Time toxicity of cancer: the time demands of cancer-related activities and their impact on well-being and quality of life

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Project Summary Cancer care is becoming increasingly complex, with growing demands on patients’ energy and time. As a result, patients often have to neglect their usual life activities and relationships. Such ‘time toxicities’ of cancer are rarely acknowledged and play little role in care considerations. Further, no scoring systems exist to measure the time burden of cancer care. Having to weigh potential survival benefits of treatments against added time burdens especially affects those at risk of premature death. Therefore, there is a critical need to measure and reduce the time toxicities of cancer. The overall objectives of the proposed research are to describe and quantify sources of cancer-related time toxicity among individuals receiving treatment for cancer and their effect on well-being, and to create time toxicity scores which can be used in future studies to identify opportunities to minimize time toxicity. The general hypothesis is that combining sensor-based objective data with subjective self-reported measures of time spent on healthcare-related activities will accurately measure the time burden of cancer care and identify areas for interventions related to treatment delivery to reduce this burden. This hypothesis will be tested via the following specific aims: (1) Measure and describe components of objective time use associated with cancer-related healthcare interactions via a mobile health application; (2) Characterize associations between measures of cancer-related time use and self-reported well-being, and explore the role of context in modifying these associations; (3) Create a time toxicity summary score based on measures of cancer-related time use and assess its association with psychosocial outcomes. We will conduct a 28-day prospective cohort study of 80 individuals with advanced stage ovarian cancer or metastatic breast cancer. Using an existing smartphone application, we will automatically track time spent on daily cancer activities, augmented by participant-reported details on specific activities, well-being (daily), and quality of life (baseline and end of study). We will estimate associations between objective time use and daily well-being, explore variations in these associations by patient characteristics, develop a multidimensional scoring system of time toxicity differentiating between episodic toxicity, travel toxicity, opportunity toxicity, and scheduling toxicity, and measure the associations of these scores with patient reported psychosocial outcomes. Upon completion we will have developed objective measures of daily time use by cancer activity and patient characteristics (Aim 1), estimated associations with daily well-being and explored variations by patient characteristics (Aim 2), and developed a multidimensional time toxicity scoring system (Aim 3). The proposed research is innovative because time toxicity is a novel concept within cancer survivorship which we will capture combining objective sensor data with self-report data. This study will have a significant impact because time matters to patients and our measures of cancer care time burdens will facilitate future interventions to reduce time toxicity.