The hidden costs of cancer treatment: time toxicity

TOPLINE:

Older adults with metastatic cancer living in Mexico spend approximately one in five days in contact with a health care provider during the first months of treatment, with a higher time burden for those receiving radiation therapy or cytotoxic chemotherapy and those who are frail.

METHODOLOGY:

• Time toxicity – days spent with healthcare professionals during treatment – ​​is “a critical but under-researched endpoint” for cancer patients. In particular, patients in low- and middle-income countries tend to live far from treatment facilities, which may increase time toxicity.
• In the current study, researchers sought to quantify time toxicity in elderly patients with metastatic cancer living in Mexico and receiving palliative systemic treatment. The researchers also wanted to identify traits associated with greater time toxicity.
• The study included 158 patients (mean age 71 years) who were recently diagnosed with metastatic cancer. Patients received 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 identify older patients with frailty and quality of life measures.
• The primary outcome was days of medical contact during the first 6 months after a cancer diagnosis; Secondary endpoints included overall survival and travel time from the patient’s home to the hospital.

TAKE AWAY:

• Patients spent an average of 21% of their days in contact with health care in the first 6 months after diagnosis, with peak exposure occurring in the first month.
• During 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 an average of 73 minutes traveling back and forth to hospital for treatment, with almost a quarter taking more than two hours. Nearly 75% of patients were alive at 6 months, and 58% were alive at 12 months.
• In a multivariable analysis, simultaneous radiotherapy is carried out (odds ratio). [OR]1.55), cytotoxic chemotherapy compared with targeted therapy (OR, 1.64), and impaired G8 score (OR, 1.27) were associated with higher temporal toxicity burden.

IN PRACTICE:

These results underscore the importance of discussing time toxicity in the decision-making process for initiating palliative cancer treatment, particularly when the treatments have modest survival benefits that may be offset by time spent in contact with health care, they write Authors.

SOURCE:

The study, led by Enrique Soto-Perez-de-Celis of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City, was published in Supportive care for cancer.

RESTRICTIONS:

The high burden of time toxicity found in this study may be partially attributed to differences in access to healthcare between patients in low- and middle-income countries and patients in developed countries. Patients who live far from the hospital may have moved in with relatives, potentially leading to an overestimated time toxicity; However, pharmacy visit times were not recorded, which may have led to an underestimation of temporal toxicity.

DISCLOSURES:

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

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