Quality or Quantity of Life? Treatment Priorities in Older Adults with Cancer in the community

Older adults with cancer often face decisions about prioritizing quality of life, survival, or both. In this prospective study of 181 patients aged ≥65 at a community cancer center, patients completed a geriatric assessment that included a validated trade-off question: “Maintaining my quality of life is more important to me than living longer.” Preferences were categorized as prioritizing quality of life, quantity of life, or both. Older age (OR 1.06; p = 0.04) and female sex (OR 2.82; p = 0.01) were associated with prioritizing quality of life. Functional, cognitive, or psychosocial impairments were not. Prioritizing quality of life was not associated with worse overall survival (HR 1.06; p = 0.89). Receipt of standard treatment improved survival (HR 0.38; p = 0.04), while ECOG 3–4 predicted worse outcomes. These findings challenge assumptions that prioritizing quality of life compromises survival and support the integration of geriatric assessment and values-based discussions into cancer care.