Time Toxicity: The Unspoken loss of treating metastatic breast cancer

A key goal of treating ER+, HER2– MBC is about maximizing the amount of time you can provide for patients1

However, another important consideration is the time patients spend seeking out treatment.2 Unfortunately, for patients living with ER+, HER2– MBC, as their disease progresses, oral therapy options become limited.3,4 IM injections requiring regular in-office appointments are a standard of care in later line treatment, which come at the cost of how and where patients spend their time.3,4

The cost to a patient’s time is spent everywhere—from clinics, to pharmacies, in cars, waiting rooms, and on phone calls.2

The cumulative burden of time lost to pursuing cancer treatment is known as time toxicity.2

Clock with different icons

Time toxicity is becoming an increasingly relevant patient-centric metric in metastatic cancer care.5

The indirect cost of time receiving metastatic breast cancer-related care comes at the expense of time spent on important activities, lost work productivity, time spent with family and friends, or time spent on leisure activities.

—Health care-related time costs in patients with metastatic breast cancer (Rocque et al, 2020)6

The burden of time toxicity affects multiple dimensions of a patient’s well-being.5,7

Regular appointments to receive treatment in later lines present more than just logistical challenges—there is a reported impact on physical and emotional health, occupational stability, and social wellness.4,6,8

A 2023 survey by Ipsos in collaboration with Living Beyond Breast Cancer provides data on the experience of patients with ER+, HER2– MBC* around time spent at oncologist appointments8:

1 in 3 icon

~1 in 3 patients has needed to take paid or unpaid time off work8

1 in 5 icon

~1 in 5 patients has needed to cancel or reschedule a family activity8

*Research conducted by Ipsos in collaboration with Living Beyond Breast Cancer and funded by Eli Lilly and Company. Survey participants have not reported that they previously received IM injectable SERD treatment.8

The journey of attending appointments adds to the burden of time toxicity. On average, appointments are Far (about 25 miles one way), frequent (every 6 weeks) and long (more than 2 hours including travel

Patients reported awareness of both advantages and disadvantages of IM injectable SERD treatment8:

31% were aware it may help patients live longer8

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Greater than 42%

More than 42% were aware of the pain and soreness8

16%

Only 16% perceived travel to an oncologist’s office as inconvenient8

The transition from an oral therapy to an IM injection creates additional stress.9

I went out of town to visit my grandkids and had to cut the trip short to get home for my appointment.

—Patient treated with an IM injectable SERD9

Patients across a range of circumstances may face a greater burden than others to attend regular in-office appointments.2

This is often due to financial constraints, distant treatment facilities, demanding schedules, and socioeconomic barriers.2

For patients in rural areas, transportation barriers, along with limited access to oncologists and treatment facilities, are factors that can be attributed to disparities in mortality rates.10

A study found that compared to non-Hispanic White patients, racial and ethnic minority groups were11:

127%

more likely to take unpaid leave

22%

more likely to stop work

As our understanding of time toxicity evolves, so too does the treatment landscape.4,7

Innovative research in ER+, HER2– MBC treatment is paving the way for new formulations, including the development of novel oral ETs.3,4

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ER+=estrogen receptor–positive; ET=endocrine therapy; HER2–=human epidermal growth factor receptor 2–negative; IM=intramuscular; MBC=metastatic breast cancer; SERD=selective estrogen receptor degrader.

References:

  1. Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  2. Johnson WV, Blaes AH, Booth CM, et al. The unequal burden of time toxicity. Trends Cancer. 2023;9(5):373-375. doi:10.1016/j.trecan.2023.01.006
  3. Hernando C, Ortega-Morillo B, Tapia M, et al. Oral selective estrogen receptor degraders (SERDs) as a novel breast cancer therapy: present and future from a clinical perspective. Int J Mol Sci. 2021;22(15):7812. doi:10.3390/ijms22157812
  4. Wang Y, Tang SC. The race to develop oral SERDs and other novel estrogen receptor inhibitors: recent clinical trial results and impact on treatment options. Cancer Metastasis Rev. 2022;41(4):975-990. doi:10.1007/s10555-022-10066-y
  5. Gupta A, Eisenhauer EA, Booth CM. The time toxicity of cancer treatment. J Clin Oncol. 2022;40(15):1611-1615. doi:10.1200/JCO.21.02810
  6. Rocque GB, Williams CP, Ingram SA, et al. Health care-related time costs in patients with metastatic breast cancer. Cancer Med. 2020;9(22):8423-8431. doi:10.1002/cam4.3461
  7. Gupta A, Jensen EH, Virnig BA, et al. Time-related burdens of cancer care. JCO Oncol Pract. 2022;18(4):245-246. doi:10.1200/OP.21.00662
  8. Ipsos. Understanding patients with metastatic breast cancer — a preference for oral treatments. Accessed February 22, 2024. https://www.ipsos.com/sites/default/files/ct/news/documents/2024-02/Metastatic%20Breast%20Cancer-%20Topline.pdf
  9. Data on File. Lilly USA, LLC. DOF-IN-US-0001.
  10. Moubadder L, Collin LJ, Nash R, et al. Drivers of racial, regional, and socioeconomic disparities in late-stage breast cancer mortality. Cancer. 2022;128(18):3370-3382. doi:10.1002/cncr.34391
  11. Samuel CA, Spencer JC, Rosenstein DL, et al. Racial differences in employment and cost-management behaviors in patients with metastatic breast cancer. Breast Cancer Res Treat. 2020;179(1):207-215. doi:10.1007/s10549-019-05449-9