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Time Toxicity of Systemic Anticancer Therapy for Metastatic Lung Cancer in Routine Clinical Practice: A Nationwide
Anne Gulbech Ording1, Flemming Skjøth2, Laurids Østergaard Poulsen3,4
1Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
For patients with stage IV lung cancer, over 1 in 5 days alive after starting treatment involved health care contact. This "time toxicity" metric helps patients and doctors make informed treatment decisions.
Area of Science:
- Oncology
- Health Services Research
- Patient-Reported Outcomes
Background:
- Time toxicity, defined as the proportion of days in physical contact with the healthcare system, is a patient-centered metric for shared decision-making in incurable cancer.
- Understanding the extent of healthcare contacts is crucial for managing treatment burdens in advanced lung cancer.
Purpose of the Study:
- To investigate the extent of healthcare system contacts (time toxicity) in Danish patients with stage IV lung cancer receiving first-line systemic anticancer therapies.
- To assess the proportion of days patients spent in physical contact with the healthcare system during the first year of treatment.
Main Methods:
- Nationwide cohort study of 4,384 newly diagnosed stage IV lung cancer patients in Denmark (2019-2021).
- Follow-up for up to 1 year, calculating time toxicity as the proportion and mean cumulative days of physical healthcare contact.
- Analysis included one-year cumulative mortality and differentiated contact proportions by cancer type and treatment regimen.
Main Results:
- The mean cumulative number of days with physical healthcare contact was 56 days within the first year, with 198 home days.
- Overall, 22% of days alive involved physical contact with the healthcare system, with similar proportions for non-small cell lung cancer (22%) and small cell lung cancer (24%).
- Contact proportions varied by treatment: chemotherapy (24%), immunotherapy (21%), immunochemotherapy (21%), and targeted therapy (16%).
Conclusions:
- More than one in five days after initiating systemic treatment for metastatic lung cancer involved physical contact with the healthcare system.
- This quantitative measure of time toxicity can inform shared decision-making, helping patients understand the expected treatment burden.
- Findings highlight the significant healthcare resource utilization and patient time commitment associated with advanced lung cancer therapies.
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