WHEN FACING ADVANCED-STAGE CANCER, people’s goals often change as the disease progresses. Some patients with a terminal diagnosis may want to try every available treatment to add months or years to their lives regardless of potential side effects. Others may be more focused on maintaining their quality of life, even if it means they only try certain treatments or stop treatment completely.
Research published Aug. 25, 2025, in Cancer highlights a disconnect between patients’ goals and their actual care. In the study, people with advanced cancer who expressed a desire for comfort-based care were more likely to report receiving discordant life-extending care than people with the same preference with other serious conditions.
These findings were based on survey responses taken over the course of two years from 1,099 people with a serious illness who participated in a clinical trial for advanced care planning. Respondents were asked whether they preferred treatment that prioritized longevity or comfort and whether they, over time, believed they were receiving care that aligned with their goals. In the study, about half of people with cancer and half of those with other serious conditions, such as advanced heart failure or chronic obstructive pulmonary disease, responded that they preferred comfort-based care. Of the 113 people with advanced cancer who expressed a desire for comfort-based care, 37% felt they were receiving life-extending care. In comparison, 19% of people with other serious conditions who preferred comfort-based care reported receiving longevity-based care.
While the research did not identify a single cause that explained the disconnect, the authors suggest that oncologists must initiate clearer conversations about treatment intent to ensure medical care aligns with what patients actually value.
“Every time there’s a change in symptom burden, the cancer is progressing or treatments are no longer working, those are all pivot points where providers and patients should have goals-of-care conversations to make sure that the patient’s goals have not changed,” says Manan Shah, a hematologist-oncologist at UCLA Health Jonsson Comprehensive Cancer Center and an author of the study.
Shah spoke with Cancer Today to provide tips to help patients facilitate those conversations.
CT: What are treatment goals and when should discussion occur?
SHAH: Treatment goals may focus on certain priorities, such as pain management or prolonging life, or on reducing other burdens, like side effects, time spent in health care settings or financial costs.
Comfort-based goals focus more on improving quality of life. That doesn’t necessarily mean palliative care or hospice care. It might include the oncologist providing treatments that are more targeted towards alleviating pain and symptoms than helping the patient live longer. Life-extending care prioritizes longevity above all else, even if it makes life a little bit more uncomfortable.
These discussions about a patient’s priorities and values should occur early on in treatment.
CT: How should people who prefer quality-of-life and comfort measures share their goals with their oncologist?
SHAH: Directly and frankly. It is the patient’s right to voice their priorities, and there is no right or wrong way to do so.
A lot of patients, and maybe some providers, have this preconceived notion that talking about comfort and making treatment choices based on quality of life and comfort means giving up or stopping treatment. That’s not necessarily the case.
It might even mean that a patient with advanced cancer chooses a less toxic treatment over a more effective but toxic chemotherapy. We’re still treating the cancer. We might still be providing anticancer systemic therapy. We’re still giving full care to the patient. But now the patient’s goals affect the choice of medication.
CT: If a patient’s goals change over time, how can they effectively communicate this to their team?
SHAH: I’d encourage patients to be honest and not hold back at every physician encounter, but especially as cancer advances and treatments change.
There seems to be a discrepancy between what the oncologist feels the patient’s goals are and what the patient feels the patient’s goals are. If changes in symptoms or disease progression get too burdensome, a patient may say, “You know what? Previously I really wanted to just pursue anything that would extend my life, but it’s getting to be a bit much. My goals are evolving.”
CT: Why did people with advanced cancer seem more likely to report goal-discordant care compared with others?
SHAH: While we can’t infer the cause for this discordance from our research, experience suggests that the perceived difference in value-based care may stem from the fact that cancer treatments are inherently more toxic—at least initially—than treatments for other advanced illnesses.
Also, reevaluation of patient goals in advanced cancer does not happen as frequently as it probably should because the oncologist doesn’t have the opportunity to do so due to time constraints during appointments.
The main take-home message for patients is oncologists want to know what your goals are. And you should always feel comfortable sharing them no matter what.
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