Presenter(s)
D. Panse1, A. E. Hotca-Cho2, M. Buckstein1, M. Jain3, and K. A. Goodman1; 1Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, 2University of California San Francisco, San Francisco, CA, 3Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, New York, NY
Purpose/Objective(s): Patients with esophageal cancer (EC) often require multimodal therapy, resulting in frequent interactions with the healthcare system. While survival and physical toxicities are routinely discussed, data describing time burden is limited. This study quantifies treatment-associated time toxicity by measuring healthcare contact days within one year after diagnosis.
Materials/Methods: We retrospectively reviewed records of patients with EC treated at a single institution between March 2019 and February 2025. Data included baseline characteristics, total observed days within one year of diagnosis (capped at 365 days or death), and health care contact days, defined as any day receiving clinical care. Time was measured from diagnosis to one year or death and categorized as pre-chemoRT (diagnosis to start of chemoRT), induction chemotherapy, chemoRT, pre-surgical (end of chemoRT to surgery), surgical, post-surgical (discharge to one year follow up/death), and post-chemoRT (end of chemoRT one year follow up/death for non-surgical patients). Time toxicity was calculated as the percentage of observed days within one year spent in health care contact.
Results: 53 patients were included, median age was 64 years, 60% had distal esophageal tumors, and 62% had squamous cell carcinoma. 49% received induction chemotherapy and 25% underwent esophagectomy. Median RT dose was 50.4 Gy (IQR, 46.0-50.4) delivered in 28 fractions. Patients spent an average of 73 health care contact days (range 41-133), median of 20.3% (IQR, 15.6-26.1) of their first year after diagnosis receiving care. The greatest contributor to time toxicity occurred after completion of chemoRT, which accounted for a median of 8.5% (IQR, 3.8-11.7). ChemoRT accounted for 7.7% (IQR 6.8-9.6%), Post-surgical care accounted for 3% (IQR, 1.6-6.6%), and surgical care for 2.7% (IQR, 2.5-4.1%). Pre-chemoRT, induction chemo, and pre-surgical periods contributed less, 1.6% (IQR, 1.2-4.7%), 3.6% (IQR 2.5-6.5%), and 1.9% (IQR, 1.6-2.2%) respectively. Hospitalizations followed a similar pattern, with the highest burden occurring post-chemoRT with a median of 1.1% (IQR 0-5.3%). One year mortality rate was 19%.
Conclusion: Patients with EC spend a significant proportion of their first year after diagnosis receiving clinical care, with one in five days involving healthcare contact. Most time toxicity occurs outside of active chemoRT, particularly post-treatment, highlighting the importance of incorporating time toxicity into shared decision making.