The review, conducted by a team of nursing researchers at Sir Run Run Shaw Hospital affiliated with Zhejiang University School of Medicine in Hangzhou, China, was motivated by a simple observation: while the financial toxicity of cancer care has become a well-established field of study, the time burden has remained fragmented across the literature. Led by He Liu, with Min Ju, Cuilan Wu, and Liting Guo as co-authors, the team systematically searched six electronic databases, PubMed, Web of Science, Embase, CINAHL, Scopus, and the Cochrane Library, for English-language articles published from database inception through February 1, 2026. Their search terms centered on cancer and time toxicity, and they followed established scoping review methodology, including the PRISMA extension for scoping reviews, to identify, screen, and synthesize the available evidence.

After screening, thirty articles made it into the final synthesis. That number is telling: it reflects a young but rapidly growing field. The concept of time toxicity was only formally articulated in the oncology literature a few years ago, most prominently in a 2022 commentary in the Journal of Clinical Oncology by Gupta, Eisenhauer, and Booth, who argued that the time a treatment demands from a patient should be weighed alongside its survival benefits and side effects when judging its value. Since then, a wave of studies has attempted to quantify exactly how many days of life cancer care consumes, and the new review organizes this emerging body of work into four categories: the current status of time toxicity, the factors that influence it, the methods used to assess it, and the interventions that might ease it.

The central finding of the review is that patients with cancer can experience notable time toxicity, and that this burden is not distributed evenly. The authors identify several clusters of influencing factors. Demographic and socioeconomic characteristics, including insurance status, shape how much time patients must spend obtaining care, since coverage, transportation, and the ability to take time off work all modulate the practical cost of every appointment. Disease-related factors matter as well: advanced-stage disease, aggressive tumor biology, and the need for palliative systemic therapy all tend to increase the frequency of healthcare contact. Treatment-related factors are perhaps the most obvious drivers, since intensive regimens, intravenous therapies delivered in infusion centers, and complex multimodal approaches involving surgery, radiation, and drug treatment each add their own layers of scheduling demands.

Some of the individual studies captured in the review illustrate the scale of the problem with striking specificity. Research on ambulatory appointments has documented how much of a patient’s day is consumed not by treatment itself but by waiting, registration, and travel. A nationwide cohort study in Denmark examined the time toxicity of systemic anticancer therapy for metastatic lung cancer in routine clinical practice, while other work has quantified healthcare contact days among patients with non-small cell lung cancer, comparing the burdens experienced in clinical trials with those in routine care. Studies of older adults with metastatic breast cancer and of older patients receiving palliative systemic therapy have highlighted how age-related vulnerabilities intersect with logistical demands, and a Japanese hospital database analysis traced how the time burden of the common lymphoma regimen R-CHOP has changed over time as practice patterns evolved.

Perhaps the most consequential finding in recent years, reflected in the review’s synthesis, is that newer drug classes may actually reduce time toxicity. Studies of immunotherapy and targeted therapy in melanoma and in other advanced malignancies have suggested that these agents, often deliverable in less frequent doses or orally, can shrink the number of healthcare contact days compared with conventional chemotherapy. One study of immunotherapy and targeted therapy in incurable malignancies went so far as to frame these treatments as reducing the unseen burden of time. This adds a genuinely new dimension to how clinicians might think about treatment selection: two regimens with similar efficacy statistics may impose radically different demands on a patient’s calendar, and therefore on their quality of life.

The review also catalogs the growing toolkit for measuring time toxicity. The most widely used metric is the concept of healthcare contact days, counting every day on which a patient has any contact with the healthcare system, whether for infusion, imaging, laboratory work, or consultation. Other approaches include patient-reported measures of time burden, qualitative interviews that capture the lived experience of scheduling chaos, and discrete choice experiments designed to determine how much weight patients actually give to healthcare-contact time when weighing treatment decisions. One study developing attributes for such an experiment among patients with advanced gastrointestinal cancers found that healthcare-contact time is genuinely important to patients making systemic treatment decisions, not an abstract concern of health services researchers. Yet the review’s authors conclude that current measurement methods, while useful, still require optimization to improve their accuracy and comprehensiveness, since no single instrument yet captures the full texture of time lost, including travel, waiting, caregiving coordination, and recovery days.

The qualitative literature synthesized in the review adds emotional depth to the numbers. Patients and caregivers describe how the absence of any predictable routine, captured in one study’s evocative subtitle about there never being a routine, disrupts work, family life, and identity. For some patients with advanced disease, the demands of treatment become so pervasive that the cancer seems to colonize their entire existence, a sentiment reflected in another qualitative study’s title quoting a patient who said the cancer is my life. Family caregivers absorb much of this burden as well, coordinating transportation, managing appointments, and reorganizing their own lives around the treatment calendar. The review notes that this time burden disrupts daily routines, induces emotional distress, and adversely affects both quality of life and treatment adherence, creating a feedback loop in which the burden of care can itself undermine the effectiveness of care.

On the intervention side, the review identifies a range of approaches already being tested. Streamlined clinic workflows, such as a consolidated preoperative surgical oncology clinic that reduces the number of separate visits, have been shown to reduce patient burden. Telehealth, which expanded dramatically during the COVID-19 pandemic, has been studied as a way to reduce in-person contact days among patients with advanced cancer. A text message intervention designed to minimize the time burden of cancer care has been piloted, aiming to replace some routine in-person touchpoints with remote monitoring. Stepped palliative care models, tested in randomized trials for patients with advanced lung cancer, offer another route by embedding supportive care more efficiently into the treatment pathway. The review’s authors emphasize that targeted interventions for different populations may warrant further development, since the needs of a working-age patient with early-stage disease differ substantially from those of an older adult receiving palliative therapy.

What emerges from this synthesis is a call to action for oncology as a discipline. Time is a finite resource, and for patients with cancer it is doubly precious, both because their remaining time may be limited and because the treatment itself consumes so much of it. The review’s authors conclude that time toxicity merits further exploration in subsequent studies, and their work provides a roadmap: better measurement instruments, a clearer understanding of which patient populations bear the heaviest burdens, and rigorously tested interventions that give some of that time back. As cancer treatments continue to improve and more patients live for years with advanced disease, the question is no longer only how long a treatment helps someone live, but how much of that life the treatment itself takes away. The growing science of time toxicity is beginning to give that question the attention it deserves, and the thirty studies assembled in this review mark the starting point for a field that could reshape how cancer care is designed, delivered, and judged.

Subject of Research: Time toxicity, the time burden imposed by cancer treatment on patients and caregivers

Article Title: Time toxicity among patients with cancer: a scoping review

Article References: Liu, H., Ju, M., Wu, C., & Guo, L. (2026). Time toxicity among patients with cancer: a scoping review. Supportive Care in Cancer, 34(10), Article 1066. https://doi.org/10.1007/s00520-026-11308-3

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11308-3

Keywords: time toxicity, cancer, oncology, patient burden, supportive care, scoping review, healthcare contact days, quality of life, immunotherapy, palliative care, telehealth, treatment adherence

The review, published in Supportive Care in Cancer by Ian Jun Yan Wee of Singapore General Hospital and colleagues, systematically searched the MEDLINE, EMBASE, and Cochrane Library databases from their inception through March 10, 2026. The team included studies that involved cancer patients and reported a definable measure of time-related burden associated with care. Fifty-six studies made the final cut, and their collective picture is one of a young research field growing fast but without a shared vocabulary or a common yardstick.

The technical details of what the reviewers found are revealing. The overwhelming majority of included studies, 45 of 56 or 80.4 percent, were observational in design, and nearly all were conducted in high-income countries, with the United States alone accounting for 29 studies, or 51.8 percent of the total. That geographic concentration matters, because the time burden of cancer care depends heavily on health system structure: how far patients must travel, how centralized specialist care is, and how efficiently clinics are run. Findings from American health systems may not translate cleanly to Europe, Asia, or low- and middle-income settings where the logistics of care can look radically different.

More striking still is how time toxicity was actually defined. The most common approach, used in 31 studies or 55.4 percent, relied on direct healthcare time measures: counting the days on which a patient had any healthcare encounter, whether a clinic visit, a treatment session, a hospitalization, or an emergency department visit. This metric, often called healthcare contact days, treats any calendar day touched by the medical system as a day partially consumed by it. It is elegant in its simplicity and easy to compute from routine data, but it is also a blunt instrument. A fifteen-minute blood draw and an eight-hour infusion day count identically.

A second family of measures, used in 20 studies or 35.7 percent, inverts the logic. Instead of counting days lost to care, these studies count time away from healthcare: days alive and out of hospital, or days spent at home. This approach, which has gained particular traction in surgical oncology, where it has been applied to procedures ranging from lung lobectomy to ovarian cancer surgery to colorectal resections, frames the outcome in terms patients might actually value: how much of their remaining life is spent in their own beds rather than institutional ones. Studies in the review applied it to acute myeloid leukemia, spinal metastases, and end-of-life cancer care, among other settings.

A third and much smaller category, appearing in just 5 studies or 8.9 percent, captured healthcare process time: the non-clinical and logistical dimensions of care, such as travel, waiting, scheduling, and coordination. These are the invisible hours that rarely appear in any medical record but can dominate a patient’s week, particularly for those in rural areas or those navigating fragmented systems. One Italian study cited in the review found that delivering treatment closer to patients’ homes reduced travel burden and time toxicity while improving satisfaction, a finding that illustrates how logistical design choices have real clinical consequences.

Perhaps the most consequential finding of the review is what was missing. Not a single study used a patient-reported definition of time toxicity. Every one of the 56 studies derived its measures from administrative databases, electronic health records, or clinical trial data. These sources are excellent at capturing healthcare utilization, but they are structurally incapable of capturing what patients perceive: whether a day at the hospital felt like a burden or a relief, whether the time was worth the benefit, or how the hours of care ripple through caregiving, employment, and family life. Prior qualitative work by some of the same researchers cited in the review has shown that patients, caregivers, and clinicians all recognize time burdens, but that recognition has not yet been translated into standardized patient-reported measures.

This gap matters because time toxicity is fundamentally a question of value, not just volume. In oncology, where treatments with marginal survival benefits are common, the trade-off between weeks of life gained and days of life consumed is not hypothetical. Research cited in the review has shown that patients do weigh time toxicity when assessing treatments with marginal benefit, and that the burden is unequally distributed, falling hardest on patients who live far from treatment centers, those without flexible jobs, and those without caregivers to drive them to appointments. A metric built purely from billing codes cannot see any of this.

To address the fragmentation, the review’s authors propose an empirical framework built on three objective measurement domains: direct healthcare time, time away from healthcare, and healthcare process time. Crucially, they position patient-reported experience not as a replacement for these objective measures but as an evidence-informed extension of them. The framework is an attempt to give the field a common architecture, so that a contact-day analysis in lung cancer and a days-at-home analysis in myeloma can eventually be compared, pooled, and translated into clinical decision-making. Standardization of this kind is a prerequisite for time toxicity to enter formal health technology assessment, where it could influence which treatments are funded and how care is delivered.

The implications reach well beyond academic taxonomy. As systemic therapies proliferate and survival improves for many cancers, the cumulative time burden of monitoring, imaging, infusions, and follow-up visits grows in parallel. Interventions already visible in the literature, from streamlined preoperative clinics to text-message interventions designed to minimize the time burden of care, to the substitution of subcutaneous for intravenous formulations of drugs, show that time toxicity is modifiable. But to modify it systematically, clinicians and policymakers first need to measure it consistently. This review makes clear that the field has taken the first step, cataloguing what exists, and the second, proposing a framework, but the hardest work remains: building measures that reflect not just how many days the healthcare system touches, but what those days cost the people living through them.

Subject of Research: Definitions and measurement methods of time toxicity in cancer care

Article Title: Time toxicity in cancer care: a systematic review of definitions and measurement methods

Article References: Wee, I. J. Y., Min, C. H., Ling, S. S., WenCong, E. E., Ying, T. S., Huat, I. T. B., & Yang, G. M. (2026). Time toxicity in cancer care: a systematic review of definitions and measurement methods. Supportive Care in Cancer, 34(10), Article 1035. https://doi.org/10.1007/s00520-026-11283-9

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11283-9

Keywords: time toxicity, cancer care, systematic review, supportive care, healthcare contact days, days alive and out of hospital, patient-reported outcomes, oncology, treatment burden, health services research, electronic health records, palliative care