity still undergo aggressive, life-extending treatments. This discordance not only challenges the ethical foundations of oncology care but also raises critical questions about communication and decision-making in late-stage cancer management.
The study focuses on a cohort of 1,099 adults diagnosed with advanced cancer or other serious illnesses, exploring the alignment between patient-reported care preferences and the intent of treatments administered. Notably, half of the 231 patients with advanced cancer expressed a preference for comfort-focused care, emphasizing quality of life and symptom relief rather than prolonged survival. However, over one third of these patients reported receiving treatments aimed at extending life, despite their stated goals. This phenomenon, termed “discordant care,” poses significant clinical and moral dilemmas by potentially subjecting patients to interventions that may diminish their remaining quality of life without meaningful survival benefit.
From a methodological standpoint, patients’ preferences were ascertained through validated survey instruments designed to capture nuanced perspectives on treatment goals, such as the dichotomy between comfort-oriented and life-prolonging care. The analysis compared mortality outcomes over a two-year period, stratified by whether patients received care aligned with their preferences. Surprisingly, the survival rates did not significantly differ between those receiving concordant comfort care and those undergoing discordant life-extending treatments, underscoring that aggressive therapies might not confer the intended longevity advantages in this subset.
The implications of these findings are profound. They suggest that life-extending treatments may be administered without clear evidence of benefit for patients who explicitly seek to avoid them, potentially exposing individuals to unnecessary side effects, hospitalizations, and decreased autonomy. This phenomenon also underscores systemic gaps in clinician-patient communication, shared decision-making processes, and possibly ingrained cultural biases favoring intervention over palliation.
Dr. Shah emphasizes the ethical imperative for oncologists and palliative care specialists to engage in transparent, iterative conversations with their patients. Such dialogues should elicit patients’ values, clarify the realistic outcomes of proposed treatments, and reconcile potential misunderstandings or therapeutic misalignments. This patient-centered approach is essential to uphold the principle of autonomy and ensure that care plans correspond to the patients’ own objectives, whether they prioritize longevity, comfort, or a balance of both.
The research also highlights the critical role of advance care planning, a process often underutilized or initiated too late in the disease trajectory, limiting its effectiveness. Early and structured discussions regarding prognosis, treatment options, and anticipated quality of life can provide a framework for care decisions that respect patients’ wishes and reduce the incidence of discordant treatments. Moreover, the integration of interdisciplinary teams, including palliative care specialists, social workers, and ethicists, may enhance the quality and alignment of care.
An intriguing aspect of the study is the comparison between patients with advanced cancer and those with other serious illnesses, such as heart failure or chronic obstructive pulmonary disease. While preferences for comfort-focused care were similarly distributed across these populations, patients with cancer were disproportionately more likely to experience discordant life-extending interventions. This differential may reflect disease-specific factors, oncologists’ treatment paradigms, or systemic pressures unique to oncology practice, pointing to the need for disease-tailored strategies to improve care concordance.
The findings challenge entrenched assumptions that more intervention equates to better care or improved survival. Instead, they call for a paradigm shift towards nuanced, individualized treatment plans that prioritize the patient’s lived experience and holistic well-being. Researchers advocate for enhanced training in communication skills for oncology clinicians and the development of decision aids that facilitate informed consent and goal-concordant care choices.
From a health systems perspective, reducing discordant care may also contribute to more sustainable resource utilization, mitigating the high costs associated with aggressive cancer treatments that do not extend life or improve quality. This approach aligns with broader trends emphasizing value-based care and ethical stewardship of medical interventions.
In conclusion, this study elucidates a critical gap in oncology care—the divergence between patients’ stated goals and the treatments they receive. Bridging this gap demands systematic improvements in patient-clinician communication, earlier advance care planning, and heightened awareness of the limitations and burdens of life-extending therapies in the context of advanced cancer. By realigning treatment intent with patient preferences, the oncology community can better honor individual values and improve end-of-life care experiences.
Subject of Research: Patient-reported discordance between care goals and treatment intent in advanced cancer
Article Title: Patient-reported discordance between care goals and treatment intent in advanced cancer
News Publication Date: 25-Aug-2025
Web References:
References:
Shah, M. P., Wenger, N. S., Glaspy, J., Hays, R. D., Sudore, R. L., Rahimi, M., Gibbs, L., Anand, S., Tseng, C.-H., & Walling, A. M. (2025). Patient-reported discordance between care goals and treatment intent in advanced cancer. CANCER. https://doi.org/10.1002/cncr.35976
Keywords: Cancer patients, health care delivery, patient preferences, advanced cancer, comfort-focused care, life-extending treatment, oncology, advance care planning, patient autonomy, end-of-life care, palliative care, medical ethics
