Goals of care discordance in advanced cancer compared to other advanced conditions.
Authors: Shah Manan P , Wenger Neil S , Glaspy John A , Hays Ron D , Sudore Rebecca L , Rahimi Maryam , Gibbs Lisa , Anand Sidharth , Walling Anne M 
Published: June 2024

12034

Background: Optimal care for patients with advanced cancer requires understanding patients’ goals of care and communicating treatment intent. We explored goals of care, perceived treatment intent, and mortality in patients with advanced cancer compared to other advanced conditions. Methods: We performed a cross-sectional analysis of survey data from a multi-site trial of advance care planning in patients with advanced cancer, end-stage liver disease, end-stage renal disease, chronic obstructive pulmonary disease, congestive heart failure, and advanced age (> 75 years). Patients described their physical health and quality of life. They also reported whether their preferred goals of care and their current treatment focus “on extending your life as much as possible, even if it means having more pain and discomfort,” or “relieving your pain and discomfort as much as possible, even if that means not living as long,” or “not sure.” We compared patients’ preference for life-extending care (LEC) versus comfort-focused care (CFC) with their perception of current treatment intent as LEC versus CFC. We evaluated the relationship between patients’ goals of care and perceived treatment intent with 24-month mortality in advanced cancer versus other advanced conditions. We used the chi-square test for statistical analyses. Results: Among 1099 patients, those with advanced cancer (n = 231) were more likely to report very good or excellent physical health (33% v 22%, p < .001) and very good or excellent quality of life (58% v 41%, p < .001) compared to other advanced conditions (n = 868). Patients with cancer had a similar 24-month mortality (16% v 13%, p = .25) and preferred LEC as often as patients with other conditions (25% v 23%, p = .58). Patients with cancer were more likely to report receiving LEC than those with other conditions (51% v 35%, p < .001). Patients with cancer were more likely to have a discordant goal of CFC while describing their treatment as LEC compared to other conditions (36% v 25%, p = .04). Among 113 patients with cancer who preferred CFC, there was no difference in 24-month mortality between those who reported receiving LEC versus CFC (24% v 15%, p = .31). Conclusions: Compared to patients with other advanced conditions, patients with advanced cancer reported better physical health and quality of life, but had similar mortality and goals of care. However, patients with advanced cancer were more likely to report receiving LEC and also more likely to have a discordant goal of CFC while receiving LEC. Among patients with advanced cancer preferring CFC, those who reported receiving LEC instead of CFC did not have improved survival. Good physical health and quality of life may prompt more aggressive care in patients with advanced cancer compared to other advanced conditions. These findings highlight the importance of oncologists explicitly eliciting patients’ goals of care and ensuring that patients understand the intent of treatment.