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Design and Participants: This study quantified TT among older patients with cancer receiving palliative systemic treatment. All patients aged 65 years and older with metastatic cancer receiving cytotoxic chemotherapy, immunotherapy, or targeted therapy at a single Mexican center were selected from a prospective patient navigation cohort. Patients completed a baseline assessment, including the G8 (identifies which older patients benefit from geriatric assessment) and quality-of-life (FACT-G) measures. Physical healthcare contact days within the first 6 months were extracted from medical records and divided by days alive during the same period. Beta regression models identified TT predictors.
Results: Patients (N=158) were aged median 71 years (IQR=68-76) and were 43% male; 86% received cytotoxic chemotherapy. Overall, 73% had an impaired G8 score and were considered vulnerable/frail, and the baseline FACT-G score was 70 (SD=15). Patients traveled a median of 73 minutes (IQR=35-112) one-way to the hospital; 24% traveled more than 2 hours. Six-month overall survival was 74%; 12-month was 58%. Within the first 6 months, patients spent a mean of 21% (95% CI=19%-23%) of days with healthcare contact; 56% visited the emergency department one or more times, with 31% visiting two or more times. Thirty percent were hospitalized once or more. In the multivariable model, concurrent radiotherapy (odds ratio [OR]=1.6; 95% CI=1.2-2.0), cytotoxic chemotherapy vs targeted therapy (OR=1.6; 1.1-2.4), and an impaired G8 (OR=1.3; 1.0-1.6) were associated with increased TT, while doublet or triplet therapy vs monotherapy was not (OR=1.2; 0.96-1.5).
Commentary: This study aimed to quantify healthcare contact time for patients receiving palliative cancer-directed therapies at a single center in Mexico. Forecasting the impact of medical contacts on daily life is an important task for all clinicians, whether palliative care subspecialists or oncologists providing primary palliative care. As the authors discuss, this is especially salient for patients with limited financial resources who may live far from any healthcare contact. Investigating associated TT for those with hematologic malignancies, who were excluded here, would be a helpful future study. Though the association of concurrent radiotherapy or cytotoxic chemotherapy with increased TT is not surprising, this is relevant when planning symptom management—for some patients (especially, as this study suggests, those with higher baseline frailty and multimorbidity), the juice may not be worth the squeeze in terms of travel back and forth to the hospital for palliative radiation or chemotherapy, instead using other means to provide symptomatic relief.
Bottom Line: Older adults with metastatic solid organ malignancies, especially those with increased baseline frailty receiving concurrent radiation and/or cytotoxic chemotherapy, have increased risk of TT within the first 6 months following diagnosis, an observation which may guide palliative-related treatment decisions in this time frame.
Reviewer: Gabrielle Langmann, MD MS, University of Utah, Salt Lake City, UT
References:
1. 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.
2. Gupta A, Jensen EH, Virnig BA, Beg MS. Time-related burdens of cancer care. JCO Oncol Pract. 2022;18(4):245-246. doi:10.1200/OP.21.00662.
Source: Baltussen JC, Cárdenas-Reyes P, Chavarri-Guerra Y, et al. Time toxicity among older patients with cancer treated with palliative systemic therapy. Support Care Cancer. 2024;32(9):621. doi:10.1007/s00520-024-08844-1.
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