Among seriously ill patients who preferred comfort care, those with cancer were nearly twice as likely as those with other diseases to report receiving life-extending care instead, according to a new study.

“We know that when navigating complex medical decisions, there will be some level of discrepancy between patients’ goals and the care they are receiving,” lead author Manan Shah, MD, a medical oncologist at the University of California at Los Angeles, told Medscape Medical News. “However, for that discrepancy to be almost twice as high in oncology compared to other similar advanced illnesses was a surprise.”

Earlier work showed that oncologists often delay or don’t initiate conversations about patients’ end-of-life goals or their treatment intentions and options, with many patients receiving last-ditch treatments that rarely benefit them. But the relationship between patients’ preferred goals and perceived treatments has not been reported, according to Shah’s team.

In the recent study, published in Cancer late last month, Shah and colleagues used baseline survey data from 1099 patients enrolled in a trial assessing advance care planning. Patients reported their care preferences as well as whether they perceived receiving life‐extending or comfort‐focused care.

Overall, the 231 patients who had advanced cancer were as likely as those with other serious illnesses, such as advanced heart failure, advanced chronic obstructive pulmonary disease, and end‐stage renal disease, to prefer comfort care (49% vs 48%; P = .47) and life-extending care (25% and 23%, respectively).

The two patient groups also did not rate physician communication differently — 3.6 out of 4 for both, with higher scores representing better communication.

Differences emerged, however, when it came to patients’ perceptions of their care.

Patients with advanced cancer reported receiving life-extending care more often (51% vs 35%; P < .001) and reported receiving comfort-focused care less often (19% vs 28%; P < .001) than those with other serious illnesses.

Notably, among patients who preferred comfort care, those with advanced cancer were more likely to report receiving life-extending care (37% vs 19%; P < .001).

Looking at survival outcomes among patients with advanced cancer, those who preferred comfort care had similar 2-year mortality rates to those who preferred life-extending care (18% vs 19%).

The 2-year mortality rate was not significantly different among cancer patients who preferred comfort care but received life-extending care and those who received the comfort care they preferred, but it was numerically higher — 24% vs 15% (P = .31).

Shah cautioned that given the retrospective nature of the study, “there might be confounding variables and factors that we don’t understand.” It’s also unlcear, he said, whether patients’ perceived concordance between their goals and the treatment they receive has a “true impact” on outcomes, including quality of life and survival.

The reasons for the higher rate of discordant care among patients with cancer remain unclear, said Nancy L. Keating, MD, MPH, who studies end-of-life care issues at Harvard Medical School and Brigham and Women’s Hospital in Boston.

Keating, who was not involved in the research, suggested that patients with advanced cancer may have a different understanding of how serious their illness is compared with patients who have other advanced diseases, or the wide range of treatment options available to patients with cancer may lead patients or physicians to believe that their illness is less serious than it is.

“Future research will be important to better understand these differences and the extent to which they are driven by physicians vs patients and their families,” Keating told Medscape Medical News.

Shah agreed, noting that “ultimately, it is our job to explain to patients what their treatment options are and what the potential risks and benefits associated with each treatment are.”

However, he added, “we must also explicitly ask patients about their goals and make sure, every step of the way, that they feel that medical decisions about their treatments are aligned with their care goals as much as possible.”

The authors had no conflicts to report.