The science of value-based cancer care is in its infancy. The association of quality and patient outcomes are still largely a thing of the future—to be informed by longitudinal studies to come that will involve a new generation of better-structured big data. Thus, aligning evidence-based treatment decisions with patient goals and patient's performance/fit status is an imperfect science. There is no better case of such a conundrum than with the advanced NSCLC patient population, where disease is often aggressive, treatment choices are numerous and complicated, patients often have high disease and treatment-related symptom burden, and the overall survival trajectory is sadly among the shortest of all cancer diagnoses.