The time toxicity of metastatic pancreatic cancer treatment.

673 Background: Optimal care for pancreatic adenocarcinoma (PDAC) involves multimodal treatment from numerous providers, which requires complex and timely care coordination. Each healthcare interaction contributes to time toxicity, or the time spent pursuing healthcare. This analysis aimed to calculate a comprehensive measurement of time toxicity and assess predictors of prolonged time toxicity for patients with metastatic PDAC. Methods: We conducted a retrospective analysis of metastatic PDAC patients treated at a high-volume center between 2018 and 2022. Patients receiving care at multiple facilities were excluded. Time toxicity was defined as cancer-related healthcare encounter days (inpatient, outpatient, emergency room) divided by overall survival (OS). Time in hospice care was not included. Beta regression was utilized to identify significant predictors of time toxicity, using OS as a scaling factor to account for differences in survival. Tested predictors included demographic, socioeconomic, and medical factors. Average marginal effects were calculated to facilitate the interpretation of the beta regression coefficients. Secondary outcomes included receipt of systemic therapy in the last 30 days of life, transitioning to hospice after hospitalization, and patients expiring while inpatient. Results: A total of 177 patients were identified, with a median age of 66 years, 57.1% male (n=101), and 81.9% White (n=145). Almost all patients received palliative chemotherapy (n=175, 98.9%) a majority received a palliative care consultation (n=107, 60.5%). The median total time toxicity of the entire cohort was 20% (IQR: 15-28%), with median inpatient time toxicity being 7% (IQR: 3-16%) and ambulatory care time toxicity being 10% (IQR: 8%-13%). A total of 69 patients (39.0%) received systemic therapy in the last 30 days of life, 75 (42.4%) transitioned to hospice after a hospitalization, and 21 (14.8%) expired while inpatient. Following multivariate beta regression, age at diagnosis, rural/urban residence, and chemotherapy regimen were significant predictors of overall time toxicity (all p