In Reply We appreciate Conner and colleagues for their interest in our article,1 as well as their thoughtful comments. The authors raise 2 important questions: (1) is aggressive care truly discordant with patient wishes, and (2) do these data, when not placed in larger context, contribute to an “institutionalization of quitting?”
In addressing the first argument, we would like to highlight a commonly encountered debate when discussing end-of-life care—the issue of timing. This study was carefully limited to the last 30 days of life to distinguish between aggressive cancer care and aggressive end-of-life care. There is no doubt that tremendous, life-prolonging advancements have been made for patients with brain tumors, especially brain metastases. This study does not contest the utility of appropriately aggressive cancer treatment early in the disease course.