Time Toxicity and End-of-Life Treatment of Metastatic Pancreatic Cancer

Purpose Optimal care for patients with metastatic pancreatic ductal adenocarcinoma (PDAC) requires coordination across multiple providers, creating substantial time toxicity—the time patients spend engaged with the health care system. This study quantified total time toxicity and identified predictors of prolonged time toxicity in patients with metastatic PDAC. Methods We retrospectively analyzed patients with metastatic PDAC treated at a high-volume center from 2018 to 2022, excluding those who did not receive cancer-directed therapy or received care at multiple facilities. Time toxicity was defined as the proportion of overall survival (OS) spent in cancer-related health care encounters, with hospice time excluded. Beta regression identified predictors of time toxicity, incorporating OS as a scaling factor. Secondary outcomes included systemic therapy in the last 30 days of life, hospice transition after hospitalization, and inpatient death. Results Among 177 patients (median age 66 years; 57.1% male; 81.9% White), the majority received chemotherapy (n = 175) and palliative care consultation (n = 107). Median total time toxicity was 20% (IQR, 15%-28%), including 7% inpatient (IQR, 3%-16%) and 10% ambulatory (IQR, 8%-13%). Overall, 39% (n = 69) received systemic therapy in the last 30 days of life, 42.4% (n = 75) transitioned to hospice after hospitalization, and 14.8% (n = 21) died inpatient. On multivariable analysis, older age, rural/urban residence, and chemotherapy regimen predicted time toxicity (all P < .05). Each additional year of age was associated with a reduced time toxicity of 0.29%; urban residence was associated with a 3.3% increase in time toxicity compared with rural; and receiving multiple chemotherapy regimens was associated with 8.65% decrease compared with 5-fluorouracil–based regimens only. Conclusion Patients with metastatic PDAC spend roughly 1 in 5 days of survival engaged in health care interactions. Demographic, socioeconomic, and treatment-related factors all influence time toxicity.