Cancer patients have a lot to consider when getting treatment, but some researchers say that one care aspect has been largely overlooked: "time toxicity," or the time a patient spends interacting with the healthcare system, which can quickly add up, Charlotte Huff writes for STAT.

Should 'time toxicity' be considered a part of cancer treatments?

According to Huff, cancer treatment studies collect numerous data points on overall survival, progression-free survival, side effects and more. Now, some researchers have proposed adding a new data point: time toxicity.

Time toxicity refers to any time that a patient interacts with the health system for care, even if it's only an hour or two. This includes clinic appointments, picking up medication, home-based care, ED visits, phone calls with insurance companies, and more.

Even an appointment that's "just a blood draw" can easily take up several hours, said Arjun Gupta, a gastrointestinal oncologist at the University of Minnesota  who is collecting data from patients, caregivers, and providers on time toxicity among cancer patients. "Seemingly short appointments turn into full-day affairs for patients and their care partners."

By providing patients information about the time they may be spending receiving medical care, clinicians "could frame difficult conversations about the pros and cons of treatment options, particularly as the end of life nears," Huff writes.

"It certainly is not up to me as the treating physician to tell a patient how they should or should not spend their time," said Christopher Booth, an oncologist and professor who practices at Queen's University in Ontario. "But as an oncologist, patients rely on us to convey to them the relative risks and benefits of a treatment. And I think we should consider time toxicity more explicitly in these conversations."

However, not all clinicians see the benefit to creating a specific measure for time toxicity. According to Anthony Back, an oncologist at the  University of Washington School of Medicine, time spent in cancer treatment can be difficult for patients, but what they need is adequate support, especially near the end of their life.

"Do we need to create jargon like time toxicity to realize that patients who have a limited amount of time left need to be enabled to understand and grasp their situation, and then make wise decisions that are really based on what really matters to them?" Back asked.

How this change could potentially help patients

According to a 2021 analysis of 298 randomized studies, the survival benefit of recent cancer drug treatments averaged just a few months. In the analysis, researchers found that the median improvement in overall survival was just 3.4 months in studies that found any benefits to different therapies for breast, colorectal, and lung cancers.

To help patients be more aware of the potential time burden associated with new treatments, both Booth and Gupta have advocated for drug treatment studies to include time spent interacting with the health system as one of their data points.

By adding this measure to studies, Booth and Gupta say patients could gain a stronger sense of the time involved in a treatment and related tasks, as well as any unexpected complications that occur.

"There are these unplanned visits, or the unanticipated visits, where someone gets sick with diarrhea and has to have an extra visit to the cancer center for IV fluids," Booth said. "Or someone develops a fever and goes to the emergency room."

In an analysis published last year in the Journal of Clinical Oncology, Booth and Gupta worked with other researchers to apply the time-spent-in-healthcare measure to two already published studies that focused on advanced bile duct cancer and glioblastoma. In both studies, the treatments increased median survival time by 27 days, but this improvement was offset by around 28 to 30 days spent interacting with the healthcare system.

"There's basically a direct tradeoff, whereby every extra day of life may be traded off by one extra day getting a CAT scan, going to the emergency room, coming to the infusion center, or seeing the oncologist," Booth said. "This is actually a fairly simple thing to measure that has real meaning to patients."

JJ Singleton, a 35-year-old cancer patient who has been receiving infusion treatments for Stage 4 colon cancer since 2016, said he believes that all patients need "a more accurate and upfront appraisal of the time involved" with treatments, Huff writes.

According to Singleton, time estimates for treatments are often based on best-case scenarios and don't account for delays in blood work, nurse availability, or other steps.

"I wish doctors wouldn't kind of make it sound easier," Singleton said. "Because they tell you treatment is going to be four to six hours. But most likely you're going to be there eight or nine hours if they say six." (Huff, STAT, 4/10)