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Cancer Treatment and the Cost of Time


The conversation around the “cost” of medical treatments usually involves a few key factors. There’s the literal cost and what it means for a patient’s medical bills, and then there’s the physical and emotional tolls some treatments can take. But there’s another cost that may not come to mind quite as quickly: Time.

In some cases, time is not something patients have in large supply. That’s especially true for cancer patients transitioning into palliative care. New research from the Abramson Cancer Center of the University of Pennsylvania is painting a clearer picture of the time commitment required in these cases.

Researchers looked at the patient experience for those diagnosed with the most common type of pancreatic cancer, pancreatic ductal adenocarcinoma (PDAC) and receiving palliative care. It’s the fourth leading cause of cancer deaths with most patients living less than one year following their diagnosis. A study of 362 patients in the University of Pennsylvania Health System, published this month in JCO Oncology Practice, showed 10 percent of patients’ remaining days involve health care, with 60 percent of that time spent commuting to and from or waiting to receive care.

The researchers framed this in terms of opportunity cost. Put simply, opportunity cost means that when you choose one thing, you lose the ability to choose something else. In this case, time spent on treatment means time not spent doing things they might enjoy, or with the people they love.

“We’re not saying people shouldn’t get treatment, but just like we are transparent about the possible side effects of chemotherapy, we should also be counseling pancreatic cancer patients about the impact any treatment may have on their quality of life,” said Erin Bange, MD, a fellow in Hematology-Oncology in the Perelman School of Medicine at the University of Pennsylvania, who led the research.

If a pancreatic cancer patient lives ten months while undergoing palliative treatment to extend their life, this study suggests that one of those months will be spent receiving care or traveling to and from appointments. If a patient has a different disease that can be cured by current treatments, the opportunity cost changes. Maybe spending that time getting treatment doesn’t seem as bad knowing you’ll be cancer-free when you’re done.

“As clinicians talk to these patients, we focus on what their goals are for their treatment, and it’s important that these conversations include a realistic picture of what a patient’s day-to-day life will be like moving forward,” said Ronac Mamtani, MD, MSCE, an assistant professor of Hematology-Oncology at Penn, and the study’s senior author. “Research has also shown that patients who are adequately prepared for the potential effects of their treatment are actually better able to cope.”

The team also says this research can serve as a call to action for health care providers to come up with better strategies on how to utilize the resources that already exist in a patient’s community. A patient living in a suburban or rural area whose treatment is based in a city or at an academic medical center — or both, like the patients in this study — may be able to receive chemotherapy infusions at a local facility rather than commuting to a downtown site. The same may be possible for imaging.

“If a patient can receive certain aspects of their care near their home without having to drive to a busy hospital, it may cut down on the overall time spent on care,” Bange said.

Interestingly, the Penn study found that patients coming into the city for care spent the same amount of time on health care as patients being treated at their community hospitals. It was the breakdown that varied, with city patients spending long hours on one day compared to community hospital patients who received treatment on multiple days per week but in shorter stints. This points to the fact that there’s not one way to streamline treatment. Instead, it will require a number of different strategies for co-management. The authors also say the promise of home care, which may be closer than you think, could be part of the answer.

The researchers say they hope this study will be a catalyst for this conversation in the field, both among health care providers as well as between doctors and patients. While solutions won’t be easy, research to better understand the typical patient experience is a critical step in improving it, and counseling patients on what to expect can help them decide what’s right for them.


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