Time toxicity during palliative chemotherapy for advanced malignancies: a prospective study

Patients with advanced malignancies spend a considerable proportion of their limited survival time on healthcare. However, it is not usual practice to consider 'time spent for therapy' when making treatment decisions. This study aimed to calculate the time toxicity associated with systemic therapy in advanced malignancies.

The study was a prospective (CTRI/2023/05/053281) single-centre study that included adult patients with advanced malignancies receiving palliative intravenous systemic therapy. The time spent away from home for the hospital visit was considered time toxicity. Time toxicity over the 2-month period, divided by total follow-up duration, was calculated to derive the time toxicity index. The time taken for the different activities determined the components of time toxicity. Time toxicity was correlated with patient quality of life.

Of the 92 recruited patients, the median age was 57 (35-88) years, 39 (42%) were women and 34 (37%) patients had gastrointestinal cancers. The median survival time was 7.6 (95% CI 5.6 to not reached) months. The mean time toxicity over the study period was 226 hours (95% CI 194 to 258.7) and time toxicity index was 17% (95% CI 14% to 20.5%). The major components of time toxicity were travel time and hospital formalities. Mean proportion of necessary to non-value-added activities was 8 (SD 9.4). The time toxicity index correlated with QoL.

The study highlights that time toxicity is an important factor in decision-making for patients planned for palliative therapy. Further studies are needed to understand the impact of time toxicity and the meaning patients attach to this.

CTRI/2023/05/053281.