Health care‐related time costs in patients with metastatic breast cancer

Abstract

Background: Burdens related to time spent receiving cancer care may be substantial for patients with incurable, life-limiting cancers such as metastatic breast cancer (MBC). Estimates of time spent on health care are needed to inform treatment-related decision-making. Methods: Estimates of time spent receiving cancer-related health care in the initial 3 months of treatment for patients with MBC were calculated using the following data sources: (a) direct observations from a time-in-motion quality improvement evaluation (process mapping); (b) cross-sectional patient surveys; and (c) administrative claims. Average ambulatory, inpatient, and total health care time were calculated for specific treatments which differed by antineoplastic type and administration method, including fulvestrant (injection, hormonal), letrozole (oral, hormonal), capecitabine (oral, chemotherapy), and paclitaxel (infusion, chemotherapy). Results: Average total time spent on health care ranged from 7% to 10% of all days included within the initial 3 months of treatment, depending on treatment. The greatest time contributions were time spent traveling for care and on inpatient services. Time with providers contributed modestly to total care time. Patients receiving infusion/injection treatments, compared with those receiving oral therapy, spent more time in ambulatory care. Health care time was higher for patients receiving chemotherapeutic agents compared to those receiving hormonal agents. Conclusion: Time spent traveling and receiving inpatient care represented a substantial burden to patients with MBC, with variation in time by treatment type and administration method.

The Time Toxicity of Cancer Treatment

“…Clinicians typically lack information necessary to help patients and care partners make fully informed decisions incorporating the impact on their time. 7 Although retrospective analyses have described where people with cancer spend their time, [8][9][10][11][12][13][14][15] patients often have health care needs from the underlying cancer, independent of treatment. These studies therefore make it difficult to ascertain how much additional time toxicity comes from a specific treatment.…”

Opportunity Costs of Surgical Resection and Perioperative Chemotherapy for Locoregional Pancreatic Adenocarcinoma

“…In one study of patients with metastatic breast cancer treated in Alabama, the mean travel time was 155 minutes. 22,23 This may reflect differences in patient sampling, as patients living in rural areas of the Southeast United States may travel greater distances than the national average because of limitations in complex cancer care accessibility. Not surprisingly, travel distance has been associated with receipt of cancer treatment as well.…”

Estimation of time cost of anti-cancer drugs approved based on comparisons to best supportive care: a cross sectional analysis

“…Real-world data indicate that the frequency of clinic visits is more often than visits for trial assessments outlined in included trial protocols. 3 One limitation is the few instances of BCS trials (N=13 trials), but this covered 13 years of FDA approvals. Time is a valuable resource for people who have cancer, but especially for patients who may have few to no remaining treatment options.…”

“…We estimated time spent on trial-related activities (physical and clinical assessments, traveling, tumor assessments, treatment infusion, if applicable, and patient-reported assessments) for patients in the intervention trial arm by multiplying previously calculated times by the frequency of activity listed in the trial protocol. 3 We conducted all analyses using R software, version 3.6.…”