Outcomes of Older Adults With Advanced Cancer Who Prefer Quality of Life vs Prolonging Survival: A Secondary Analysis of the GAP70+ Cluster Randomized Clinical Trial.

Limited data exist on the outcomes achieved by patients with cancer with different treatment outcome preferences.

关于不同治疗结果偏好的癌症患者所取得的结果，现有数据有限。

Background

To describe treatment outcome preferences among older adults with advanced cancer and explore differences in outcomes between patients prioritizing survival vs quality of life (QoL), testing the hypothesis that patients prioritizing survival would live longer, while those prioritizing QoL would have fewer treatment-related adverse effects (TRAEs) and hospitalizations.

描述老年晚期癌症患者对治疗结果的偏好，并探讨优先考虑生存与生活质量（QoL）的患者在结果上的差异，测试这样一个假设：优先考虑生存的患者生存时间更长，而优先考虑QoL的患者治疗相关的不良反应（TRAEs）和住院次数会更少。

DESIGN, SETTING, AND PARTICIPANTS: This study was an exploratory secondary analysis of the GAP70+ cluster randomized clinical trial conducted at National Cancer Institute's Community Oncology Research Program centers.

设计、设置和参与者：本研究是对国家癌症研究所社区肿瘤研究计划中心进行的GAP70+群组随机临床试验的探索性二次分析。

Older adults (≥70 years) with incurable solid tumors or lymphoma and 1 or more impaired geriatric assessment domain(s) who were starting a new systemic cancer treatment as part of the GAP70+ trial were eligible.

年龄≥70岁的不可治愈的实体瘤或淋巴瘤患者，且有1个或多个老年评估领域受损，作为GAP70+试验的一部分开始新的系统性癌症治疗的患者有资格参与。

The primary trial took place between July 29, 2014, and March 13, 2019.

主要试验于2014年7月29日至2019年3月13日进行。

All secondary analyses were conducted between January 1, 2025, and May 30, 2025.

所有次要分析均在2025年1月1日至2025年5月30日之间进行。

exposure

Patients were divided into 2 cohorts based on their reported preference for prioritizing extending survival vs maintaining QoL.

患者根据其报告的偏好被分为两组，一组优先考虑延长生存期，另一组优先考虑维持生活质量。

main_outcomes_and_measures

Treatment outcome preferences, hospitalization, TRAEs, and survival at 6 months and 1 year.

治疗结果偏好、住院情况、治疗相关不良事件（TRAEs）以及6个月和1年的生存情况。

Results

A total of 706 patients were included in the analysis.

分析共纳入了706名患者。

The mean (SD) patient age was 77.2 (5.4) years; 306 (43.3%) were female, and 400 (56.7%) were male.

患者的平均年龄为77.2（标准差5.4）岁；其中306名（43.3%）为女性，400名（56.7%）为男性。

Gastrointestinal (244 patients [34.6%]), lung (175 patients [24.8%]), and genitourinary (109 patients [15.4%]) cancers were the most common.

胃肠道（244名患者[34.6%]）、肺部（175名患者[24.8%]）和泌尿生殖系统（109名患者[15.4%]）癌症是最常见的。

Only 59 patients (8.4%) preferred to prioritize extending survival over maintaining QoL, while 506 patients (71.7%) preferred to prioritize maintaining QoL.

只有59名患者（8.4%）更倾向于延长生存期而不是维持生活质量，而有506名患者（71.7%）更倾向于维持生活质量。

No significant associations were identified between cohorts prioritizing survival vs QoL and treatment modifications (risk ratio, 1.03; 95% CI, 0.84-1.27), grade 3 to 5 TRAEs (hazard ratio[HR], 0.84; 95% CI, 0.57-1.23), hospitalization (HR, 0.74; 95% CI, 0.39-1.41), and survival (at 6 months: HR, 0.72; 95% CI, 0.40-1.29; at 1 year: HR, 1.18; 95% CI, 0.81-1.72).

在优先考虑生存与优先考虑生活质量的患者群体之间，未发现与治疗调整（风险比，1.03；95%置信区间，0.84-1.27）、3至5级TRAEs（风险比[HR]，0.84；95%置信区间，0.57-1.23）、住院（HR，0.74；95%置信区间，0.39-1.41）以及生存率（6个月时：HR，0.72；95%置信区间，0.40-1.29；1年时：HR，1.18；95%置信区间，0.81-1.72）之间存在显著关联。

conclusions_and_relevance

In this secondary analysis of a randomized clinical trial, fewer than 1 in 10 older adults with advanced cancer participating in the trial prioritized extending survival over maintaining QoL.

在这项随机临床试验的二次分析中，参与试验的不到十分之一的患有晚期癌症的老年人将延长生存置于维持生活质量之上。

Patient preference for extending survival or maintaining QoL was not associated with up-front treatment modifications or downstream outcomes, suggesting a possible lack of responsiveness of the current oncology care delivery system to patient preference.

患者对于延长生存或维持生活质量的偏好与治疗的初步调整或下游结果无关，这表明当前肿瘤护理提供系统可能对患者偏好缺乏响应。

CLINICALTRIALS.GOV IDENTIFIER: NCT02054741.

临床试验注册号：NCT02054741。