Time toxicity in patients with advanced pancreatic cancer in Mexico.

Abstract

4214 Background: Advanced pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies despite advances in systemic therapy. Beyond survival, the burden of time spent receiving health care (also known as time toxicity) has emerged as a relevant patient-centered outcome, particularly in diseases where treatment benefits may be modest. This study aimed to quantify time toxicity in patients with advanced PDAC and to analyze differences in time toxicity by demographic and clinical characteristics. Methods: We conducted a subanalysis of a single-center prospective cohort of patients with advanced solid tumors enrolled in a patient navigation program in Mexico. Patients ≥18 years diagnosed with advanced PDAC between June 2017 and August 2023 were included; patients with a second invasive malignancy or treated outside the institution were excluded. Demographic and clinical variables, baseline quality of life (FACT-G), and days with in-person healthcare encounters (clinic visits, treatments, tests, emergency visits, and hospitalizations, regardless of whether oncology-related) were collected from the diagnosis of advanced disease. Overall survival (OS) was defined as the time from diagnosis of advanced PDAC to death or loss to follow-up. Time toxicity was defined as the proportion of days involving in-person healthcare contact relative to OS. Comparisons used nonparametric tests and beta regression models were fitted to evaluate factors associated with time toxicity. Results: A total of 103 patients were included. Median age was 64 years, 65% were women, 83.5% presented with de novo advanced PDAC, and 75.7% received palliative chemotherapy. The mean baseline FACT-G score was 63.7±15.4. Median follow-up was 13.0 months, and median OS for the entire cohort was 11.5 months (95% CI, 6.2-16.7). The median time toxicity of the sample was 21.8% (IQR, 14.9-31.7). Patients with recurrent advanced PDAC experienced lower time toxicity than those with de novo disease (14.9% vs 22.8%, p = 0.003). In multivariable beta regression, disease presentation remained the only independent factor associated with increased time toxicity (β-0.51, p = 0.011). Age, sex, receipt of chemotherapy, and baseline FACT-G score were not independently associated with time toxicity. In an exploratory subgroup analysis among patients receiving palliative chemotherapy, patients ≥65 years had higher time toxicity compared to younger patients (23.4% vs. 17.9%; p = 0.041). Conclusions: In this cohort of Mexican patients with advanced PDAC, approximately one-fifth of OS time was spent in direct contact with health care system. Time toxicity was associated with disease trajectory rather than treatment or patient characteristics. Among patients receiving palliative chemotherapy, older patients experienced higher time toxicity. These findings highlight the importance of incorporating time toxicity into shared decision-making.