The Time Toxicity of Cancer Treatment

Gupta, Arjun; Eisenhauer, Elizabeth; Booth, Christopher M.

doi:10.1200/jco.21.02810

Cited by 129 publications

(110 citation statements)

References 52 publications

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“…Lastly, participants believed emphatically that any treatment offering PFS gains should not worsen QoL, and it was noted that periods of time where disease is not growing or spreading may be able to provide some QoL benefits such as symptom relief, prolonged ability to work (which may ameliorate financial concerns), and the pursuit of personal goals such as traveling or participating in meaningful family events. This is consistent with a new concept of treatment-related time toxicity recently posited by Gupta et al whereby patients may value treatments differently if they knew precisely how much time they would need to spend pursuing cancer-directed therapy that would disrupt normal activities of daily living and negatively impact QoL relative to gains in survival or day-to-day functioning [ 41 ].…”

Section: Discussionsupporting

confidence: 77%

Progression-free survival and quality of life in metastatic breast cancer: The patient perspective

Mertz

Benjamin

Girvalaki³

et al. 2022

The Breast

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Section: Discussionsupporting

confidence: 77%

Progression-free survival and quality of life in metastatic breast cancer: The patient perspective

Mertz

Benjamin

Girvalaki³

et al. 2022

The Breast

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“…People with cancer already spend a significant portion of their time pursuing cancer-related care. 1,3,[21][22][23] Adding to confusion and logistic burdens, for a pharmacy that appears on the GoodRx page for zip code 55455, the closest physical pharmacy is almost 400 miles away in Sterling, IL.…”

Section: Discussionmentioning

confidence: 99%

“…University of Minnesota, Minneapolis, MN 2 University of Chicago Medicine, Chicago, IL3 University of Pennsylvania, Philadelphia, PA4 Vanderbilt University, Nashville, TN…”

mentioning

confidence: 99%

Finding the Lowest-Cost Pharmacy for Cancer Supportive Care Medications: Not So Easy

Etteldorf

Rotolo

Sedhom

et al. 2022

JCO Oncology Practice

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PURPOSE: To decrease the financial burden on people with cancer, clinicians and patients increasingly use medication price comparison websites to seek pharmacies where medications may be cheaper. Shopping around at different pharmacies can add additional time and logistic burden to patients and care partners. We sought to determine whether a single pharmacy consistently offered the lowest price for symptom control medications. METHODS: We compiled medications/formulations used to manage two common cancer-associated symptoms: nausea/vomiting and anorexia/cachexia. We extracted discounted, lowest price with coupon prices for a typical fill of these medications at nine pharmacies in Minneapolis, MN, using GoodRx. We compared prices across formulations and pharmacies to assess whether a pharmacy consistently offered the lowest price. RESULTS: We included 24 formulations for nausea/vomiting (14 generic and 10 brand-name) and 19 for anorexia/cachexia (12 generic and seven brand-name). Prices for brand-name formulations were similar across pharmacies, but prices of generic formulations varied widely across pharmacies. For example, the prices of a seven-unit fill of generic 5-mg olanzapine tablets ranged from $4 to $57 US dollars. No single pharmacy consistently offered the lowest price across the formulations studied. For example, for the 12 generic formulations for anorexia/cachexia, one pharmacy had the highest price for four formulations and the lowest price for two others. CONCLUSION: In this study of discounted medication prices, we found that no single pharmacy in an urban zip code consistently offered the lowest price for medications used to manage two common cancer-associated symptoms. Well-intentioned efforts to pursue the cheapest source of each medication by visiting multiple pharmacies may add extra time and logistic toxicity to patients and care partners. This approach can increase redundant scripts and expose patients to medication-related adverse events.

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“…4 Additionally, these 16 hours may be distributed over at least 4-5 days per month, leading to fewer treatment-free 'home days'. 5 Time estimates were based on process mapping via direct observation in oncology clinics and patient surveys but applied to only the minimal frequency of visits for trial participation. Real-world data indicate that the frequency of clinic visits is more often than visits for trial assessments outlined in included trial protocols.…”

Section: Discussionmentioning

confidence: 99%

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

Prasad

Thibault

Chen

et al. 2022

Preprint

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Background: Financial costs from cancer treatment are increasingly recognized, but what has historically been underrecognized is the time cost of therapy. We sought to estimate the time burden of anti-cancer drugs approved based on comparisons to best supportive care (BCS), with the assumption that without this drug, a patient could have been treated with observation, home palliative care or hospice services, with minimal time seeking medical care. Methods: We searched all FDA approvals (2009 - March 2022) for randomized trials that used BCS as a treatment option for an anti-tumor drug in the metastatic setting and abstracted data on treatment related activities. We then estimated time spent on these activities using previously calculated times. Results: Of the 13 drugs tested against BSC, nine studies demonstrated an improvement in median OS (median 2.1 months). The median monthly time spent for patients in the intervention arm of BSC trials was 15.8 hours. Conclusion: Time is a valuable resource for people who have cancer, but especially for patients who may have few to no remaining treatment options, and yet, we found that patients can spend up to 16 hours in anti-cancer drug related activities per month.

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The Time Toxicity of Cancer Treatment

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 129 publications

References 52 publications

Progression-free survival and quality of life in metastatic breast cancer: The patient perspective

Progression-free survival and quality of life in metastatic breast cancer: The patient perspective

Finding the Lowest-Cost Pharmacy for Cancer Supportive Care Medications: Not So Easy

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

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