To the Editor We commend Prigerson et al1 for undertaking their important work evaluating chemotherapy use, performance status, and quality of life at the end of life. The importance of the results presented in this study extends beyond the obvious benefit to patients to include economic ramifications in the era of value in oncology.2 As oncologists, we must be able to translate for our patients the meaning of true clinical benefit as a balance between patient-centered and tumor-centered outcomes, and there must be a greater shared understanding regarding goals of care among oncologists, patients, and caregivers earlier during the course of cancer care.