{ "abstract": "Importance: Time toxicity, defined as the time patients spend receiving cancer treatment and interacting with health care systems, is an emerging treatment-related burden. Existing studies typically quantify time toxicity using health care contact days, which may inadequately capture patient burden because encounters of different durations are weighted equally.\n\nObjective: To develop and internally validate the Multinational Association of Supportive Care in Cancer (MASCC) Time Intensity and Measurement of Encounters (TIME) tool, a standardized medical record abstraction instrument for measuring documented health care encounter time.\n\nDesign, Setting, and Participants: This multiphase mixed-methods prognostic study, including tool development, was conducted from March to May 2026, through a 3-round international consensus process involving 16 oncology trialists from 9 countries and internal validation using electronic medical records from a cohort of patients with prostate cancer treated at a tertiary cancer center in Toronto, Ontario, Canada. Validation compared standardized abstraction using the MASCC TIME tool with prior unstructured medical record abstraction across 367 health care encounters.\n\nMain Outcomes and Measures: Content validity, extraction accuracy compared with investigator consensus review, interrater reliability assessed using the Gwet agreement coefficient 1 (AC1) and percentage agreement, and abstraction feasibility.\n\nResults: Sixteen oncology trialists participated in tool development. The final tool included 8 variables: encounter start date, start time, end date, end time, purpose, planned or unplanned status, mode of contact, and primary clinician. All variables achieved a content validity ratio of 1.0. Accuracy of medical record extraction increased from 31% (95% CI, 28%-35%) to 90% (95% CI, 87%-93%) without the tool to 66% (95% CI, 62%-69%) to 99% (95% CI, 99%-100%) with the tool, with absolute differences of 2 percentage points (95% CI, −1 to 5 percentage points) to 35 percentage points (95% CI, 30 to 40 percentage points); 7 of 8 variables demonstrated statistically significant increases with the tool. Percentage agreement between abstractors increased from 31% to 82% without the tool to 42% to 99% with the tool, while the Gwet AC1 increased from −0.24 to 0.87 without the tool to 0.14 to 0.99 with the tool. Mean abstraction time decreased from 10 to 5 minutes per encounter.\n\nConclusions and Relevance: In this prognostic study of the MASCC TIME tool, it was found to be associated with excellent content validity, improved accuracy, high interrater reliability, and acceptable feasibility for standardized measurement of documented health care encounter time. Standardized assessment of time toxicity may improve comparability across oncology studies and support more rigorous evaluation of health care–related burden in cancer research.", "abstract_shown": true, "affiliations": [ "Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada", "Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada", "Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada", "Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom", "Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts", "School of Pharmacy and Biomedical Science, Adelaide University, Adelaide, South Australia, Australia", "The University of Texas MD Anderson Cancer Center, Houston", "Caring Futures Institute, College of Health and Enablement, Flinders University, Adelaide, South Australia, Australia", "City of Hope Cancer Center Phoenix, Phoenix, Arizona", "Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia", "Mount Vernon Cancer Centre, Northwood, United Kingdom", "Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom", "Department of Pharmacy, Gifu University Hospital, Gifu, Japan", "Centre for Health Services Research in Cancer, Australia Cancer Survivorship Centre, and Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia", "Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Parkville, Victoria, Australia", "Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore", "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore", "Clinical Oncology Department, AC Camargo Cancer Center, Sao Paulo, Brazil", "Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California", "Department of Oncology, Odense University Hospital, Odense, Denmark", "New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, New York", "Department of Toxicology and Forensic Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom" ], "article_type": null, "arxiv": null, "author_total": 26, "authors": [ { "affs": [ 0, 1, 2, 3 ], "name": "Ronald Chow" }, { "affs": [ 0 ], "name": "Sarah Bayrakdarian" }, { "affs": [ 0 ], "name": "Olivera Gojsevic" }, { "affs": [ 0 ], "name": "Emily MacMillan" }, { "affs": [ 4 ], "name": "Tracy Balboni" }, { "affs": [ 5 ], "name": "Joanne Bowen" }, { "affs": [ 6 ], "name": "Eduardo Bruera" }, { "affs": [ 7 ], "name": "Raymond J. Chan" }, { "affs": [ 8 ], "name": "Arjun Gupta" }, { "affs": [ 7, 9 ], "name": "Nicolas H. Hart" }, { "affs": [ 10, 11 ], "name": "Peter Hoskin" }, { "affs": [ 6 ], "name": "David Hui" }, { "affs": [ 12 ], "name": "Hirotoshi Iihara" }, { "affs": [ 13, 14 ], "name": "Michael Jefford" }, { "affs": [ 15, 16 ], "name": "Shing Fung Lee" }, { "affs": [ 17 ], "name": "Rachel Riechelmann" }, { "affs": [ 18 ], "name": "Hope S. Rugo" }, { "affs": [ 19 ], "name": "Christina H. Ruhlmann" }, { "affs": [ 20 ], "name": "Charles B. Simone" }, { "affs": [ 20 ], "name": "Henry C. Y. Wong" }, { "affs": [ 1, 2 ], "name": "Camilla Zimmermann" }, { "affs": [ 0, 2 ], "name": "Hans Chung" }, { "affs": [ 21 ], "name": "Georgia C. Richards" }, { "affs": [ 3 ], "name": "Carl Heneghan" }, { "affs": [ 0, 2 ], "name": "Jennifer Leigh" }, { "name": "MASCC Emerging Toxicities Study Group" } ], "bibtex": "https://research.draconitic.com/paper/cvh6r9gad3aen.bib", "cited_by": 0, "doi": "10.1001/jamanetworkopen.2026.38034", "fulltext_url": null, "id": "cvh6r9gad3aen", "issns": [ "2574-3805" ], "landing_url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854970", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2730|Cancer survivorship and care" ] ], "openalex": "W7220913449", "pdf_url": null, "pmcid": null, "pmid": null, "published": "2026-10-08", "publisher": "American Medical Association (AMA)", "ris": "https://research.draconitic.com/paper/cvh6r9gad3aen.ris", "sources": [ { "first_seen": "2026-10-30T12:19:46Z", "native_id": "10.1001/jamanetworkopen.2026.38034", "source": "crossref", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854970" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2730|Cancer survivorship and care", "subfield": "oncology" } ], "title": "Development and Validation of a Tool to Measure Documented Health Care Encounter Time", "title_text": "Development and Validation of a Tool to Measure Documented Health Care Encounter Time", "type": "peer-reviewed", "updated_at": "2026-10-30T12:19:46Z", "url": "https://research.draconitic.com/paper/cvh6r9gad3aen", "venue": "JAMA Network Open", "versions": [] }