# Documentation of Advance Care Planning in Early Phase Cancer Clinical Trials: An Australian Single-Centre Experience

## TL;DR

This study found that most cancer patients in early phase trials have important future care discussions late in their illness, often triggered by worsening health.

## Contribution

The study provides insights into when and how advance care planning occurs in early phase cancer trials, emphasizing the need for earlier discussions.

## Key findings

- ACP discussions typically occurred within the final year of life, with a median of 23.5 months from diagnosis.
- Disease progression and hospital admission were the most common triggers for ACP conversations.
- Most discussions focused on limiting invasive care like intubation.

## Abstract

Many people with advanced cancer take part in early phase clinical trials to access new treatments. These patients face complex medical decisions, yet conversations about their future care wishes (also called advance care planning) are often delayed. This study reviewed the medical records of cancer patients who participated in an early phase clinical trial to understand when and how these important discussions occurred. We discovered that most conversations about future care happened late, usually in the last year of life, and were often triggered by worsening illness or hospital admission. By identifying how and when these talks take place, this research highlights opportunities to start them earlier, with the goal of ensuring that future medical care is aligned with each patient’s individual values and priorities.

Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care.