Cancer treatments failing to consider older patients' preferences
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Protocol driven treatment strategies, are rarely adjusted for patient priorities
CANCER DIGEST – March 7, 2026 – A new large-scale analysis of older adults with advanced cancer reveals a stark "preference gap" in modern oncology, showing that clinical treatments rarely align with what patients actually value most.
The study, published in the March 5, 2026 JAMA Oncology involved a secondary analysis of a randomized controlled clinical trial, called GAP70+ Clinical Trial. They found that an overwhelming majority of older patients—more than 90%—prioritize Quality of Life (QoL) over extending survival. Despite this clear preference, researchers found that medical teams are not consistently adjusting treatment plans to match these goals.
Key Findings:
Preferences are Personal: A patient’s desire for QoL versus survival could not be predicted by age, demographics, or even physical frailty. This suggests doctors must ask every patient individually rather than making assumptions.
The "Responsiveness" Gap: There was no significant difference in treatment modifications or clinical outcomes (such as hospitalizations or side effects) between patients who wanted to live longer and those who wanted to live better.
Systemic Barriers: Researchers point to a medical system that incentivizes "protocolized regimens" and productivity over personalized care. Current data suggests oncologists only ask patients what matters most about one-third of the time before starting therapy.
Led by Daniel R. Richardson, MD, MSc, of the University of North Carolina, Lineberger Comprehensive Cancer Center, and researchers at six other cancer centers analyzed patients participating in the GAP70+ cluster randomized Clinical Trial conducted at National Cancer Institute’s Community Oncology Research Program. They interviewed only those patients who were 70 or older with incurable solid tumors or lymphoma and one or more geriatric conditions who were starting a new systemic cancer treatment.
A total of 706 patients were included in the analysis. The average patient age was 77.2; 306 (43.3%) were female, and 400 (56.7%) were male. Patients were divided into two groups based on their preference for prioritizing extending survival vs maintaining QoL. A total of 506 patients (71.7%) preferred maintaining QoL vs 59 (8.4%) prioritized extending survival, and 141 (20.0%) expressed no preference.
When the researchers analyzed treatments based on patient preference, treatment choice, and clinical outcomes, they found no differences or modifications in treatment approach between those who prioritized QoL vs. those who preferred extending survival. In addition, they did not find any statistically significant differences in clinical outcomes or treatment-related side effects, hospitalizations, or death.
Taken together, the researchers concluded that these data suggest a possible lack of responsiveness of the current oncology care delivery system to patient preferences, and highlights a significant bias in medical research. While most older adults prioritize QoL, only 3% of oncology clinical trials over the last two decades have focused on improving quality of life as a primary goal.
The authors suggest that to bridge this gap, the oncology care delivery system must shift away from "one-size-fits-all" protocols and integrate Geriatric Assessments (GA) with direct inquiry to ensure the care delivered is the care the patient actually wants.
Sources: JAMA Network press release and the journal JAMA Oncology
(Draft text generated by Google Gemini AI, edited and checked by the editor)
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