Decision-Making Process of Older Adults with Advanced Cancer Regarding Continuation of Systemic Therapy

This qualitative study explored the decision-making process regarding continuation of systemic therapy among older adults with advanced cancer, focusing on how treatment choices are interpreted within the context of aging and remaining life. Seventeen participants aged ≥70 years with recurrent or metastatic cancer receiving systemic therapy were recruited from two cancer centers in Japan. Semi-structured interviews were conducted and analyzed using a modified grounded theory approach. The analysis identified six interrelated categories describing a dynamic decision-making process. Central to this process was discovering a moderately acceptable state, which functioned as a turning point through which participants recalibrated expectations of treatment and health in relation to aging. This turning point enabled participants to integrate cancer treatment into the aging process rather than perceiving treatment and aging as competing forces. Throughout the process, adopting more flexible views of health shaped how participants evaluated treatment burden, partial effectiveness, and acceptability over time. These findings highlight treatment continuation as an evolving interpretive process grounded in aging and uncertainty, underscoring the importance of nursing practices that support older adults in reflecting on lived experiences and making treatment decisions aligned with their values in later life.