The Hidden Cost of Cancer Treatment: Time Toxicity

TOPLINE:

Older adults with metastatic cancer living in Mexico spend about 1 in 5 days during the initial months of treatment in contact with a healthcare provider, with a higher time burden for those receiving radiotherapy or cytotoxic chemotherapy and for frail individuals.

METHODOLOGY:

• Time toxicity — days spent with healthcare contact during treatment — is “a critical but understudied outcome” for patients with cancer. Patients living in low- and middle-income countries, in particular, tend to live far from the treatment facilities, which can increase time toxicity.
• In the current study, researchers aimed to quantify time toxicity among older patients with metastatic cancer living in Mexico and receiving palliative systemic treatment. Researchers also aimed to identify characteristics associated with greater time toxicity.
• The study included 158 patients (median age, 71 years) with a recent metastatic cancer diagnosis. Patients were receiving cytotoxic chemotherapy (86%), targeted therapy (10%), or immunotherapy (4%) at a single center in Mexico City.
• Participants completed baseline assessments, including the G8 geriatric screening tool to help identify older patients with frailty as well as quality of life measures.
• The primary outcome was days with healthcare contact during the first 6 months following a cancer diagnosis; secondary outcomes included were overall survival and travel time from patients’ homes to the hospital.

TAKEAWAY:

• Patients spent a mean of 21% of their days during the first 6 months following their diagnosis with healthcare contact, with the highest burden occurring in the first month.
• In the first 6 months, more than half of patients (56%) visited the emergency department at least once, and 30% were hospitalized at least once.
• Overall, 73% of patients had an impaired G8 score, indicating potential vulnerability or frailty, and patients spent a median of 73 minutes traveling one-way to the hospital for care, with nearly a quarter traveling more than 2 hours. Almost 75% of patients were alive at 6 months, and 58% were alive at 12 months.
• In a multivariable analysis, having concurrent radiotherapy (odds ratio [OR], 1.55), cytotoxic chemotherapy compared with vs targeted therapy (OR, 1.64), and an impaired G8 score (OR, 1.27) were associated with a higher time toxicity burden.

IN PRACTICE:

These findings highlight the importance of discussing time toxicity in the decision-making process to start palliative anticancer treatment, particularly when treatments have marginal survival benefits which may be offset by time spent with healthcare contact, the authors wrote.

SOURCE:

Th study, led by Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City, was published in Supportive Care in Cancer.

LIMITATIONS:

The high burden of time toxicity found in this study others may be attributed, in part, to differences in healthcare access between patients living in low and middle-income countries and those living in developed countries. Patients living far from the hospital may have moved in with relatives, possibly leading to overestimate time toxicity; however, pharmacy visit times were not captured, which may have underestimated time toxicity.

DISCLOSURES:

Joosje C. Baltussen received travel grants from the Piso-Kuperus Fonds, René Vogels Stichting, and Stichting de Drie Lichten to work as a visiting PhD student in Mexico. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.