A Call to Action for Revisiting Goals of Care Discussions With Adolescents and Young Adults With Cancer

In "Evolution in Documented Goals of Care at End of Life for Adolescents and Young Adults With Cancer," Mastropolo et al 1 addresses an important and understudied question regarding whether and how goals of care (GOC) change for adolescents and young adults (AYAs) with cancer as death approaches.To answer this question, the authors 1 conducted a multisite, cross-sectional, retrospective study of nearly 2000 AYAs who died between 2003 and 2019 at 3 sites across 2 states.Eligible AYAs were aged 12 to 39 years at time of death with documentation of metastatic, relapsed, or refractory cancer.Standardized data abstraction algorithms were used to extract data from the electronic health record related to demographics, disease type, medical interventions, and documented conversations about GOC and treatment preferences.The study's primary objective focused on assessing frequency, timing, and evolution of GOC discussions during the last 90 days of life; secondary objectives explored factors associated with earlier documentation of palliative goals as well as associations of GOC with medical interventions received.For purposes of analysis, timing of documented GOC was stratified as early (>60 days before death), middle (31-60 days before death), or late (30 days before death). 1 Intuitively, the study findings showed that AYAs with cancer had increased documentation of palliative GOC as they approached end of life.More specifically, 1 in 5 AYAs had GOC documentation that transitioned from nonpalliative goals in the early or middle periods to palliative in the final 30 days before death. 1 While perhaps unsurprising, the clinical relevance of this finding is significant: a sizeable minority of AYAs may change their GOC during the final weeks of life, underscoring the importance of revisiting GOC conversations as death approaches to align medical interventions with a patient's wishes.Mastropolo et al 1 make a compelling argument that sensitivity to evolution of GOC is particularly critical in the AYA population, given decisional ambivalence intrinsic to this development phase and the unique challenges of facing death in the prime of life.The authors hypothesize that older adults, who often shoulder greater life experience, may be less likely to shift goals over time.A recent publication 2 substantiates their hypothesis,