Most older adults with advanced cancer care more about the quality of their remaining life than the quantity, but those priorities do not seem to alter their up-front care or their outcomes, according to a new study.

The findings, published in JAMA Oncology, raise questions about whether oncology care teams are considering and responding to the personal goals of older patients with incurable cancers.

“Without knowing what matters most to each patient, patient-centered care is accidental at best and neglected at worst,” said lead author Daniel Richardson, MD, of the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill.

He and his colleagues found that among 706 older adults (mean age, 77 years) with incurable cancer, nearly three quarters said they prioritized maintaining quality of life over living longer. Fewer than 1 in 10 prioritized extending survival.

Yet, the study found, patients’ preferences showed no association with up-front treatment modifications, their likelihood of severe treatment side effects, or their overall survival.

The findings, Richardson and other experts said, underscore some critical gaps: Healthcare systems need to do a better job of finding out what matters most to patients, and oncology teams need better evidence on howto help patients who prioritize quality of life.

In an editorial published with the study, Ryan Nipp, MD, MPH, pointed to a notable lack of clinical interventions specifically designed to enhance quality of life among patients with geriatric oncology.

Older adults represent most patients with cancer, and future research “must assess and address” their quality-of-life priorities, wrote Nipp, of the Stephenson Cancer Center, University of Oklahoma Health in Oklahoma City.

For their study, Richardson and his colleagues aimed to see whether patient goals influence their care and clinical outcomes. They used data from 706 older adults with advanced cancer who were part of a cluster randomized clinical trial and were scheduled to begin a systemic treatment with a high risk for adverse events.

Upon enrollment, patients were asked whether maintaining quality of life was more important to them than living longer. Just under 72% affirmed that it was, while only 8% prioritized extending survival. The remainder had no preference or were neutral.

But while most patients had a preference, the study found no evidence that it swayed their care: There was no significant association between patient preferences and up-front treatment modifications (risk ratio, 1.03; 95% CI, 0.84-1.27). Nor were they associated with downstream clinical outcomes, including grade 3-5 treatment-related adverse effects (hazard ratio [HR], 0.84; 95% CI, 0.57-1.23), hospitalization (HR, 0.74; 95% CI, 0.39-1.41), or survival at 6 months (HR, 0.72; 95% CI, 0.40-1.29) and 1 year (HR, 1.18; 95% CI, 0.81-1.72).

The results align with a 2025 study led by Manan P. Shah, MD, of UCLA Health in Santa Monica, California. It found that among patients with late-stage cancer who prioritized symptom relief and comfort care, 37% instead received care focused on prolonging life.

In contrast, only 19% of patients with other serious illnesses reported a similar mismatch between their preferences and actual care.

The greater disconnect in oncology, Shah told Medscape Medical News, likely has multiple underlying reasons, including “incomplete discussion” of patients’ goals and a “general bias toward pursuing life-extending care.”

Richardson went further, saying there is a “widespread functional belief that patient preferences don’t matter to treatment decision-making.”

“This lie has been smuggled into our oncology training, has been reinforced on the wards, and has been codified by our clinical guidelines and clinical pathways that fail to include patient preferences,” Richardson told Medscape Medical News.

He argued that routine measurement and documentation of individual patient values are the foundation of high-quality care.

Regulatory changes are beginning to address the quality-of-life blind spot, Richardson said, citing a 2024 Centers for Medicare & Medicaid Services (CMS) rule requiring documentation of how older adults’ preferences are integrated into their care plans.

“I believe that CMS and others are increasingly going to incentivize care that is aligned with what matters to patients,” Richardson said.

Exactly how to best provide that type of care remains in question. Nipp pointed out that this study used a single question at one timepoint to gauge patients’ priorities and stressed that “future work should seek to understand how best to communicate patient preferences and ensure actionability of responses.”

Richardson recommended that health systems invest in new ways to capture patient preferences, such as integrating them into the routine collection of patient-reported outcomes or geriatric assessments.

“Health systems could take note from other industries that diligently work to know what matters most to their customers and deliver on outcomes that matter,” Richardson said.

For his part, Shah highlighted the need for changes in clinical trial design. One recent analysis found that out of nearly 800 phase 3 clinical trials in oncology over the past 20 years, only 3% had quality of life as a primary endpoint.

“Funding for such trials is not available as readily as funding for new pharmaceutical treatments aiming to improve survival,” Shah pointed out.

He said that “at the very least,” future trials should recruit patients like those in the real world — including older and frail patients — and incorporate treatment modifications aimed at improving health-related quality of life.

Doing so, Shah said, “would help steer the treatment paradigm in the right direction for our patients.”

The primary cluster randomized clinical trial was supported by the National Cancer Institute. Two study co-authors reported financial relationships with Agenus, MiNK Therapeutics, and Gilead. Nipp and Shah reported having no conflicts of interest.