Life “Consumed” by Cancer Care: Lung Cancer Patients Spend 1 in 3 Days in Healthcare Contact, Study Finds

A cancer diagnosis is life-changing event for patients and their families, triggering a cascade of tests and treatments often resulting in frequent, time-consuming healthcare appointments. How many healthcare contact days should patients ideally have? A recent study sought to address this question by examining the number of healthcare contact days for patients with advanced lung cancer. The results were published today in JAMA Network Open.

Healthcare contact days refers to days spent receiving healthcare outside of the patient’s home. A high number of healthcare contact days can significantly affect families and caregivers as well as take away from personal time available for patients who may be facing limited life expectancy. The term "time toxicity" has been coined for the large amounts of time taken up healthcare that may interfere with other priorities. “We have previously demonstrated that patients with advanced stage gastrointestinal cancers can spend one in four days with healthcare contact, coming back and forth to the clinic or hospitalized, all while surviving just a few months,” lead researcher Arjun Gupta, M.D., an oncologist and assistant professor of hematology, oncology, and transplantation at the University of Minnesota, states in an email interview with Managed Healthcare Executive.

A U-shaped pattern of healthcare contact days has been observed for these patients, with the most frequent healthcare contact occurring just after diagnosis and again as they neared the end of life, with a middle phase of less frequent sandwiched in between.

“However, an unanswered question was what the patterns of these healthcare contact days look like in cancers with tremendous progress in terms of new drugs,” Gupta explains. Lung cancer is one of those cancers with dozens of new immunotherapies and targeted drugs approved over the past decade.

The results reported in JAMA Network Open are from a retrospective, population-based decedent cohort study aimed to describe the experiences of patients with stage IV non-small cell lung cancer (NSCLC) in Ontario, Canada. Contact days were defined as days with healthcare contact that occurred outside of the home and included both outpatient and hospital-based encounters. Such days were identified through administrative records. The weekly percentage of contact days and fitted models with cubic splines were quantified to describe trajectories from diagnosis until death.

Among the nearly 6,000 patients evaluated, the median survival was about three and a half months and these patients spent 1 in 3 days with healthcare contact outside the home.

About one-third received systemic treatment such as chemotherapy, immunotherapy or targeted therapy. These patients had a median survival of approximately nine months and experienced almost 1 in 4 days with healthcare contact.

Overall, the percentage of weekly healthcare contact days followed a U-shaped trajectory from the time of diagnosis to the time of death, similar to what was observed in prior research in other types of advanced cancers. Contact days were found to vary based on sociodemographic characteristics and clinical factors, such as the type of therapy received and symptom severity. Even patients receiving newer, relatively less toxic types of cancer treatments such as immunotherapy and targeted therapy experienced high numbers of healthcare contact days.

“These findings are sobering and are a call for the oncology community to recognize what patients and care partners go through while receiving cancer care, and how their lives can be consumed by cancer care, even in the more contemporary era of newer and supposedly less toxic treatments,” says Gupta.

“We need to better prepare and support patients with cancer for expected time burdens, as we continue work to benchmark appropriateness and optimize care towards appropriateness,” he adds.