The stability of treatment preferences of advanced cancer patients over time.
e21501 Background: The stability of patient treatment preferences has important implications for the optimal timing of advance care planning. Nevertheless, longitudinal data on cancer patients in real-life settings have not examined stability of treatment preferences over time. This study examines the stability of treatment preferences of advanced cancer patients over time and the potential influence of changes in physical functioning. Methods: The patient sample (N = 104) was drawn from a multi-institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients with metastatic solid tumor cancer that had progressed on prior chemotherapy regimens were interviewed after an initial clinic meeting in which their most recent scan results were discussed (baseline) and, subsequently, completed monthly follow-ups. Patients reported their treatment preferences (i.e., comfort versus life-extending care) and physical functioning at each assessment. Results: The treatment preferences of the majority of patients (80.8%) remained stable within the first month of follow-up. Patient characteristics, such as age or type of cancer, were not significantly associated with treatment preference stability. The proportion of patients whose preferences changed in favor of comfort care (10.6%) was only slightly higher than the proportion of patients whose preferences changed in favor of life-extending care (8.7%). The same pattern held for the two- and three-month follow-up assessments. Improvement in physical functioning was significantly associated with change in treatment preferences. However, the vast majority of patients (72.2%) had stable or declining physical functioning. Conclusions: Most advanced cancer patients have stable treatment preferences regarding comfort versus life-extending care in the months leading up to their death. Thus, advance care planning earlier in the course of illness may not be premature for the vast majority of patients. As physical functioning changes, treatment preferences should be re-evaluated.