Opinion: Oncology Nurses Can Ease the Burden of Time Toxicity in Cancer Care

Amanda Brink, DNP, APRN, FNP-BC, AOCNP

Oncology nurses are familiar with the concept of financial toxicity, which refers to the significant financial burden cancer and its treatments place on patients. However, an equally impactful but less discussed issue is time toxicity—the considerable amount of time patients must dedicate to medical appointments, treatments, and waiting for test results, among other factors. This burden can profoundly affect their quality of life (QOL), disrupting personal lives, work, and relationships. Oncology nurses play a pivotal role in recognizing and alleviating this time burden.

Measuring Time Toxicity

One way to measure time toxicity is by assessing the number of days a patient interacts with the healthcare system, which allows researchers to estimate how many days are spent at home. While this approach treats all healthcare interactions equally—from brief outpatient visits to inpatient hospitalizations—it still provides a meaningful basis for evaluating the time demands of treatment. A recent study by Ording et al¹ used this method and found that patients with metastatic lung cancer spent an average of 22.0% of their remaining days interacting with the medical system rather than being at home. The burden was highest for those receiving combination chemotherapy (23.9%) and lowest for those on targeted therapies (16.1%).

For many patients, particularly those with advanced disease, maximizing time at home with family is an important goal. Oncology nurses play a crucial role in integrating time toxicity into shared decision-making and goals-of-care discussions, helping patients balance treatment burden with QOL. Importantly, some patients find reassurance in frequent healthcare visits, especially near the end of life, highlighting the need for individualized discussions tailored to each patient's specific goals.

Despite the strengths of the Ording et al study, including its nationwide design in Denmark and the use of the Danish National Patient Register, which minimizes loss to follow-up, it has limitations. The study does not account for factors such as general practitioner visits or time spent traveling for care, likely underestimating the true time burden. Additionally, it excludes patients who declined treatment, making it difficult to compare time toxicity between those who pursued systemic therapy and those who opted for supportive care alone.

As a nurse practitioner working in clinical trials, I see firsthand how my patients often experience even greater time toxicity than those receiving standard treatment. While an infusion may take only 30 to 60 minutes, total appointment times can extend to 8 to 12 hours due to frequent monitoring and pharmacokinetic studies, which involve multiple blood draws over several hours to assess how a drug is metabolized. Additionally, many trial participants travel long distances to access investigational therapies, further compounding the time burden. Because patients with cancer are often encouraged to participate in clinical trials, time toxicity is an important factor to consider in these discussions as well.

Nursing Considerations

Oncology nurses can advocate for telemedicine appointments, when appropriate, as a valuable strategy for reducing time toxicity. While virtual visits still take time and may come with their own challenges, they allow patients to remain at home, eliminating travel time and reducing overall strain. Telemedicine provides a convenient way for patients to check in with their oncology team while conserving time and energy. Similarly, home-based care options, such as home lab draws, can minimize unnecessary trips to the hospital, further easing the logistical burden of treatment.

When in-person visits are necessary, oncology nurses can coordinate multidisciplinary appointments, allowing patients to see multiple providers in a single visit rather than making repeated trips. Additionally, if patients require lab work before their treatment and are having re-staging scans the day before their visit, consider scheduling the lab work at the same time as the scan to minimize waiting for lab results on the day of treatment.

Proactive symptom management is another essential strategy to reduce time spent in healthcare settings. Addressing side effects such as nausea, fatigue, or dehydration early can prevent emergency visits and hospital admissions.

Through thoughtful care coordination, symptom management, and open discussions about time toxicity, oncology nurses can help patients maximize their time at home while still receiving high-quality, individualized cancer care. Nurses can also encourage other members of the oncology team to consider time toxicity in decision-making and discussions with patients.

References

Ording AG, Skjøth F, Poulsen LØ, et al. Time toxicity of systemic anticancer therapy for metastatic lung cancer in routine clinical practice: A nationwide cohort study. JCO Oncol Pract. Published online December 20, 2024. doi:10.1200/OP-24-00526