<p>Gastric cancer with peritoneal involvement is becoming increasingly common, particularly among younger patients with diffuse-type disease. This aggressive subtype carries a high symptom burden and severely impacts quality of life (QoL). Novel therapeutic strategies targeting peritoneal metastases, including normothermic intraperitoneal and systemic chemotherapy (NIPS), pressurised intraperitoneal aerosol chemotherapy (PIPAC), and cytoreductive surgery with HIPEC, are reshaping the treatment landscape. Among these, only NIPS has demonstrated a clear overall survival benefit, as shown in the phase III DRAGON-01 trial. PIPAC and CRS with HIPEC hold promise and are currently being investigated in randomised studies. However, patient-reported outcomes (PROs) remain inconsistently captured. For example, neither DRAGON-01 nor PHOENIX-GC reported QoL data despite their clinical impact. By contrast, PERISCOPE II and PIPAC VER-ONE have incorporated PRO measures, including EORTC QLQ-C30 and QLQSTO22, which are expected to provide more patient-centred insights. These instruments, while valuable, may not fully capture peritoneal-specific symptoms, highlighting the need for tailored tools. Routine integration and standardised reporting of PROs are critical to ensure that survival gains are accompanied by meaningful improvements in patient experience. As therapeutic strategies evolve, embedding PROs in trial design is essential for delivering value-based, patient-centred care in gastric cancer with peritoneal metastases. [KD1]LE: Structured abstract is required in this type of journal. Please consider providing the aforesaid.</p>