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 (GA) 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 = .04) and female sex (Odds Ratio 2.82; P = .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 (Hazard Ratio 1.06; P = .89). Receipt of standard treatment improved survival (HR 0.38; P = .04), while Performance status 3-4 predicted worse outcomes. These findings challenge assumptions that prioritizing quality of life compromises survival and support the integration of GA and values-based discussions into cancer care.
Keywords: geriatric oncology; incurable cancer community oncology; patient preference; quality of life.
© The Author(s) 2025. Published by Oxford University Press.