Examining the Experience and Preferences of Patients with Advanced Cancer at a Tertiary Care Center

Background and Objectives: Cancer care has been transformed with the advent of new personalized and targeted therapies, and the integration of specialist palliative care (PC). Comparatively little is understood about the patient experience in this modern context. This study aims to examine the experience of oncology patients receiving treatment at a tertiary care center. Design, Settings, and Measurements: We recruited patients with advanced solid cancer (N = 200) from medical oncology clinics of the Duke Cancer Institute. Participants completed the modified COMPASS questionnaire (mCOMPASS), assessing a broad range of topics including quality of life (QoL), quality of care (QoC), health care utilization, and preferences for treatment and decision making. We summarized responses descriptively and used regression models to examine associations between variables of interest. Results: The survey response rate was 56.1%. Patients unaware of their advanced cancer diagnosis (21.2%) reported better QoL than patients who were aware of their diagnosis (+2.667, 95% CI: -4.459,9.793, p < 0.05). Despite all having advanced cancer diagnoses, most participants did not receive PC services (85.0%) and approximately half (49.2%) reported having an advance care plan (ACP). Those receiving PC services had lower (worse) mean QoL scores (-11.32, 95% CI: -19.26, -3.39, p < 0.05). Those reporting prognostic awareness were more likely to have an ACP and have discussed their treatment preferences with family members (p < 0.05). Conclusion: Patients with advanced cancer undergoing treatment at a large tertiary cancer center exhibit high QoL and awareness of PC, but the underuse of PC services persists. The relationship between poor prognostic awareness and better QoL warrants further examination.