Time toxicity of patients with advanced malignancies receiving palliative intravenous systemic therapy - a multicenter observational study (GiveMeTIME)

The concept of time toxicity in cancer care is an often-neglected aspect of the significant time commitment demanded of patients undergoing treatment. While advancements in survival outcomes are pivotal, comprehending and quantifying the repercussions of time invested in cancer care are significant to patients with limited life-expectancy. “Time toxicity” includes diverse elements, including coordinating care, frequent visits to healthcare facilities (involving travel and wait times), and addressing side effects through urgent or emergent care, hospitalizations, and follow-up tests. These components collectively contribute to the overall burden of time devoted to pursuing cancer-directed therapy. Also, it is critical that the time spent on these activities can be substantial and, in certain instances, might outweigh the modest gains in survival offered by specific treatments. In addition to the medical and time-related considerations in cancer care, the financial aspect also plays a significant role in the overall impact of treatments on patients. While the providers commonly discuss side effects and medical costs associated with cancer therapy, the financial burden extends beyond direct medical expenses. It includes indirect costs that contribute to the overall financial toxicity. Patients and their families often face considerable financial challenges related to their cancer treatment, such as high out-of-pocket expenses for medications, co-pays for medical visits, and costs associated with supportive care and managing treatment-related side effects. Additionally, the indirect costs, including lost wages due to time away from work, transportation expenses for frequent visits to healthcare facilities, and the potential need for additional caregiving support, further contribute to the financial strain experienced by patients and their families. The time toxicity and financial toxicity associated with cancer care can have profound consequences on a patient’s quality of life, affecting their ability to meet basic needs, adhere to treatment plans, and maintain overall well-being. It may even influence treatment decisions also. Understanding the attitudes of oncologists, patients and caregivers regarding the relation of time toxicity to the relative gain in QoL and survival time is also important to understand different priorities. To address the financial and time-related aspects of cancer care, it is essential to integrate a comprehensive approach that considers both the direct and indirect implications on patients.