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Peer-reviewedCC BY-NC-ND 4.0Supportive Care in Cancer

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

  • Ian Jun Yan Wee1,2,3
  • Cheo Hao Min4
  • Soh Si Ling5
  • Ernest Eu WenCong6
  • Tan Si Ying7,8,9
  • Iain Tan Bee Huat10
  • Grace Meijuan Yang11,12,13,14
14 affiliations
  1. 1Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
  2. 2Duke-NUS Medical School, Singapore, Singapore
  3. 3Health Services Research Unit, Singapore General Hospital, 30 Hospital Boulevard, Singapore, 168583 Singapore
  4. 4Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  5. 5Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
  6. 6Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
  7. 7Department of Breast Surgery, Div of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
  8. 8Department of Breast Surgery, Div of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
  9. 9SingHealth DukeNUS Breast Centre, Singapore, Singapore
  10. 10Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
  11. 11Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
  12. 12Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
  13. 13Duke-NUS Medical School, Programme in Health Services Research & Population Health, Singapore, Singapore
  14. 14Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Abstract

Purpose: Time toxicity has emerged as an important concept in oncology, reflecting the burden of time patients spend receiving care. However there is no consensus on how time toxicity is defined or measured. We conducted a systematic review to characterise the definitions and measurement methods.

Methods: MEDLINE, EMBASE, and Cochrane Library were searched from inception to 10th March 2026. Studies were included if they involved cancer patients and reported a definable measure of time-related burden associated with care. Data were extracted on study characteristics, sample size, data sources, and definitions of time toxicity.

Results: Fifty-six studies were included. Most studies were observational (n = 45, 80.4%) and conducted in high-income countries, predominantly the United States (n = 29, 51.8%). Time toxicity was most commonly defined using direct healthcare time measures (n = 31, 55.4%), representing days involving healthcare encounters such as clinic visits, treatment sessions, hospitalisations, and emergency department visits. Time away from healthcare measures, including days alive and out of hospital or days at home, were used in 20 studies (35.7%). Healthcare process time incorporating non-clinical and logistical aspects of care were used in 5 studies (8.9%). No studies used patient-reported definitions of time toxicity. Most measures were derived from administrative, electronic health record, or clinical trial data, capturing healthcare utilisation but not patients’ perceived burden or value of healthcare-related time.

Conclusion: Current definitions of time toxicity in cancer care are heterogeneous and predominantly system-derived, with minimal incorporation of patient-centred perspectives. We propose an empirical framework comprising three objective measurement domains: direct healthcare time, time away from healthcare, and healthcare process time—with patient-reported experience incorporated as an evidence-informed extension.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00520-026-11283-9.

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Cite

BibTeXRIS
BibTeX
@article{wee2026time,
  title = {{Time toxicity in cancer care: a systematic review of definitions and measurement methods}},
  author = {Ian Jun Yan Wee and Cheo Hao Min and Soh Si Ling and Ernest Eu WenCong and Tan Si Ying and Iain Tan Bee Huat and Grace Meijuan Yang},
  journal = {Supportive Care in Cancer},
  year = {2026},
  month = sep,
  doi = {10.1007/s00520-026-11283-9},
  url = {https://doi.org/10.1007/s00520-026-11283-9},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Time toxicity in cancer care: a systematic review of definitions and measurement methods
AU  - Ian Jun Yan Wee
AU  - Cheo Hao Min
AU  - Soh Si Ling
AU  - Ernest Eu WenCong
AU  - Tan Si Ying
AU  - Iain Tan Bee Huat
AU  - Grace Meijuan Yang
PY  - 2026
DA  - 2026/09/29
JO  - Supportive Care in Cancer
DO  - 10.1007/s00520-026-11283-9
UR  - https://doi.org/10.1007/s00520-026-11283-9
AB  - Purpose: Time toxicity has emerged as an important concept in oncology, reflecting the burden of time patients spend receiving care. However there is no consensus on how time toxicity is defined or measured. We conducted a systematic review to characterise the definitions and measurement methods.  Methods: MEDLINE, EMBASE, and Cochrane Library were searched from inception to 10th March 2026. Studies were included if they involved cancer patients and reported a definable measure of time-related burden associated with care. Data were extracted on study characteristics, sample size, data sources, and definitions of time toxicity.  Results: Fifty-six studies were included. Most studies were observational (n = 45, 80.4%) and conducted in high-income countries, predominantly the United States (n = 29, 51.8%). Time toxicity was most commonly defined using direct healthcare time measures (n = 31, 55.4%), representing days involving healthcare encounters such as clinic visits, treatment sessions, hospitalisations, and emergency department visits. Time away from healthcare measures, including days alive and out of hospital or days at home, were used in 20 studies (35.7%). Healthcare process time incorporating non-clinical and logistical aspects of care were used in 5 studies (8.9%). No studies used patient-reported definitions of time toxicity. Most measures were derived from administrative, electronic health record, or clinical trial data, capturing healthcare utilisation but not patients’ perceived burden or value of healthcare-related time.  Conclusion: Current definitions of time toxicity in cancer care are heterogeneous and predominantly system-derived, with minimal incorporation of patient-centred perspectives. We propose an empirical framework comprising three objective measurement domains: direct healthcare time, time away from healthcare, and healthcare process time—with patient-reported experience incorporated as an evidence-informed extension.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00520-026-11283-9.
SN  - 0941-4355
SN  - 1433-7339
ER  -