Measuring Time Burdens Around Cancer Care

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Many might agree that cancer—and the care associated with it—often involves major time commitments on patients and their caretakers.¹` In fact, within the oncology community, these types of commitments are being coined as the “time toxicity” of cancer care.²

Patients with advanced solid tumors are believed to spend 20-30% of their days with healthcare contact, with the potential for it to be counterweighed by this aforementioned time toxicity.3 As of now, there is limited research on the concept, such as the sources, who it impacts, and impacting results.

As a result, a qualitative analysis published in JAMA Network Open³ sought to identify the facets of cancer care that may be considered most taxing and those impacted most by the time burdens, while measuring the associated consequences.

The study investigators recruited participants from the University of Minnesota’s M Health Fairview clinic, which is considered a National Cancer Institute-designed cancer center. In order to have a demographically diverse group when it came to age, gender, socioeconomic status, and cancer site, they utilized what are considered “purposive and criterion sampling methods.” In total, three groups were recruited:

1. Patients: These consisted of English-speaking adults with advanced gastrointestinal cancer who were receiving systemic treatment.
2. Care partners: There were patient-identified informal (unpaid) partners, who could qualify for the study even if the patient did not.
3. Oncology clinicians: These were advanced practice clinicians (physician assistants and nurse practitioners), physicians, nurses, social workers, and schedulers.

Qualitative interviews were conducted from Feb. 1 to Oct. 31, 2023, while the data were analyzed from February 2023 to February 2024. There was a total of 47 participants interviewed, with 16 of those being patients [8 aged ≤60 years; 12 women (75.0%)], 15 care partners [12 aged ≤60 years; 9 women (60.0%)], and 16 clinicians [11 women (68.7%)]); 15 care partners [12 aged ≤60 years; 9 women (60.0%)], and 16 clinicians [11 women (68.7%)]).

There was also a total of 31 subthemes gathered, which were divided into five themes.

Theme 1 monitored the time burdens related to health care outside the home (such as parking, travel, and waiting time); theme 2 consisted of invisible tasks hanlded at home (eg, handling insurance and medical bills, receiving formal home-based care); theme 3 was centered around how care partners were impacted alongside patients (burdens involving the greater network of family, friends, and community); theme 4 reported on the consequences of time burdens (demoralization or short visits that shifted to all-day events), and theme 5 represented the positive time spent in clinical interactions and hope for change.

Overall, said the study authors, “the results of this study will guide the oncology community to map, measure, and address future time burdens,” but it’s also important to note—as a limitation—these findings may not be an accurate representation of beliefs of the entire community of people who have either lived with or have professional experience of cancer.

References

1. Banerjee R, George M, Gupta A. Maximizing home time for persons with cancer. JCO Oncol Pract. 2021;17(9):513-516. doi:10.1200/OP.20.01071PubMedGoogle ScholarCrossref

2. Gupta A, Eisenhauer EA, Booth CM. The time toxicity of cancer treatment. J Clin Oncol. 2022;40(15):1611-1615. doi:10.1200/JCO.21.02810

3. Gupta A, Johnson WV, Henderson NL, et al. Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care. JAMA Netw Open. 2024;7(11):e2447649. doi:10.1001/jamanetworkopen.2024.47649