The research team, led by Eilidh M. Duncan of Myeloma Patients Europe in Brussels, brought together an unusually diverse group of 38 participants to tackle the problem. Rather than consulting only clinicians or researchers, the investigators recruited patients with direct experience of CAR-T or bispecific antibody treatment, informal family carers, patient advocates from myeloma, lymphoma, and leukaemia communities, academic researchers, trialists, pharmaceutical industry representatives, and officials from regulatory and health technology assessment bodies, including the FDA and EMA. Data came from 14 one-to-one interviews with 16 participants and two online focus groups involving 15 and 19 participants respectively. Transcripts were analysed using a deductive-inductive thematic approach with double coding by independent researchers, a methodological rigor that strengthens the credibility of the resulting themes.

The technical context makes the challenge clear. CAR-T therapy involves engineering a patient’s own T cells to recognise cancer cells, while bispecific antibodies, or BsAbs, are laboratory-made molecules that physically link T cells to malignant cells. Both can trigger cytokine release syndrome, an immune overreaction causing fever, nausea, headache, low blood pressure, and potentially multi-organ failure. They can also cause immune effector cell-associated neurotoxicity syndrome, or ICANS, a neuropsychiatric condition ranging from mild tremor and confusion to haemorrhage, coma, and death. According to the study, CRS occurs in roughly 87 percent of CAR-T patients and 67 percent of those receiving BsAbs, while neurotoxicity affects 40 to 64 percent of CAR-T recipients, with 27 percent requiring intensive care admission. These acute toxicities typically emerge within one to four weeks after treatment, yet longer-term experiences are rarely assessed or reported.

One of the most striking findings concerns the logistical maze surrounding CAR-T treatment. Because the therapy is only available at specialised centres, patients frequently travel more than 100 kilometres for infusion and hospitalisation, then return to local providers for follow-up. This fragmentation across multiple treatment sites complicates PROM data capture and contributes to missing data. Participants also highlighted a sobering measurement paradox: patients experiencing the worst toxicities, such as cognitive impairment from ICANS or severe CRS, are often too unwell to complete questionnaires at all. As one researcher explained, the data dip between pre-lymphodepletion and week two captures only the sick patients who are still fit enough to fill out forms, not the sickest ones, making the reasons for missing data critically important to understand.

Bispecific antibodies present their own distinct measurement headache. Unlike CAR-T, which is a fixed-duration treatment, BsAbs involve continuous administration with a wide variety of side effects occurring over different time periods. Participants described agents such as talquetamab, a GPRC5D-targeting bispecific, which produces gastrointestinal effects, skin toxicity, complete taste loss, falling nails, itchy rashes, and weight loss. Some symptoms resolve over several months while others, like taste changes and weight loss, persist indefinitely. These treatment-specific domains fall outside the scope of generic instruments such as the EORTC QLQ-C30, which was designed for broad applicability rather than therapy-specific sensitivity. A recent review found 15 distinct PROMs used within just 16 CAR-T studies, highlighting the heterogeneity that undermines evidence synthesis across trials.

The timing of assessments emerged as a central controversy. Participants broadly agreed that baseline measurements for CAR-T and BsAbs trials should occur earlier than for older anticancer therapies, yet uncertainty persists about what baseline actually means. Because the CAR-T process spans several weeks, including leukapheresis, bridging therapies, and hospitalisation, a patient’s disease status and quality of life can shift dramatically between initial stages and infusion. Several researchers argued that future analyses should include two baselines, one right before lymphodepletion and one at the time of apheresis. Health technology assessment representatives insisted that baseline should mean study baseline, tied to treatment decision or randomisation, not any later time point.

Follow-up timing proved equally contentious. Participants suggested assessments as early as one week after infusion could serve as a crucial anchor point to capture the frequency, intensity, severity, and resolution of side effects. Industry representatives acknowledged the feasibility challenges, noting that patients are often hospitalised and facing severe complications like CRS shortly after infusion. For BsAbs with step-up dosing, where patients receive three doses during week one, some argued quality of life and toxicity should be explored after each individual dose. A regulatory representative called for weekly assessments during the first two months after CAR-T administration, using an item library to select really important symptoms such as headache and fatigue, alongside physical functioning measured on a high-frequency basis.

Perhaps the most emotionally resonant finding concerns what current PROMs systematically miss. Patients described the intense mental strain of waiting for CAR-T, including fear that their health would deteriorate during the manufacturing interval and render them ineligible. One patient recounted that doctors and nurses focused on physical side effects while never asking about the mental part, which was the most difficult aspect, and that her doctor essentially told her the mental part was hers to handle alone. Participants also flagged emerging concepts like time toxicity, meaning the time patients spend managing treatment and its effects, along with the burden on family carers, financial strain, and the psychological weight of living with an immunocompromised state. None of the three commonly used PROMs in trials, the EORTC QLQ-C30, MDASI-CAR, and PRO-CTCAE, capture waiting anxiety, logistical burden, caregiver burden, or treatment-free survival.

The study’s recommendations form a concrete blueprint for reform. The authors propose a dual-baseline strategy appropriate for rapid clinical changes preceding CAR-T infusion, mandated early high-frequency assessments, meaning weekly for the first four weeks, systematic inclusion of patient-important domains currently under-captured such as emotional well-being and time toxicity, continued PRO data collection beyond clinical progression, and transparent, comprehensive reporting of PRO findings. They also endorse interim strategies like combining instruments, adding PRO-CTCAE items to primary measures, and incorporating qualitative interviews or free-text responses. Longer-term, they support developing new treatment-specific PROMs, potentially with a modular core-plus-supplement design, alongside computerised adaptive testing to tailor questionnaires to individuals and reduce respondent burden.

The stakes extend far beyond academic measurement. CAR-T and BsAbs are high-cost therapies whose cost-effectiveness for health systems remains controversial, and PROM data directly informs reimbursement decisions. Under-reporting PRO data, the authors argue, is not just a concern for research validity but an unethical waste of patients’ time and energy, breaking the implicit agreement that patients’ contributions will meaningfully inform knowledge generation. Patients were willing to complete PROMs when they understood how their data would be used and felt confident it would not be wasted. As these immunotherapies continue to expand across haematological malignancies, the gap between what patients endure and what trials record can no longer be ignored. Clearer guidance from regulators and payers on instrument selection, assessment schedules, and reporting would substantially improve the quality and patient-centredness of evidence in this rapidly evolving field.

Subject of Research: Optimisation of patient-reported outcome measures for haematological cancer patients receiving CAR-T and bispecific antibody immunotherapies

Article Title: Optimisation of patient-reported outcome measurement for haematological cancer patients receiving novel immunotherapies: perspectives of multi-stakeholders

Article References: Duncan, E. M., Salviano, J., Kyriakou, C., Nier, S., Oerlemans, S., Salek, S., Morgan, K., & Joyner, K. (2026). Optimisation of patient-reported outcome measurement for haematological cancer patients receiving novel immunotherapies: perspectives of multi-stakeholders. Frontiers in Hematology, 5, Article 1800304. https://doi.org/10.3389/frhem.2026.1800304

Image Credits: AI Generated

DOI: 10.3389/frhem.2026.1800304

Keywords: CAR-T therapy, bispecific antibodies, patient-reported outcomes, PROMs, haematological malignancies, cytokine release syndrome, ICANS, quality of life, clinical trials, time toxicity, regulatory guidance, survivorship

Financial toxicity is the term researchers use for the material, psychological, and social burden associated with the cost of cancer care. It encompasses direct out-of-pocket expenses, lost income, disrupted employment, and the downstream effects of financial strain on patients and their households. Over the past decade, a growing body of evidence has linked financial hardship to worse quality of life, heavier symptom burden, treatment nonadherence, and adverse psychosocial outcomes across cancer types. Patients with hematologic malignancies such as multiple myeloma are considered especially vulnerable, because their treatment trajectories are long, their care pathways are complex, and modern therapy leans heavily on high-cost drugs delivered over many years.

Autologous stem cell transplant, or ASCT, remains a cornerstone of treatment for eligible myeloma patients and is associated with improved survival and disease control. But the procedure demands intensive preparation: prolonged engagement with the health care system, frequent travel, extended time away from work, and substantial reliance on unpaid informal caregivers. Even among insured patients, studies have documented depleted savings, lost income, and long-term financial insecurity. Quantitative work suggests nearly half of transplant patients experience meaningful financial hardship, and that this burden tracks with worse health-related quality of life and mental health. Yet most of this evidence comes from cross-sectional surveys and standardized instruments such as the Comprehensive Score for Financial Toxicity, which establish prevalence but reveal little about how strain is lived and negotiated in real time.

To close that gap, Halpin turned to data from the Ready for Transplant evaluation, an ethnographic quality improvement initiative run over roughly 18 months at a large U.S. academic cancer center. The project was originally designed to improve patient education for people preparing for ASCT, not to study money. But as Halpin reviewed the material, consistent patterns of embedded financial strain kept surfacing, prompting a focused secondary analysis. The dataset included approximately 150 hours of ethnographic observation across 70 nurse-patient education encounters, along with 35 semistructured interviews with patients, many conducted in their hospital rooms during the first days of admission for transplant. Education sessions themselves were lengthy, averaging 89 minutes and ranging from 36 to 124 minutes, giving researchers a detailed window into how transplant preparation was communicated and absorbed.

The patient population reflected the typical transplant cohort: average age 64, with participants ranging from 29 to 77 years old, evenly split by sex, predominantly White, and mostly married. Most arrived accompanied by spouses or adult children who took active roles in the sessions. Using conventional qualitative content analysis, with financial toxicity serving as a sensitizing concept rather than a rigid coding framework, Halpin deliberately distinguished experiences with clear resource implications, such as missed work or lodging costs, from broader expressions of emotional overwhelm. This boundary-setting was designed to avoid over-interpreting ordinary treatment burden as financial distress, a risk in any secondary analysis.

The most striking finding was what did not appear. Explicit discussion of out-of-pocket costs, insurance coverage, or affordability was uncommon across interviews, observations, and field notes. Financial toxicity instead surfaced indirectly, enacted through patterns of accommodation and endurance rather than articulated as complaint. When one patient reacted to the launch of transplant preparation by saying, “They are throwing everything at me at once,” the comment was framed as cognitive overload but occurred amid same-day scheduling of multiple appointments, new medications, and ongoing travel, conditions that entail time away from work, transportation costs, and logistical strain for everyone involved. When a nurse apologized for the sheer number of required appointments, a caregiver quipped, “If it’s a scavenger hunt then we need to get something fun in the end,” using humor to normalize the added time and travel.

Even when financial trade-offs became explicit, participants often deferred them in favor of perceived medical necessity. In one session, a nurse explained that a medication could reduce the risk of severe mouth sores but would require additional days spent lodging near the transplant center. Rather than questioning the cost of the extended stay, the caregiver responded, “I prefer to be on the safe side,” while the conversation turned to possible grant funding and cheaper nearby hotels. Halpin interprets such exchanges as moral commitments to safety effectively backgrounding cost while still absorbing its consequences, a pattern consistent with earlier qualitative work showing that patients avoid raising financial concerns for fear of appearing noncompliant or ungrateful in the context of serious illness.

Work and income disruption emerged as a central, if unspoken, dimension of strain. One employed patient tried to align procedure dates with work obligations across his family network; when his son could not drive him on a treatment day because of his own job, the discussion turned to rescheduling. “Transportation was ‘not the problem,'” the patient explained, “but rather ‘getting everybody lined up on the same day,'” a phrasing that implicitly acknowledged the limits imposed by employment. Caregivers’ constraints were even more visible: one asked when to plan “three weeks of vacation” to support his spouse, while another said he would “just move some things around at work,” minimizing what likely represented significant occupational trade-offs. Travel compounded everything. One patient lived nearly four hours from the center and depended on multiple relatives for rides, while another couple, shut out of subsidized housing, paid more than $200 per night at a nearby hotel as the caregiver actively hunted for alternatives. A patient who forgot to fast for a scan had to return the next day, adding yet another trip. These are the “hidden costs” of cancer care, transportation and lodging that insurance rarely covers and that clinicians often treat as unavoidable rather than as targets for intervention.

Caregiver labor formed the third pillar of the findings, and perhaps the most underrecognized. Family members coordinated appointments, managed medications, administered subcutaneous injections, maintained external catheters, and served as de facto financial navigators, all without pay or formal recognition. One caregiver declared, “I’ll do this. I have watched the videos,” when discussing infection-preventing dressing changes. Field notes recorded caregivers growing visibly uncomfortable during marathon sessions, repeatedly leaving the room or appearing agitated. Patients, meanwhile, oriented to the moral weight of this dependence: one noted his husband “is the one who remembers things about my treatment,” others fretted over missing birthdays and holidays, and one reminded himself that “other people are worse off than me.” In the United States, where paid leave for caregivers remains limited and uneven, such demands can force unpaid leave, reduced hours, or workforce exit, amplifying strain at the household level while remaining invisible in clinical decision-making.

The implications are significant. Screening tools that rely on direct questions about affordability may miss meaningful burden, particularly during the preparatory phase of transplant, when strain is distributed across time, geography, and family networks in ways that resist naming. Halpin argues that financial toxicity may be more readily identified by attending to logistical strain, caregiver labor, and repeated negotiations over travel and work, and that proactive financial navigation should begin during treatment planning, before transplant initiation, rather than after costs have accumulated. The study carries limitations typical of its design: it draws on data from a single academic center, was collected for a different original purpose, and was coded by a single researcher, though rigorous memoing, an audit trail, and attention to contrast cases were used to guard against interpretive drift. Even so, the ethnographic depth captures processes that surveys cannot. For a treatment as intensive as ASCT, the message is clear: the true cost of a stem cell transplant is paid not only in dollars, but in days, miles, and the quiet labor of the people who show up to help.

Subject of Research: Financial toxicity during autologous stem cell transplant preparation for multiple myeloma

Article Title: Financial toxicity as logistical and relational burden across the lifespan during autologous transplant preparation

Article References: Halpin, S. N. (2026). Financial toxicity as logistical and relational burden across the lifespan during autologous transplant preparation. Frontiers in Cancer Control and Society, 4, Article 1818523. https://doi.org/10.3389/fcacs.2026.1818523

Image Credits: AI Generated

DOI: 10.3389/fcacs.2026.1818523

Keywords: financial toxicity, multiple myeloma, autologous stem cell transplant, caregiver burden, qualitative research, cancer care costs, time toxicity, patient education, health disparities, cancer survivorship, work disruption, financial navigation

The research team, led by Danyang Li and colleagues at the First Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, conducted in-depth, face-to-face interviews with fifteen lymphoma patients aged 18 to 50 between June and December 2025. All participants were undergoing active treatment at the hematology department of a tertiary Grade A hospital. Using purposive sampling with maximum variation, the researchers deliberately recruited a diverse group spanning different ages, employment statuses, lymphoma subtypes, disease stages, treatment modalities, and places of residence. Interviews lasted between 25 and 58 minutes, totaling 546 minutes of recorded conversation, and the team reached code saturation by the thirteenth interview, confirming it with two additional sessions.

What sets this study apart methodologically is its theoretical grounding in Time-Geography Theory, a framework developed by Swedish geographer Torsten Hägerstrand in 1970. The theory explains how everyday human activity is shaped by three kinds of constraints: capability constraints tied to physical capacity, coupling constraints requiring presence at particular times and places, and authority constraints imposed by institutions. Rather than forcing the data into these categories, the researchers used the framework as a sensitizing lens, allowing themes to emerge inductively through conventional content analysis. The result is a picture of time toxicity that is not merely a count of healthcare contact days but a lived, spatially embedded experience.

The analysis revealed five interconnected themes. The first was a multidimensional time burden driven by treatment itself. Participants described schedules dominated by frequent hospital visits for blood tests, catheter maintenance, and injections to manage side effects, often recurring several times a week. One patient explained that pre-admission tests and hospital stays typically consumed about a week, while follow-up appointments required roughly two days each week. Another described traveling between a local hospital twice weekly for blood tests and a tertiary hospital for injections whenever white blood cell counts dropped, spending several days each week in transit between facilities.

Perhaps more striking were the hidden time costs that never appear on any treatment schedule. Patients reported that although actual consultations might last only minutes, registration, queuing, waiting for examinations, and delays in receiving results could consume entire days. One participant captured the frustration succinctly: occasionally waiting several hours for a consultation that lasts merely a few minutes, with the waiting itself being the most draining aspect. Compounding this friction, treatment cycles often overlapped with recovery periods, leaving patients feeling that the next round of chemotherapy was scheduled before their bodies had recuperated from the last. Complications such as port infections, fevers, and abrupt changes in treatment plans following PET-CT results added further layers of unpredictability and additional visits.

The second and third themes exposed how these temporal demands cascaded into every corner of patients’ lives. Career interruptions were particularly acute for this age group, striking just as professional trajectories were gaining momentum. Participants described missed promotions, eroded professional identity, and mounting financial strain, with one noting that sick leave pay constituted only a fraction of their salary and that the family had depleted all its savings. Family responsibilities were redistributed as spouses, parents, and relatives absorbed childcare, household chores, and hospital accompaniment. Social life contracted sharply as weakened immunity and infection fears confined patients to a narrow orbit of hospital and home, with some avoiding public transport entirely and one participant staying in a hotel near the hospital throughout six treatment cycles, returning home only three or four times to avoid crowded trains.

Healthcare mobility emerged as a distinct dimension of the burden, shaped by the interaction of geography, transportation, and physical capacity. Patients traveling from cities such as Taizhou faced journeys exceeding three hours each way, combining high-speed rail with taxi rides, and arriving exhausted before treatment even began. Urban congestion and parking difficulties extended even short trips, with one patient remarking that finding a parking space could be harder than seeing the doctor. Chemotherapy-related fatigue and dizziness made long-distance travel physically hazardous; one participant fainted on the way home and afterward became apprehensive about leaving the house. The economic dimension was equally tangible, as many patients opted for taxis over public transport to reduce infection risk, accumulating costs that added up visit after visit.

The emotional toll of this temporal disruption formed the fourth theme. Participants described anxiety over the uncertain duration and effectiveness of treatment, nervousness each time blood test results arrived, and a profound sense of disconnection from society while peers continued working and progressing through normal life stages. Prolonged waiting and repeated hospital trips produced cumulative emotional exhaustion and irritability, illustrating how sustained time demands compound psychological distress. The researchers interpret these emotional consequences as partly reflecting disrupted temporal rhythms and a reduced sense of control over personal time, a framing that links psychological suffering directly to the organization of healthcare itself.

Yet the study is not solely a catalog of burdens. The fifth theme documented multilevel coping strategies that patients deployed to reclaim some measure of control. Several used digital tools proactively, scheduling PET-CT scans through online hospital platforms and sending blood test results to physicians via WeChat to avoid unnecessary trips. Others practiced health-oriented self-management, learning the predictable patterns of their blood count fluctuations after chemotherapy so they could time blood tests and injections more efficiently, while adjusting sleep, diet, and exercise routines to reduce infection risk. Cognitive reframing played a role as well: some listened to music during infusions to manage anxiety, while others reported that illness had prompted them to slow down, rethink their priorities, and value time with family more deeply. Family members, meanwhile, formed an essential support infrastructure, handling daily tasks so patients could focus on treatment and recovery.

The study’s implications reach well beyond the hematology ward. The authors argue that reducing time toxicity requires attention not only to treatment schedules but to modifiable care-process factors such as waiting times, fragmented appointments, and the coordination of supportive care. They point to prior evidence, including analyses of the CCTG LY.12 trial showing that lymphoma regimens with comparable oncologic outcomes could differ substantially in healthcare contact days, and a Japanese database study demonstrating that time toxicity of R-CHOP varies with treatment setting and patient factors. Nurse-led navigation, anticipatory information about expected time demands, coordinated scheduling, telehealth, and decentralized supportive care all emerge as promising avenues. The authors caution that their single-center study in eastern China, subjective self-reported data, and single-time-point interviews limit generalizability, and they call for multicenter, longitudinal, mixed-methods research integrating patient experiences with objective measures of time use. As survival from lymphoma continues to improve, the study makes a compelling case that how patients spend their time during treatment is not a peripheral concern but a central measure of the quality of cancer care itself.

Subject of Research: Time toxicity experiences and coping strategies among young and middle-aged lymphoma patients in China

Article Title: Experiences and coping strategies of time toxicity in young and middle-aged patients with lymphoma: a descriptive qualitative study

Article References: Li, D., Zheng, K., Chen, L., & Zhang, M. (2026). Experiences and coping strategies of time toxicity in young and middle-aged patients with lymphoma: a descriptive qualitative study. Supportive Care in Cancer, 34(10), Article 976. https://doi.org/10.1007/s00520-026-11213-9

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DOI: 10.1007/s00520-026-11213-9

Keywords: time toxicity, lymphoma, cancer care, qualitative research, Time-Geography Theory, supportive care, healthcare mobility, coping strategies, patient experience, China, nursing, treatment burden

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

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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