Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, United States.
Cancer Care and Epidemiology, Sinclair Cancer Research Institute, Queen's University, Kingston, ON K7L3N6, Canada.
Oncologist. 2024 Nov 4;29(11):978-985. doi: 10.1093/oncolo/oyae187.
Effective techniques for eliciting patients' preferences regarding their own care, when treatment options offer marginal gains and different risks, is an important clinical need. We sought to evaluate the association between patients' considerations of the time burdens of care ("time toxicity") with decisions about hypothetical treatment options.
We conducted a secondary analysis of a multicenter, mixed-methods study that evaluated patients' attitudes and preferences toward palliative-intent cancer treatments that delayed imaging progression-free survival (PFS) but did not improve overall survival (OS). We classified participants based on if they spontaneously volunteered one or more consideration of time burdens during qualitative interviews after treatment trade-off exercises. We compared the percentage of participants who opted for treatments with no PFS gain, some PFS gain, or who declined treatment regardless of PFS gain (in the absence of OS benefit). We conducted narrative analysis of themes related to time burdens.
The study cohort included 100 participants with advanced cancer (55% women, 63% age > 60 years, 38% with gastrointestinal cancer, and 80% currently receiving cancer-directed treatment. Forty-six percent (46/100) spontaneously described time burdens as a factor they considered in making treatment decisions. Participants who mentioned time (vs not) had higher thresholds for PFS gains required for choosing additional treatments (P value .004). Participants who mentioned time were more likely to decline treatments with no OS benefit irrespective of the magnitude of PFS benefit (65%, vs 31%). On qualitative analysis, we found that time burdens are influenced by several treatment-related factors and have broad-ranging impact, and illustrate how patients' experiences with time burdens and their preferences regarding time influence their decisions.
Almost half of participating patients spontaneously raised the issue of time burdens of cancer care when making hypothetical treatment decisions. These patients had notable differences in treatment preferences compared to those who did not mention considerations of time. Decision science researchers and clinicians should consider time burdens as an important attribute in research and in clinic.
当治疗方案提供边际收益和不同风险时，有效技术来引出患者对自身护理的偏好是一项重要的临床需求。我们旨在评估患者对护理时间负担（“时间毒性”）的考虑与对假设性治疗方案的决策之间的关联。
我们对一项多中心、混合方法研究进行了二次分析，该研究评估了姑息治疗意向的癌症治疗方法对延缓影像学无进展生存期（PFS）但不改善总生存期（OS）的患者态度和偏好。我们根据患者在治疗权衡后进行定性访谈时是否自发提出一个或多个时间负担考虑因素进行分类。我们比较了无论 PFS 获益如何（无 OS 获益），选择无 PFS 获益、有一定 PFS 获益或拒绝治疗的参与者的百分比。我们对与时间负担相关的主题进行了叙述性分析。
该研究队列纳入了 100 名晚期癌症患者（55%为女性，63%年龄>60 岁，38%为胃肠道癌，80%正在接受癌症定向治疗）。46%（46/100）的患者自发地将时间负担描述为他们在做出治疗决策时考虑的因素之一。提到时间（与未提到时间）的患者对 PFS 获益的要求更高，才会选择额外的治疗（P 值<.004）。提到时间的患者更有可能拒绝无 OS 获益的治疗方案，而无论 PFS 获益的幅度如何（65%，与 31%）。在定性分析中，我们发现时间负担受到多种治疗相关因素的影响，且具有广泛的影响，并说明了患者对时间负担的体验及其对时间的偏好如何影响他们的决策。
在做出假设性治疗决策时，近一半的参与患者会自发地提出癌症护理时间负担的问题。这些患者与未提及时间考虑的患者在治疗偏好方面存在显著差异。决策科学研究人员和临床医生应将时间负担视为研究和临床中的一个重要属性。
