In reality, only 2 major reasons exist for administering chemotherapy to most patients with metastatic cancer: to help them live longer and/or to help them live better. In exchange for treatment-related toxic effects (as well as substantial time, expense, and inconvenience), chemotherapy can prolong survival for patients with a variety of—though not all—solid tumors. Chemotherapy may also improve quality of life (QOL) for patients by reducing symptoms caused by a malignancy. In this issue of JAMA Oncology, Prigerson and colleagues1 report some troubling trial results: chemotherapy administered to patients with cancer near the end of life achieved neither goal.