Most Older Adults With Advanced Cancer Prioritize Quality of Life, but Treatment Rarely Reflects That
When older adults with advanced cancer are asked what matters most to them -- living longer or living better -- the overwhelming majority choose quality of life. Fewer than one in ten prioritize extending survival.
That preference is clear. What is less clear is whether the oncology care system is actually listening.
Preferences stated, but not reflected in care
A secondary analysis of a randomized clinical trial, published in JAMA Oncology, examined whether older adults' stated priorities -- extending survival versus maintaining quality of life -- were associated with differences in the treatment they received or in their outcomes.
They were not. Whether a patient said they wanted to prioritize quality of life or wanted to prioritize survival, the up-front treatment modifications and downstream outcomes looked essentially the same. The study describes this as a possible lack of responsiveness in the current oncology care delivery system to patient preference.
A disconnect worth examining
This finding raises important questions. If the vast majority of older patients with advanced cancer want their care to prioritize quality of life, and if the care they receive does not differ based on that preference, something in the system is not translating patient values into clinical decisions.
There are multiple possible explanations. Oncologists may not consistently ask about or document patient preferences. Treatment protocols may be driven by disease characteristics rather than patient goals. Or the tools for adjusting care based on preference -- dose modifications, treatment selection, palliative care integration -- may not be applied differently even when preferences are known.
The study cannot determine which of these explanations applies. It identifies the gap; closing it will require further investigation.
What the study does not cover
The original JAMA press release provides limited methodological detail. The study is identified by DOI (10.1001/jamaoncol.2026.0072), and the corresponding author is Daniel R. Richardson, MD, MSc, of the University of North Carolina. Details about sample size, cancer types, specific treatment modifications examined, and outcome measures are available in the full article but were not included in the press materials available for this summary.
This is a secondary analysis of an existing trial, which means the preference data was collected within a structured research context. Whether the same pattern holds in routine clinical practice is an open question.
Why it matters
The finding is particularly relevant for older adults, who may face greater treatment toxicity, more competing health conditions, and different priorities than younger patients. Patient-centered care -- care that aligns with what patients actually want -- is a stated goal across oncology. This study suggests the field has further to go in achieving it.