Time toxicity associated with treatment of metastatic or unresectable gastro-oesophageal cancers in the second-line setting - Abstract

Q: What were the key survival and early mortality findings?

The median time on second-line treatment was 2.4 months, with median overall survival from second-line commencement of 5.8 months. One in eight patients died within 30 days of receiving second-line treatment.

Sep 22, 2026

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Time toxicity (TT) is increasingly recognized as a hidden burden of cancer therapy, especially when second-line treatments provide only modest survival gains. This retrospective cohort study quantified TT for patients with metastatic or unresectable gastro-oesophageal cancers receiving second-line systemic therapy. TT was defined as days spent physically interacting with the healthcare system across three Sydney hospitals. Findings highlight substantial healthcare contact time and elevated 30-day mortality, informing shared decision making and consent.

LanguageEnglish

CategoryHealthcare

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Supportive Care in Cancer (2026) 34:144 [https://doi.org/10.1007/s00520-026-10359-w](https://doi.org/10.1007/s00520-026-10359-w) Time toxicity associated with treatment of metastatic or unresectable gastro-oesophageal cancers in the second-line setting Rebecca Han Nguyen1,2 · Joanne Tang1 · Udit Nindra1,3 · Aflah Roohullah1,4 · Robert Yoon1,4 · Annette Tognela4 · Stephanie Hui‑Su Lim4 · Ray Asghari5 · Wei Chua1,3,6 · Weng Ng1,3,6 Received: 27 June 2025 / Accepted: 16 January 2026 / Published online: 29 January 2026 © The Author(s) 2026 Abstract Purpose Patients with metastatic or unresectable gastro-oesophageal cancers (mGECs) have poor prognoses and often face high symptom burdens and rates of disease-related complications. Second-line treatments offer modest survival gains, which need to be balanced with treatment toxicities. Time toxicity (TT) is increasingly recognised as a hidden toxicity of cancer therapy, and thus, this study aimed to quantify TT to patients undergoing second-line treatment for mGECs. Methods This was a retrospective cohort study across three major hospitals in Sydney, Australia. Records were reviewed for all patients who received second-line systemic therapy for mGECs over 10 years. TT was defined as the number of days patients spent physically interacting with the healthcare system. Results Eighty patients were identified, with the majority male (83%) and a median age of 64 years. The median time on second-line treatment was 2.4 months, and the median overall survival from the commencement of second-line treatment was 5.8 months. Patients spent a median 25% of days in physical contact with healthcare, of which 20% were planned encounters (e.g. clinic appointments, scheduled investigations, and treatment days). TT was lower in patients who remained on secondline treatment for more than 2 months versus those on treatment less than 2 months (29% vs. 23%, p < 0.001) . One in eight patients died within 30 days of receiving second-line treatment. Conclusion Patients on second-line treatment for mGEC spent 1 in 4 days in contact with healthcare, and 30-day mortality following systemic treatment was high. These findings may guide decisions and informed consent surrounding second-line treatment in mGECs. Keywords Time toxicity · Gastric cancer · Oesophageal cancer · Shared decision making · Risk versus benefit * Rebecca Han Nguyen [RebeccaHan.Nguyen@health.nsw.gov.au](RebeccaHan.Nguyen@health.nsw.gov.au) 1 Department of Medical Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Cnr Elizabeth & Goulburn Street, Liverpool, NSW, Australia 2 School of Clinical Medicine, South Western Sydney Clinical Campuses, UNSW Sydney, Sydney, NSW, Australia 3 School of Medicine, Western Sydney University, Sydney, NSW, Australia 4 Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia 5 Department of Medical Oncology, Bankstown Cancer Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia 6 Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia Introduction Gastro-oesophageal cancers (GECs) represent a significant health burden globally, ranking among the most common malignancies worldwide [1] . Up to half of patients with newly diagnosed GECs will have unresectable or metastatic disease [2], and in patients treated with curative intent, disease recurrence including metastatic recurrences remains common [3–5] . Despite recent treatment advances, prognosis for patients with unresectable or metastatic GECs remains poor, and the survival benefit of systemic treatment in the second-line setting remains limited [6, 7] . The proportion of patients with metastatic GECs who received first-line treatment and proceed to second-line treatment varies significantly in real-world studies, ranging from approximately 23 to 47%[8–11]. In clinical trials, the overall survival (OS) benefit of second-line syst

FAQs

How was time toxicity (TT) defined in this study?

TT was defined as the number of days patients spent physically interacting with the healthcare system during second-line systemic treatment.

What proportion of days were patients in physical contact with healthcare?

Patients spent a median 25% of days in physical contact with healthcare, including 20% planned encounters such as clinic visits, scheduled investigations, and treatment days.

What were the key survival and early mortality findings?

The median time on second-line treatment was 2.4 months, with median overall survival from second-line commencement of 5.8 months. One in eight patients died within 30 days of receiving second-line treatment.

Sep 22, 2026

Upload by Eliana