Many patients with advanced cancer feel the treatment they receive does not reflect what matters most to them, according to a new study examining whether medical care aligns with patient goals at the end of life.
Researchers analysed survey responses from more than 1,000 adults taking part in a large multisite trial of advance care planning. The study compared patients with advanced cancer to those living with other serious illnesses, focusing on whether care prioritised comfort or life extension and whether this matched patient preferences.
Similar goals across serious illness
Of the 1,099 patients included, 231 had advanced cancer and 868 had other serious conditions. Nearly half of patients in both groups said they preferred comfort-focused care rather than treatment aimed primarily at prolonging life. Mortality over 24 months was also similar between the two groups, suggesting comparable levels of illness severity.
Despite these similarities, important differences emerged when patients were asked whether their current treatment matched their stated goals. Patients reported whether they believed their care focused on comfort or longevity, allowing researchers to assess goal concordance from the patient perspective.
Cancer patients report more discordance
Among patients who said comfort was their priority, those with advanced cancer were far more likely to report that they were receiving life-extending treatment instead. More than a third of cancer patients in this group felt their care was discordant with their goals, compared with fewer than one in five patients with other serious illnesses.
The study also examined whether this mismatch affected outcomes. Among cancer patients who preferred comfort-focused care, there was no statistically significant difference in 24-month mortality between those who believed they were receiving life-extending treatment and those who felt their care focused on comfort.
The findings suggest that aggressive treatment in advanced cancer may not confer a survival advantage for patients who would rather prioritise comfort. The authors note that cancer care often involves ongoing interventions and a strong emphasis on treatment options, which may make it harder to shift focus towards comfort even when patients express that preference.
The researchers conclude that a substantial proportion of patients with advanced cancer experience care that does not align with their stated goals. They argue that earlier and clearer conversations about treatment priorities, supported by structured advance care planning, could help ensure that care better reflects what patients want as they approach the later stages of illness.
Reference
Shah MP et al. Patient-reported discordance between care goals and treatment intent in advanced cancer. Cancer. 2025; https://doi.org/10.1002/cncr.35976.
