Penn Medicine takes on ‘time toxicity’ in cancer treatment

Time is a valuable resource. We all want more of it—for our families, for our friends, for our hobbies, for fun, and for learning. It’s an even more pressing need for those with a cancer diagnosis.  

In a moment when a newly diagnosed patient may be reckoning with mortality and placing an even higher value on time, more of it is taken away. Free moments are sacrificed for phone calls, and waiting rooms, and traffic jams. 

This particular pile-up of inconveniences in the health care system is a phenomenon called “time toxicity.” It doesn’t just affect cancer patients, but because of their ongoing treatment needs, cancer patients feel its impacts more than many others.  

“More than 50 percent of time toxicity comes from commuting to, waiting for, or receiving acute care traditionally delivered in an ED (emergency department) or hospital,” said Ronac Mamtani, MD, an associate professor of Hemotology-Oncology in the Perelman School of Medicine. He is a leading expert on the effects of time toxicity and senior author of a study illustrating the time toll paid by cancer patients.  

It doesn’t have to be that way. Penn Medicine teams are pursuing technologies and processes that make care easier and give patients more of their own time back during treatment. 

New technologies are helping to make this possible.

For example, at Penn Medicine’s Abramson Cancer Center, Mamtani is working on a tool that allows patients to self-triage whether they need certain clinic visits before they receive an immunotherapy treatment. Patients respond to a text message, and if they don’t report side effects from their previous treatment, they can move along to their next treatment without having to schedule another appointment in between. Mamtani says it’s an innovative approach to limit time toxicity, “by creating a ‘fast-track’ option for eligible patients to safely bypass their regular office visit, and associated wait time, and proceed directly to their cancer treatment infusion—giving them back their precious time.”

This text messaging-based platform was developed with the Penn Center for Cancer Care Innovation. The results of a pilot trial of the program published in February 2025 showed patients saved more than an hour at each visit that was part of the study.

Timely care that gives patients hours and ease

The Oncology Evaluation Center at the Hospital of the University of Pennsylvania (HUP), which recently expanded to round-the-clock operations, is another tool helping to alleviate time toxicity. It offers evaluation and symptom management 24 hours a day, seven days a week, in a space dedicated to caring for cancer patients.

Patients save hours they might otherwise spend waiting in an emergency department or urgent care when they can instead get a same-day appointment at the center for symptoms or side effects like severe nausea and dehydration. Knowing the center offers patients a backstop to handle any symptom flare-ups, oncologists in the hospital can also feel more confident discharging patients sooner.

Similarly, an urgent home-care nursing program from Penn Medicine called Cavalry can deliver quick care to patients to address symptoms such as nausea and dehydration. Once a Cavalry nurse is activated, the average time to the patient’s doorstep clocks in at an hour and 36 minutes. Patients can wait in the comfort of their homes, with the company of their loved ones.

Time toxicity often shows up in ways that cannot be measured in hours or minutes, too. People worry about what they’ll do if they need care on nights and weekends and holidays. That concern can get in the way of enjoying important moments spent with family and friends.

“I think it can be all-consuming for cancer patients, really devastating in a way. And I think [expanding the hours of the Oncology Evaluation Center] has been one small step forward to getting where I think we can get,” said Colleen Kucharczuk, DNP, the manager of advanced practice providers for inpatient oncology services at HUP.

While these earliest advances in reducing time toxicity serve cancer patients, the lessons learned are helping in the design of a roadmap for the entire health care system.

“It’s reimagining how we deliver care, refocusing on giving the patient back some critical time they need,” said University of Pennsylvania Health System CEO Kevin B. Mahoney, in highlighting Mamtani’s work during a health system employee town hall in April.

To that end, Mamtani emphasizes that addressing time toxicity has less to do with what disease a patient is facing, than with willingness to take a different approach and the willingness to experiment.

“You can’t innovate if you’re just trying to ‘fit in’—that’s why you have to ‘fit-out,’” Mamtani said.