When does time become a burden? Evaluating the association between time spent on cancer care and patient distress.

Abstract

11057 Background: While cancer care is time-intensive, the specific impact of various tasks on patient well-being is poorly understood. We evaluated how time spent on specific cancer-care tasks contributes to patient distress and identified patient populations most vulnerable to these time burdens. Methods: We enrolled individuals receiving treatment for advanced-stage ovarian or metastatic breast cancer at the University of Minnesota and the University of Alabama-Birmingham. Participants used a mobile app for 28 days to log time spent on out-of-home and at-home cancer-care related tasks. Daily distress was measured via the National Comprehensive Cancer Network (NCCN) Distress Thermometer (0-10; 0=no distress, 10=extreme distress). The primary outcome was clinically significant distress (NCCN distress score <4 vs. ≥4). Predictors included any time spent on each task type on a given day for both out-of-home healthcare tasks (lab, clinic, treatment, research, imaging, other) and at-home tasks (taking medications, scheduling appointments, managing medical bills/insurance claims, symptom management, monitoring health status, seeking information, and arranging help/transportation). A multi-level model with a random intercept for participants was used, adjusting for age, employment, education, dependent and partner status. Odds ratios and 95% confidence intervals are reported. Results: Analysis included 1,869 days from 60 participants (median age 59; 42% employed; 35% with dependents). Experience of significant distress was more likely on days including out-of-home treatment compared to days without treatment (OR: 2.54 [1.47, 4.39]). Participants were also more likely to experience significant distress on days including time spent on symptom management (OR: 2.59 [1.85, 3.64]), health monitoring (OR: 2.50 [1.56, 3.98]), and managing bills/claims (OR: 2.24 [1.22, 4.12]) compared to days without those tasks. Vulnerability varied: employed patients were more distressed by managing bills/claims and information seeking, while non-working patients experienced more distress on treatment days. Among those with dependents, scheduling was a unique stressor. Conclusions: Out-of-home treatment and at-home cancer-care tasks are significantly associated with patient distress. Findings suggest that interventions reducing at-home administrative and symptom burdens would reduce patient distress, and resources may need to be tailored based on employment and caregiving status. Clinical trial information: NCT05708703 .