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

项目摘要 癌症护理正变得越来越复杂，对患者的精力和时间的要求越来越高。作为 因此，患者往往不得不忽视他们的日常生活活动和人际关系。癌症的“时间毒性” 很少得到承认，在护理考虑中几乎没有发挥作用。此外，不存在评分系统， 测量癌症护理的时间负担。必须权衡治疗的潜在生存益处， 额外的时间负担特别影响那些有过早死亡风险的人。因此，迫切需要 测量和减少癌症的时间毒性。拟议研究的总体目标是 描述和量化接受癌症治疗的个体中癌症相关时间毒性的来源 以及它们对健康的影响，并建立时间毒性评分，可用于未来的研究，以确定 尽量减少时间毒性的机会。一般的假设是，结合基于传感器的客观数据， 与主观自我报告的措施，花在医疗保健相关的活动的时间将准确地衡量 癌症护理的时间负担，并确定与治疗提供相关的干预领域，以减少这一负担 负担这一假设将通过以下具体目标进行测试：（1）测量和描述的组成部分， 通过移动的健康应用程序与癌症相关的医疗保健交互相关的客观时间使用;（2） 描述癌症相关时间使用和自我报告的幸福感之间的关系， 探索环境在修改这些关联中的作用;（3）基于以下内容创建时间毒性汇总评分： 测量癌症相关的时间使用，并评估其与心理社会结果的关联。我们会进行 在80名晚期卵巢癌或转移性乳腺癌患者中进行的28天前瞻性队列研究 癌使用现有的智能手机应用程序，我们将自动跟踪每天癌症花费的时间 活动，由参与者报告的具体活动、幸福感（每日）和生活质量的详细信息增强 （基线和研究结束）。我们将评估客观时间使用和日常幸福感之间的关联， 通过患者特征探索这些关联的变化，开发多维评分系统 时间毒性的区别，情节毒性，旅行毒性，机会毒性，和调度 毒性，并测量这些评分与患者报告的心理社会结果的相关性。后 完成后，我们将制定出癌症活动和患者日常时间使用的客观措施， 特征（目标1），估计与日常幸福感的关联，并探索患者的变化 特征（目标2），并开发了多维时间毒性评分系统（目标3）。拟议 研究是创新的，因为时间毒性是癌症存活率中的一个新概念，我们将捕捉到 将客观传感器数据与自我报告数据相结合。这项研究将产生重大影响，因为时间 我们对癌症护理时间负担的测量将有助于未来的干预措施， 时间毒性

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.