Outcomes of Older Adults With Advanced Cancer Who Prefer Quality of Life vs Prolonging Survival

Importance: Health care systems should strive to achieve outcomes that matter to patients. Limited data exist on the outcomes achieved by patients with cancer with different treatment outcome preferences. Objective: To describe treatment outcome preferences among older adults with advanced cancer and explore differences in outcomes between patients prioritizing survival vs quality of life (QoL), testing the hypothesis that patients prioritizing survival would live longer, while those prioritizing QoL would have fewer treatment-related adverse effects (TRAEs) and hospitalizations. Design, Setting, and Participants: This study was an exploratory secondary analysis of the GAP70+ cluster randomized clinical trial conducted at National Cancer Institute's Community Oncology Research Program centers. Older adults (≥70 years) with incurable solid tumors or lymphoma and 1 or more impaired geriatric assessment domain(s) who were starting a new systemic cancer treatment as part of the GAP70+ trial were eligible. The primary trial took place between July 29, 2014, and March 13, 2019. All secondary analyses were conducted between January 1, 2025, and May 30, 2025. Exposure: Patients were divided into 2 cohorts based on their reported preference for prioritizing extending survival vs maintaining QoL. Main Outcomes and Measures: Treatment outcome preferences, hospitalization, TRAEs, and survival at 6 months and 1 year. Results: A total of 706 patients were included in the analysis. The mean (SD) patient age was 77.2 (5.4) years; 306 (43.3%) were female, and 400 (56.7%) were male. Gastrointestinal (244 patients [34.6%]), lung (175 patients [24.8%]), and genitourinary (109 patients [15.4%]) cancers were the most common. Only 59 patients (8.4%) preferred to prioritize extending survival over maintaining QoL, while 506 patients (71.7%) preferred to prioritize maintaining QoL. No significant associations were identified between cohorts prioritizing survival vs QoL and treatment modifications (risk ratio, 1.03; 95% CI, 0.84-1.27), grade 3 to 5 TRAEs (hazard ratio [HR], 0.84; 95% CI, 0.57-1.23), hospitalization (HR, 0.74; 95% CI, 0.39-1.41), and survival (at 6 months: HR, 0.72; 95% CI, 0.40-1.29; at 1 year: HR, 1.18; 95% CI, 0.81-1.72). Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, fewer than 1 in 10 older adults with advanced cancer participating in the trial prioritized extending survival over maintaining QoL. Patient preference for extending survival or maintaining QoL was not associated with up-front treatment modifications or downstream outcomes, suggesting a possible lack of responsiveness of the current oncology care delivery system to patient preference. ClinicalTrials.gov Identifier: NCT02054741.