Oncologist perspectives on the time toxicity of palliative systemic treatments for advanced cancer

BACKGROUND: People with advanced cancer often invest substantial amounts of time to receive palliative treatments. This has been labeled the "time toxicity" of cancer treatment. However, stakeholder views on time toxicity are still being established. This study used mixed methods to explore Australian oncologists' perspectives on the time burdens of palliative systemic cancer treatments. METHODS: Semistructured qualitative interviews were conducted with a convenience sample of gastrointestinal oncologists recruited from 1 metropolitan and 1 regional center, supplemented by online advertising through the Australian Gastro-Intestinal Trials Group. Themes emerging from initial interviews (n = 8) informed the development of an online survey disseminated to Australian oncologists via professional groups. Qualitative data were analyzed using an inductive approach. Survey data were summarized descriptively. RESULTS: Fifteen oncologists were interviewed, 60% of whom were primarily based in major metropolitan areas. One overarching theme-the value of time-unified 4 subthemes: (1) contributors to time toxicity, (2) benefits and uncertainties, (3) time as a decision-modifier, and (4) proposed solutions. Surveyed oncologists (n = 108) expressed broad agreement with the thematic framework in interviews, affirming the importance of time for patients with advanced cancer and supporting strategies to reduce time burdens. However, responses acknowledged the subjectivity of time toxicity to individual patients. CONCLUSIONS: This mixed-methods study establishes Australian oncologists' perspectives on the time toxicity of palliative systemic cancer treatments, identifying potential barriers and opportunities for including discussions of health-care time into shared decision making, and system-level strategies for addressing unwanted health-care contact time.