Time toxicity in cancer care: a systematic review of definitions and measurement methods

Time toxicity has emerged as an important concept in oncology, reflecting the burden of time patients spend receiving care. However there is no consensus on how time toxicity is defined or measured. We conducted a systematic review to characterise the definitions and measurement methods.

MEDLINE, EMBASE, and Cochrane Library were searched from inception to 10th March 2026. Studies were included if they involved cancer patients and reported a definable measure of time-related burden associated with care. Data were extracted on study characteristics, sample size, data sources, and definitions of time toxicity.

Fifty-six studies were included. Most studies were observational (n = 45, 80.4%) and conducted in high-income countries, predominantly the United States (n = 29, 51.8%). Time toxicity was most commonly defined using direct healthcare time measures (n = 31, 55.4%), representing days involving healthcare encounters such as clinic visits, treatment sessions, hospitalisations, and emergency department visits. Time away from healthcare measures, including days alive and out of hospital or days at home, were used in 20 studies (35.7%). Healthcare process time incorporating non-clinical and logistical aspects of care were used in 5 studies (8.9%). No studies used patient-reported definitions of time toxicity. Most measures were derived from administrative, electronic health record, or clinical trial data, capturing healthcare utilisation but not patients' perceived burden or value of healthcare-related time.

Current definitions of time toxicity in cancer care are heterogeneous and predominantly system-derived, with minimal incorporation of patient-centred perspectives. We propose an empirical framework comprising three objective measurement domains: direct healthcare time, time away from healthcare, and healthcare process time-with patient-reported experience incorporated as an evidence-informed extension.