The Hidden Cost of Cancer Care: When Treatment Steals Patients’ Time

For most people, a visit to the doctor is an occasional inconvenience. For patients living with cancer, it can become the organizing principle of their lives. Appointments, infusions, scans, blood draws, pharmacy trips, and the travel between them can consume entire days, week after week, month after month. Researchers have a name for this burden: time toxicity. A new scoping review published in Supportive Care in Cancer has now brought together, for the first time in a systematic way, the scattered evidence on how much time cancer treatment demands from patients, what drives that demand, how it can be measured, and what might be done to reduce it.

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