Time toxicity associated with treatment of metastatic or unresectable gastro-oesophageal cancers in the second-line setting

TL;DR

This study finds that patients with advanced gastro-oesophageal cancers spend a significant portion of their time in healthcare settings during second-line treatment, with high 30-day mortality rates.

Contribution

The study quantifies time toxicity in second-line treatment for metastatic gastro-oesophageal cancers, linking it to treatment duration and mortality.

Findings

Patients spent a median of 25% of days in physical contact with healthcare during second-line treatment.

30-day mortality after starting second-line treatment was 12.5%.

Time toxicity was higher in patients on treatment for more than 2 months compared to those on treatment less than 2 months.

Abstract

Patients with metastatic or unresectable gastro-oesophageal cancers (mGECs) have poor prognoses and often face high symptom burdens and rates of disease-related complications. Second-line treatments offer modest survival gains, which need to be balanced with treatment toxicities. Time toxicity (TT) is increasingly recognised as a hidden toxicity of cancer therapy, and thus, this study aimed to quantify TT to patients undergoing second-line treatment for mGECs.

This was a retrospective cohort study across three major hospitals in Sydney, Australia. Records were reviewed for all patients who received second-line systemic therapy for mGECs over 10 years. TT was defined as the number of days patients spent physically interacting with the healthcare system.

Eighty patients were identified, with the majority male (83%) and a median age of 64 years. The median time on second-line treatment was 2.4 months, and the median overall survival from the commencement of second-line treatment was 5.8 months. Patients spent a median 25% of days in physical contact with healthcare, of which 20% were planned encounters (e.g. clinic appointments, scheduled investigations, and treatment days). TT was lower in patients who remained on second-line treatment for more than 2 months versus those on treatment less than 2 months (29% vs. 23%, p < 0.001). One in eight patients died within 30 days of receiving second-line treatment.

Patients on second-line treatment for mGEC spent 1 in 4 days in contact with healthcare, and 30-day mortality following systemic treatment was high. These findings may guide decisions and informed consent surrounding second-line treatment in mGECs.

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