{"paper_id":"4ceeda46-1cee-48cc-aa5a-2bcc49faac8d","body_text":"The Weight of Time: Experience of time toxicity among advanced cancer patients and their family caregivers: A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Weight of Time: Experience of time toxicity among advanced cancer patients and their family caregivers: A qualitative study Jie Jing, Mohan Li, Yehao Rui, Danruo Wang, Qiuchen Zhu, Ling Yuan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6490205/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Sep, 2025 Read the published version in Supportive Care in Cancer → Version 1 posted 9 You are reading this latest preprint version Abstract Background Substantial time investments are required from patients and caregivers due to cancer management and treatment demands. These cumulative time burdens can lead to the disruption of daily life order, aggravation of psychological distress, and economic burden. However, time toxicity is often overlooked in the current healthcare environment. Therefore, this study examined perceptions of time toxicity from advanced cancer patients and their family caregivers. Methods A qualitative study based on semi-structured interviews was conducted among 12 advanced cancer patients and 6 family caregivers at Oncology departments in a tertiary hospitals and a community hospital. The interviews were analyzed according to thematic analysis. The reporting of this qualitative research conformed to the COREQ consolidated criteria. Results The findings of this study have revealed four key themes: (1) The experience of time toxicity stems from multi-dimensional contributing factors; (2) Time Toxicity has multiple negative impacts on patients and caregivers; (3) Strategies for coping with time toxicity in cancer patients and caregivers; (4) Clinical needs and expectations of cancer patients and caregivers regarding time burden. Conclusion Healthcare professionals should receive training to identify time toxicity manifestations and their cascading effects on patient distress, systematic time burden assessments must be initiated at cancer diagnosis, coupled with implementation of time-saving care pathways and continuous evaluation of temporal resource adequacy. cancer caregivers time toxicity time burden qualitative study Introduction With the increase of treatment options for cancer patients, particularly the advent of immunotherapies and targeted therapies, the treatment of cancer patients is more complex and longer lasting, which leads to the need for patients to invest a lot of time in the treatment process, imposing negative impact on time and quality of life of patients[1,2]. While physical and psychological adverse events are commonly the primary endpoints in routine oncology care assessment[3], an important understudied outcome that should also be taken into account is treatment-related time toxicity[4]. Time toxicity has been defined as the large amount of time consumed by cancer patients during treatment due to frequent medical appointments, treatment, and their subsequent recovery[5,6]. Approximately 20-30% of the remaining lifespan in individuals diagnosed with advanced-stage solid malignancies is allocated to clinical engagements[7]. While certain therapeutic interventions may confer modest survival advantages, these benefits could be negated by treatment-related time burdens[8]. Notably, heightened time expenditure within healthcare systems correlates with diminished quality-of-life metrics[9,10]. As care increasingly prioritizes adapting treatments to patients' specific objectives, there has been growing awareness within the oncology community regarding the time burdens of cancer care[11-13]. Existing research has quantified the time-related burdens associated with both undergoing cancer treatment[14-16]. It was estimated that patients with stage IV spent 1 in 3 days with healthcare contact, following a U-shaped trajectory in the percentage of days of contact over time, with higher percentages after diagnosis and at the end of life[14]. Patients with metastatic lung cancer accumulated 56 days of in-person healthcare visits during the first year of survival following anticancer therapy initiation[15]. The time burden of clinical engagements may paradoxically diminish the perceived benefit of survival gains, as treatment-related time commitments can compromise the quality of extended life[17]. In addition, in the process of cancer treatment, the caregivers of cancer patients need to sacrifice their personal time to help patients make appointments, visit doctors, travel, medical examinations, and other care services, which has a negative impact on the quality of life of caregivers[18,19]. Most of the existing studies focus on the management of physical symptoms or psychological pain of cancer patients, and there is a lack of attention to the subjective experience of time toxicity[20]. Although quantitative research can count the \"amount\" of time investment, it is difficult to reveal the perception, emotional response, and adaptive strategy of patients to time burden. To get a full view of time toxicity, a qualitative approach was used to explore the sources, populations affected, and consequences of time toxicity through the lens of advanced cancer patients and their caregivers. Methods Participants, Recruitment, and Setting Participants were recruited using purposeful sampling at a comprehensive hospital and a Community hospital in Jiangsu Province, China. Included participants were cancer patients undergoing treatment, over the age of 18 who could speak Chinese, and volunteered. Patients with psychiatric problems who are unable to communicate properly are excluded from this survey. Based on our study design, we explicitly stated in the recruitment announcement that this interview would not cause any harm to participants other than consuming 30-60 minutes. Oncology nurse leaders are very knowledgeable about their patients and can provide guidance to the research team to help us choose more appropriate subjects for the study. The first author contacted the oncology nurse managers at both institutions. They were asked to help distribute recruitment information. Oncology nurse leaders possess specialized insights into patient profiles, enabling them to enhance methodological rigor through targeted participant selection guidance. The research team initiated collaboration by contacting nurse managers at both institutions, who subsequently facilitated the dissemination of recruitment materials. We conducted interviews in the Separate office of the host hospital between October 2024 and February 2025. This study was approved by the Medical Ethics Committee of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. (No. 2023-047-01). During the research process, the participants were always guaranteed to participate in the study voluntarily, and the participants could withdraw from the study at any time. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline[21]. Interviews An interdisciplinary study team, including Clinical Nurse Specialists, clinicians, and qualitative methodology experts, created interview guides for patients and caregivers after a literature review(The detailed interview guideline can be found in Supplement 1). We sampled 10-20 participants, and when the content of the interviews no longer appeared new topics, it was judged that the information was saturated and the interviews were terminated[22]. Prior to the formal interview, participants were required to complete a general information questionnaire（Supplement 2). The interviews were conducted in a private room situated within a hospital office environment, with the specific location being determined by each participant's preference, and each participant engaged in a face-to-face in-depth semi-structuredinterview session lasting between 30 and 60 minutes to ensure comprehensive data collection while maintaining methodological consistency across all research subjects. Both quantitative and qualitative data were collected during the interview process. Two researchers conducted face-to-face interviews with the interviewees: both Li Mohan and Jing Jie are graduate nursing students trained in qualitative research, and both have many years of experience in qualitative research. Both researchers in the interviews, all of were conducted in the presence of only two researchers and one interviewee, with Li Mohan acting as the interviewer and guiding the interviews. Jing Jie was the recorder and observer, responsible for observing whether the conversation was off-topic and recording the talking points. All interviews were audio-recorded with the consent of the interviewees. Eventually all 16 participants were interviewed in full and no one dropped out. Data analysis The obtained data were analyzed using Colaizzi’s phenomenological analysis[23]. Following the Standards for Reporting Qualitative Research (SRQR) guidelines, we implementedrigorous reporting protocols to ensure methodological transparency[24]. The audio recordings of the interviews were transcribed by one researcher and another researcher checked the accuracy of the transcription within 24 hours. The two researchers coded the datausing NVivo, version 15(Lumivero), and merged them into a shared codebook. We had regular discussions together to identify themes and sub-themes and map their relationships. The codes and themes were continuously refined until a consensus was reached. Results Participant characteristics On the whole, 12 cancer patients and 6 caregivers from the Oncology ward signed the consent and participated in this study. All of them Interviewed for 30-60 minutes. Of these 12 patients, 7 were aged 60 years or older; 6 were female and 6 were male. Three had colon cancer, three had gastric cancer, two had Rectal cancer, one had lung cancer, one had liver cancer, one had Breast cancer and one had pancreatic cancer. The mean age of the included participants was 57（±12）years old, and only one was unmarried. Among them,73% lived in rural and the average travel time to the hospital was 84(±60) minutes. They and their caregivers come to the hospital once every 15（±6）days on average. Detailed demographic and clinical characteristics of the participants can be seen in Table 1. Table 1: The demographic and clinical characteristics of the participants (n = 18) No Age (years) Sex Residency Marital status Educational background Cancer type Treatment options Travel time (Minutes) Frequency of hospital admission(days) P1 60 Female Rural Married Middle school Breast cancer Combined treatment 120 30 P2 63 Female Rural Married University Colon cancer Combined treatment 60 14 P3 37 Female Urban Married University Colon cancer Combined treatment 30 14 P4 60 Female Rural Married Middle school Rectal cancer Combined treatment 120 21 P5 47 Male Rural Married Middle school Rectal cancer Combined treatment 120 14 P6 56 Male Rural Married Primary school Gastric cancer Combined treatment 50 7 P7 38 Male Rural Married Middle school Gastric cancer Combined treatment 10 14 P8 62 Female Rural Married University Pancreatic cancer Chemotherapy 45 14 P9 60 Male Rural Married Middle school Colon cancer Combined treatment 50 14 P10 56 Male Rural Married Middle school Gastric cancer Combined treatment 120 7 P11 83 Female Urban Married Primary school Liver cancer Combined treatment 20 14 P12 74 Male Rural Married Primary school Lung cancer Chemotherapy 180 7 C13 46 Female Urban Married Middle school 40 21 C14 51 Female Rural Married Primary school 45 21 C15 30 Female Rural Unmarried University 240 21 C16 68 Female Urban Married Middle school 100 14 C17 35 Male Urban Married University 25 14 C18 47 Male Rural Married Primary school 70 12 Qualitative findings Thematic analysis revealed 5 themes, (1) The experience of time toxicity stems from multi-dimensional contributing factors; (2)Time Toxicity has multiple negative impacts on patients and caregivers; (3) Strategies for coping with time toxicity in cancer patients and caregivers; (4) Clinical needs and expectations of cancer patients and caregivers regarding time burden. Theme 1: The experience of time toxicity stems from multi-dimensional contributing factors. The complexity of ambulatory appointment procedures contributes to time burden (1) From the interview, It is known that cancer patients and their caregivers spend a lot of time traveling for ambulatory appointments, and this is especially bad in rural areas. P4:“The whole process of my ambulatory appointment was inconvenient, we traveled from far away and had to drive to the hospital from 4:00 in the morning.” C15:“We live in a remote rural area that can be costly in terms of time and money.Ambulatory appointment consumes a lot of time.” P7:“Looking back on the day I went from here to there, getting tests and going to the hospital, I think it was a huge waste of time.” (2) In China's healthcare environment, medical resources in higher-level hospitals are not enough, often resulting in the phenomenon of “hard to find a bed” and a relative lack of medical equipment, which leads to patients traveling between hospitals and their homes and even spending the night in facilities, creating logistical burdens for the patients. P4:“When I first came here I didn't realize it was so difficult to park here, it took me 2.5 hours to get my car in and that's not an exaggeration, it's really awful.” P12:“Each time we drive to the hospital, passing through in the center of town is very congested and this wait is too long.” P8:“Hospitals in Shanghai are more specialized, so I went there to seek treatment, but there were no beds, and we ended up going back to our hometown, which was a torturous process.” (3) Patients consistently report difficulty in parking due to traffic congestion on the city's roads and a severe lack of infrastructure such as parking spaces. P1:“It just doesn't have a hospital bed for me, it's too lacking. There's no way to do anything but spend time waiting.” C13:“Now that these beds are in short supply and we can't apply for award. We take him to the hospital for an infusion every day, and then we go home, for over a month.” Cancer is a complex procedure to diagnose and treat, adding to time burden. （1）Early diagnosis and decision-making on treatment options for cancer patients require the participation of patients, their families, and physicians, and repeated multidisciplinary consultations impose a time burden。 P1:“I think the process of getting a diagnosis of cancer is the biggest waste of time.how many times you need a doctor's consultation, how many times you need to do all kinds of screening. My gosh, it's really painful.” C15:“My father's case is so complicated that there were many consultations in the first place and it took a long time. Is there a more convenient way?” （2）Cancer patients due to untimely early screening and uncertainty in diagnosis, delay their optimal treatment time and make advanced cancer patients spend more time on treatment. C14:“He felt sick in his chest, then i accompanied him to the hospital for screening but it was not found the laryngeal cancer. If it had been diagnosed earlier, we wouldn't have had to spend so much time on treatment.” Time burden associated with cancer treatment and screening Cancer patients perceive time and energy as being consumed by treatment infusions, queuing for outpatient appointments, waiting for elevators, and untimely discharges with medications during treatment and examinations. Further time burdens are placed on the patient if post-test indicators do not meet the indications for medication. C16:“The patient needs to be with me all the time while the infusion is going on. What's even more hopeless is that I have to accept that the size of the bag of medicine can't be changed and the speed of the infusion can't be changed.” P3:“I find this really time-consuming: every time I go to line up for an appointment for an investigation. Once it even took three days to get in line for an MRI.” P11:“When I was in the hospital for a screening, I needed to take the elevator because I was weak due to my illness. But elevators were full of people queuing up and the going up and down was slow.” P9:“The pharmacy is not consistent in dispensing medications. When I was ready to be discharged, I could not leave if my medication was not available in the morning. It made my discharge a little more of a wait.” P2:“My tumor markers keep going up, so I can't get chemotherapy.” Healthcare system-related impacts (1) Cancer patients do not trust the standard of care in primary hospitals. They spend more time going to higher-level hospitals rather than wanting to receive care and treatment closer to home. Some patients are skeptical of remote visits and opt for more time-consuming face-to-face visits. P4:“I came here for a lab test because I don't really trust the equipment or test results in my hometown. I know it's a waste of time but it has to be done.” P4:“I don't trust telemedicine enough. Please don't consider my time, I think face-to-face diagnosis and treatment needs would be more careful.” (2) Day clinics in most hospitals are closed on weekends, delaying the timing and availability of patient care. Especially for patients returning to work, who often have sufficient time to receive treatment only on weekends. P9:“The hospital's day clinic is closed. It's going to be postponed until Monday, and this two-day window creates a sense of uncertainty for us, and we will always think that time is more pressing.” P10:“I mainly want to be able to use the medication on Saturday and Sunday as well, so that I don't have to wait until Monday to get it done. For a portion of the workforceweekends may be the only ones that will be free and will have time to deal with a sickrelative.” (3) The irrational layout of some hospitals and the lack of coordination among medical institutions have caused much inconvenience to cancer patients. P3:“The layout of this hospital was very inconvenient for us, their pharmacy was in this building but the admission and discharge procedure was in another, although not far away, it took time to walk there each time, plus I was not feeling well, which was very unreasonable.” Lack of effective communication and bias in transmitting information between healthcare professionals, resulting in more time burden C16:“The doctor may be too busy, I often can't find him in the ward, many times I need to show the doctor after the test report to further determine the treatment plan, but often I can't contact him, this is very consuming my time.” P3:“Once, I went to queue up for a test, and it was supposed to be a 20-minute affair, but due to a lack of communication between the medical personnel, they got my number plate wrong, resulting in me waiting for almost two hours and I didn't eat. I was really angry at that time.” Theme 2: Time Toxicity has multiple negative impacts on patients and caregivers Time burden creates adverse mood swings for patients The burden associated with the timing of treatment for cancer patients can cause a range of adverse emotions. For example, anxiety and feelings of helplessness about scheduling appointments for checks or waiting for the results of treatment, feelings of guilt about not being able to take care of family responsibilities due to time conflicts, and feelings of uncertainty and fear. P4:“I want to know the lab results report early every time, what exactly is the nature of this tumor? The waiting process makes me worried and anxious.” C17:“The last time we came in for an MRI, we waited close to three hours, and there was no way around it.” P3:“When my child needs me to participate and accompany him to school, I feel a bit sad and guilty because I don't have time to accompany him/her due to treatment.” P10:“There is still psychological pressure: it invisibly adds a sense of uncertainty and fear about time to you.” The patients' life rhythm is disrupted, making it difficult to achieve social reintegration Cancer patients perceive very different time expenditures before and after anti-cancer treatment. Repeated radiation or chemotherapy treatments fill the patient's survival time,making it difficult to balance family and work, and forcing the patient to give up hobbiesand social activities. P2: “Before my treatment, I was able to do chores and work, but now I don't have time to take care of things, It's painful!” P6: “Oh my god, my life is completely different now! I don't have time to play football or go to the gym anymore, let alone communicate with my former trainer and have coffee. My time is occupied by endless treatments...” Significantly lower treatment adherence in cancer patients Partial cancer patients perceive the time and financial costs of treatment and screening. They tend to abandon treatment programs or undergo treatment in stages to enjoy the remaining time of survival. P5:“I can't afford the money and time this treatment costs. I'm already in an advanced stage, I want to spend the rest of my time with my family or traveling, so I don't really want to go to chemotherapy or radiation therapy.” Caregivers are impaired in multiple dimensions, including physically, psychologically, and socially （1）The loss of self-care ability in cancer patients after treatment leads to a dramatic increase in the demand for care time. The majority of patients emphasize that the time burden of cancer is not only a negative experience for themselves, but also leads to impaired levels of physical and mental health, work limitations, and disruption in the lives of caregivers. C18:“It takes a lot of time out of my life to transition between the hospital and home when you're constantly running around like that. It would also have an impact on my life, most of all the mental stress.” P10:“He (the caregiver) is more stressed, he's feeling sick, and I asked him to go for a checkup, but he won't go in order to spend time caring for me.” P9:“After I became ill, I had to deal with the hospital more. Since I fell ill, my daughter always has to drive for over an hour to take me to the hospital each time, which greatly affects her work.” （2）Caregivers of cancer patients also perceive accompanying the patients for treatments and screenings as imposing a significant time burden, with what seems like brief medical procedures turning into all-day affairs. C17:“Even though it took just a few hours to accompany him to the blood draws and tests, I needed a lot of preparation and I felt exhausted. The whole day was wasted.” Theme 3: Strategies for Coping with Time Toxicity in Cancer Patients and Caregivers Self-regulation at the individual level （1）Cancer patients alleviate anxiety caused by time pressure by distracting themselves to fill their time expenditure; some patients regain a sense of control over their lives during the intermission of recovery from symptom burden. P2:“I would read novels or watch some videos to distract myself while undergoing treatment or waiting for test results, which helps reduce the sense of wasted time.” P2:“My treatment cycle is 14 days at a time, I schedule work for the periods when I'm comfortable, and when I feel bad I choose to lie down.” （2）Some cancer caregivers reduce the number of nonessential readmissions by learning and developing caregiving skills, thereby easing time pressures on patients and themselves. C13: “Cleaning his wound is really time-consuming and I get really anxious when I don't know how to handle it at first, and we're not close enough to the hospital to come over every day, so I'm learning some skills to cut down on time wasted traveling and attending appointments.” Full utilization of medical and social resources （1）Some cancer patients choose to have follow-up visits and treatment at nearby hospitals, and make full use of the advantages of the internet for telemedicine or convenient Oncology Day Care Unit, thereby reducing the time spent on accessing healthcare. P10:“I just do blood routine tests at home to monitor my condition. When the results are not good, I take medications and injections. Generally, after such treatment, my indicators return to normal in about two or three days, and then I proceed with further treatment. However, this also takes up a lot of my time.” P9:“The Oncology Day Care Unit provides us with great convenience. After the infusion is completed in the morning, we can go back in the afternoon, which basically does not consume too much time. It is very convenient.” （2）Partial cancer caregivers seek support from family, friends, or volunteers. C13:“I have three sisters, when I am short of time, I will ask for their help, and they will help me share some.” P2:“If there is something we need help with, the volunteers will guide us on the process we need to do, help us get a number, etc... saving us time!” Theme 4: Clinical Needs and Expectations of Cancer Patients and Caregivers Regarding Time Burden Establishing an interactive bond （1）Hope to establish contact with healthcare professionals who can help answer questions related to treatment indicators and provide ongoing professional support in a timely manner. C15:“Patients can travel to a higher level hospital, and once diagnosed or post-treatment, they can apply treatment options to our nearest hospital while taking advantage of the Internet. We hope that all these resources can cooperate.” （2）Cancer patients and their caregivers hope to have a clear understanding of the treatment cycle information to reduce unnecessary time burden. P2:“It bothers me every day that I'm curious as to why the Cycles of chemotherapy are so short. Can't you make me come in 21 or 30 days? Which factors actually determine the efficacy of a drug?” Meet patient-centered needs （1）Cancer patients expect healthcare professionals to take the patient's perspective. Plan their time well and provide a consistent schedule of treatments and tests. P4:“The doctor's schedule is very tight. For example, I needed to fast for the enhanced CT scan. After I had my blood drawn on an empty stomach, the time arranged by the doctor was exactly what I needed. You can go for a CT scan, which makes the process less painful for the patient. This is very humane.” (2) Cancer patients hope healthcare professionals can pay attention to their time burden and treatment decision preferences, taking into account the Time Toxicity when choosing appointments and deciding on treatment plans. P9:“The doctor would ask about financial pressure, but never mentioned the time spent. However, when I make choices, I do consider the time factor and want to make it as convenient as possible.” Discussion This study employed a phenomenological qualitative approach to explore the perspectives and coping strategies of advanced cancer patients and family caregivers regarding current experiences of time toxicity. The findings indicate that the majority of cancer patients and their caregivers perceived sources of time toxicity, which exerted multifaceted negative impacts on their physical, psychological, and social well-being. Furthermore, they adopted both individual-level strategies and external support-seeking approaches to cope with the cascading effects of time toxicity. Crucially, healthcare professionals should promptly identify the experience of time toxicity in cancer patients, thoroughly consider patients' temporal needs and preferences, and subsequently provide adequate support to mitigate its detrimental effects. Cancer patients and their caregivers report significant complexities in participating in frequent ambulatory appointments, encompassing challenges such as transportation, parking, and difficulties in securing appointments. These time and financial burdens are particularly pronounced for those residing in remote rural areas. In China's densely populated urban areas, heavy traffic congestion exacerbates transportation and parking challenges[25]. Unlike in developed countries, valet parking services are scarcely available across most regions in China[26]. Furthermore, over 60 minutes of travel time to medical facilities is common for the majority of patients, further escalating time-related costs. Therefore, enhancing infrastructure development—including dedicated green channels and valet parking services for patients—is critical to reducing healthcare access barriers[27]. Whitaker emphasized that early cancer diagnosis is crucial, as compared to patients diagnosed at an early stage, incurable advanced-stage cancer patients typically require treatment regimens that are more time-consuming, costly, and procedurally complex[28]. National and medical institutional authorities should prioritize the development of practical and actionable screening, early diagnosis, and treatment protocols for high-risk populations[29,30]. This includes establishing a more robust cancer screening network system, integrating high-incidence cancer screenings into government-led public welfare initiatives or public health service programs, and regularly providing free cancer screening examinations to high-risk groups[31]. Such measures would effectively prevent disease progression to advanced stages, thereby avoiding unnecessary medical resource depletion and alleviating the therapeutic burden on patients. For patients with advanced cancer, time represents a finite resource that can be further diminished by the cumulative burden of therapeutic interventions. Healthcare institutions should strengthen collaboration and coordination to enhance the efficiency and service precision of the healthcare system through innovative clinical pathways or by promoting the reform of medical service delivery models[32]. Our qualitative findings in this article demonstrate concordance with published literature on cancer-related time-related toxicity among cancer patient survivors[33]. Participants acknowledged the necessity of certain time expenditures in cancer care and treatment, but highlighted that some therapeutic time investments were non-beneficial[10,34]. These time burdens exerted adverse effects on advanced cancer patients undergoing multiple treatment modalities, manifesting as adverse emotional experiences (anxiety, helplessness, guilt), disrupted daily rhythms, challenges in maintaining work-life balance, forced discontinuation of social engagements and decreased treatment adherence, along with consequent feelings of isolation and loss of autonomy. It is worth noting that these time burdens extend to friends and family, they face substantial unanticipated challenges across multidimensional domains encompassing physical, psychological, and social well-being, this is consistent with the perspective of Thana et al[35]. Healthcare professionals in oncology departments should dynamically assess and monitor time toxicity in both patients and caregivers, actively listen to their emotional needs and sources of time pressure, and implement tailored intervention plans. This can be achieved by coordinating examination and care schedules, optimizing medical and nursing workflows through enhanced clinical pathways, and providing psychosocial interventions such as cognitive behavioral therapy (CBT) or psychological counseling to deliver both emotional support and practical assistance[36,37]. These measures are crucial for alleviating treatment-related temporal burdens, helping individuals cope with the psychological impacts of time toxicity, and ultimately reducing psychosocial distress during cancer care. In this study, we found that cancer patients and their caregivers adopt proactive coping strategies to address time toxicity. Cancer patients actively engage in self-perception adjustment and behavioral adaptation to mitigate the negative emotions caused by time toxicity, thereby rebuilding confidence and hope in social life. Meanwhile, caregivers alleviate their temporal and financial burdens by developing essential caregiving skills to reduce unnecessary hospitalizations. Additionally, both patients and caregivers utilize telemedicine to lower healthcare-related costs, which aligns with Brown's study suggesting that telemedicine effectively reduces travel[38], accommodation, and financial expenditures, particularly in rural areas, by bridging gaps in unequal healthcare resource distribution and saving time costs[39]. Furthermore, governments and healthcare institutions should collaborate closely to establish and improve a hospital-family-community multi-level social support system, providing sustainable assistance and support for them[40]. Findings demonstrate that cancer patients desire proactive engagement with healthcare professionals to comprehend time commitments associated with treatment regimens and obtain professional support. Insufficient communication and coordination among healthcare providers lead to inaccuracies in information transfer, resulting in unnecessary treatments and outpatient appointments. With the continuous evolution of oncology care, oncology nurse specialists play a pivotal mediating role in clinician-patient interactions through their nuanced understanding of patient experiences and distinct positioning within healthcare teams. By collaborating with interdisciplinary teams, these nurses provide cancer patients and caregivers with information counseling and communication liaison services, while implementing systemic healthcare reforms to deliver streamlined, continuous, and accessible care plans that minimize temporal burdens[41]. Furthermore, our study reveals that time burden serves as a critical factor in patients' and caregivers' selection of treatment options. However, healthcare providers tend to prioritize financial toxicity while overlooking the potential impact of time toxicity[42]. Oncologists and nursing staff should actively listen to patients' perspectives, engage in regular goal-oriented dialogues, and develop personalized treatment schedules to ensure alignment with patients' values, personal preferences, and life goals. Additionally, oncologists should provide comprehensive estimates of overall time expenditure based on different treatment protocols and patients' travel time. They can use visual tools to design tailored temporal roadmaps taht could help patients intuitively understand time allocation strategies, thereby facilitating more informed medical and caregiving decisions[43]. Limitation This study has several limitations. First, the heterogeneity of cancer types and treatment regimens may limit the generalizability of the findings, and the sample may not be fully representative. Second, the interview results were based on self-reported data from cancer patients and caregivers, which are subject to recall bias regarding the treatment process. Consequently, this study may carry potential subjectivity and bias. Future research should further focus on expanding the thematic scope and geographical coverage by incorporating perspectives from diverse regions and multiple stakeholders, including healthcare professionals, patients, and family caregivers. Furthermore, longitudinal qualitative studies should be conducted to explore temporal toxicity variations across different phases of patient care (diagnosis, treatment, and post-discharge periods), which could inform the development of personalized clinical interventions. Conclusion In conclusion, reducing time toxicity associated with cancer treatment and care is essential for improving disease outcomes and quality of life in cancer survivors, particularly those with incurable advanced malignancies. Understanding the experiences of time toxicity among cancer patients and their caregivers, as well as their corresponding coping strategies, will facilitate the development and refinement of healthcare policies that prioritize time burden mitigation and reduce its adverse impacts. Future research should prioritize patient-centered time needs and preferences to develop effective interventions and provide personalized support for this population to mitigate the effects of time toxicity. Declarations Acknowledgments We would like to thank all participants for their effort and time. Authors’ contributions Conceptualization and Methodology: Jie Jing, Mohan Li, and Ling Yuan; Data Acquisition and Investigation: Jie Jing, Mohan Li, Yehao Rui Data curation and Resources: Jie Jing, Mohan Li, Qiuchen Zhu, Danruo Wang Formal analysis: Jie Jing, Mohan Li, Qiuchen Zhu Funding acquisition: Ling Yuan, Danruo Wang Writing - original draft: Jie Jing, Mohan Li, Ling Yuan, Qiuchen Zhu Funding This work was supported by “Research project on Fine Management and Evaluation of Public Hospitals”（NIHA23JXH020） Data availability The dataset analyzed in this study is available upon reasonable request from the corresponding author during the submission process or after publication. The data are not publicly accessible due to confidentiality concerns associated with the qualitative data. Ethics approval All methods used in this study involving participants and data analysis were conducted in accordance with the Declaration of Helsinki and its future amendments. This research was approved by the Medical Ethics Committee of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. (No. 2023-047-01). The authors highlighted the assurance of maintaining participants’ confidentiality and anonymity. Consent to participate Prior to executing written informed consent, all participants (or their caregivers) underwent comprehensive protocol disclosure detailing the study objectives and procedures. Consent for publication All authors reviewed the manuscript and approved the final version submitted for publication. Conflict of interest The authors declare no competing interests. References Agrawal NY, Thawani R, Edmondson CP, Chen EY (2023) Estimating the Time Toxicit y of Contemporary Systemic Treatment Regimens for Advanced Esophageal and Gastric Cancers. Cancers (Basel) , 15(23). 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Araie H, Seki T, Okada A, Yamauchi T, Nangaku M, Kadowaki T, Ohe K, Yamauchi T, Yamaguchi S (2025) Temporal trends in time toxicity of R-CHOP: a nationwide hospital -based database analysis in Japan. Support Care Cancer 33: 293. Gupta A, Brundage MD, Galica J, Karim S, Koven R, Ng TL, O'Donnell J, tenHove J, Robinson A, Booth CM (2024) Patients' considerations of time toxicity when assessing c ancer treatments with marginal benefit. Oncologist 29: 978-985. Banerjee R, Cowan AJ, Ortega M, Missimer C, Carpenter PA, Oshima MU, Salit RB, Vo PT, Lee CJ, Mehta RS, Kuderer NM, Shankaran V, Lee SJ, Su CT (2024) Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma. Clin Lymphoma Mye loma Leuk 24: 446-454.e443. Hall ET, Sridhar D, Singhal S, Fardeen T, Lahijani S, Trivedi R, Gray C, Schapira L (2021) Perceptions of time spent pursuing cancer care among patients, caregivers, and oncology professionals. Support Care Cancer 29: 2493-2500. Bange EM, Lin JK (2025) Time Toxicity of Clinical Trials-Better Than Feared. JAMA Netw Open 8: e255044. Katikaneni PS, Joung B, Jeon WJ, Agrawal N, Chitkara A, Thawani R (2025) HSR25- 147: Time Toxicity of Different Frontline Regimens in EGFR Mutated Non-Small Cell Lung Cancer. J Natl Compr Canc Netw 23. Gupta A, Eisenhauer EA, Booth CM (2022) The Time Toxicity of Cancer Treatment. J Clin Oncol 40: 1611-1615. Johnson WV, Phung QH, Patel VR, Tsai AK, Arora N, Klein MA, Westanmo AD, Bla es AH, Gupta A (2024) Trajectory of Healthcare Contact Days for Veterans With Advan ced Gastrointestinal Malignancy. Oncologist 29: e290-e293. Ording AG, Skjøth F, Poulsen L, Szejniuk WM, Jakobsen E, Christensen TD, Noble S, Overvad TF (2024) Time Toxicity of Systemic Anticancer Therapy for Metastatic Lung Cancer in Routine Clinical Practice: A Nationwide Cohort Study. JCO Oncol Pract: Op2 400526. Gupta A, Nguyen P, Wilson BE, Booth CM, Hanna TP (2025) Health Care Contact D ays and Outcomes in Clinical Trials vs Routine Care Among Patients With Non-Small Cell Lung Cancer. JAMA Netw Open 8: e255033. Baltussen JC, Cárdenas-Reyes P, Chavarri-Guerra Y, Ramirez-Fontes A, Morales-Alfaro A, Portielje JEA, Ramos-Lopez WA, Rosado-Canto V, Soto-Perez-de-Celis E (2024) Ti me toxicity among older patients with cancer treated with palliative systemic therapy. Su pport Care Cancer 32: 621. Sekar P, Johnson WV, George M, Breininger A, Parsons HM, Vogel RI, Blaes AH, G upta A (2025) \"The biggest challenge is there's never a routine\": a qualitative study of t he time burdens of cancer care at home. Support Care Cancer 33: 80. Atre SY, Soulos PR, Kuderer NM, Gross CP, Baum LVM, Dinan MA, Lustberg MB (2024) Characterization of time toxicity in older patients with metastatic breast cancer. Breast Cancer Res Treat 207: 541-550. Sentana-Lledo D, Morgans AK (2024) Time's up: the urgency to investigate time toxic ity in patients with genitourinary malignancies. Ther Adv Med Oncol 16: 175883592413 05088. Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative rese arch (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19: 349-357. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K (2015) Purp oseful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implemen tation Research. Adm Policy Ment Health 42: 533-544. Liu M (2019) Using an example to illustrate Colaizzi’s phenomenological data analysis method. J Nurs Sci 34(11):90–92 (In Chinese). O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA (2014) Standards for reporti ng qualitative research: a synthesis of recommendations. Acad Med 89: 1245-1251. Zhen Chen, Jing Yang (2024) Urban Parking Space Shortage Dilemma: A Simulation Study on Formation Mechanisms and Guiding Strategies. Journal of Chongqing Universit y of Technology(38): 236-245. Premnath N, Grewal US, Gupta A (2020) Park the Parking. JCO Oncol Pract 16: 215- 217 (In Chinese). Wangyi Chun, Ming Li, Linning Han (2024) Study on the Evaluation Index System a nd Parking Index of Urban Parking Systems. Modern Urban Research: 114-118(In Chine se). Whitaker K (2020) Earlier diagnosis: the importance of cancer symptoms. Lancet Onco l 21: 6-8 Rassy E, Mosele MF, Di Meglio A, Pistilli B, Andre F (2024) Precision oncology in patients with breast cancer: towards a 'screen and characterize' approach. ESMO Open 9: 103716. Robbins HA, Cheung LC, Chaturvedi AK, Baldwin DR, Berg CD, Katki HA (2022) Management of Lung Cancer Screening Results Based on Individual Prediction of Curre nt and Future Lung Cancer Risks. J Thorac Oncol 17: 252-263. Fathi JT, Barry AM, Greenberg GM, Henschke CI, Kazerooni EA, Kim JJ, Mazzone PJ, Mulshine JL, Pyenson BS, Shockney LD, Smith RA, Wiener RS, White CS, Thoms on CC (2024) The American Cancer Society National Lung Cancer Roundtable strategic plan: Implementation of high-quality lung cancer screening. Cancer 130: 3961-3972. Espinoza MA, Zamorano P, Zuñiga-San Martin C, Taramasco C, Martinez F, Becerra S, Letelier MJ, Armijo N (2025) Improving Efficiency in Healthcare: Lessons from Succ essful Health Policies in Chile. Arch Med Res 56: 103105. Gupta A, Johnson WV, Henderson NL, Ogunleye OO, Sekar P, George M, Breininger A, Kyle MA, Booth CM, Hanna TP, Rocque GB, Parsons HM, Vogel RI, Blaes AH (20 24) Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care. JAMA Netw Open 7: e2447649. Koo Y, Kim E, Jo Y, Nam I (2023) Patient Experience Factors and Implications for I mprovement Based on the Treatment Journey of Patients with Head and Neck Cancer. Cancers (Basel) 15. Thana K, Lehto R, Sikorskii A, Wyatt G (2021) Informal caregiver burden for solid t umour cancer patients: a review and future directions. Psychol Health 36: 1514-1535. Petre I, Barna F, Gurgus D, Tomescu LC, Apostol A, Petre I, Furau C, Năchescu ML, Bordianu A (2023) Analysis of the Healthcare System in Romania: A Brief Review. Hea lthcare (Basel) 11. Nakao M, Shirotsuki K, Sugaya N (2021) Cognitive-behavioral therapy for managemen t of mental health and stress-related disorders: Recent advances in techniques and techno logies. Biopsychosoc Med 15: 16. Brown E, Fisher GA, Jr., Shelton A, Chang DT, Pollom E (2024) Advancing clinical t rial equity through integration of telehealth and decentralized treatment. JNCI Cancer Sp ectr 8. Johnson WV, Blaes AH, Booth CM, Ganguli I, Gupta A (2023) The unequal burden o f time toxicity Trends. Cancer 9: 373-375. Wilson BE, Hanna TP, Booth CM (2024) Efficacy-effectiveness gaps in oncology: Loo king beyond survival. Cancer 130: 335-338. Quinn PL, Saiyed S, Hannon C, Sarna A, Waterman BL, Cloyd JM, Spriggs R, Rush LJ, McAlearney AS, Ejaz A (2024) Reporting time toxicity in prospective cancer clinical trials: A scoping review. Support Care Cancer 32: 275. Wieringa TH, León-García M, Espinoza Suárez NR, Hernández-Leal MJ, Jacome CS, Zisman-Ilani Y, Otten RHJ, Montori VM, Pieterse AH (2024) The role of time in invol ving patients with cancer in treatment decision making: A scoping review. Patient Educ Couns 125: 108285. Wörns MA, Burns D, Paskow M, Makin H, Miller J, Turner LM, Sah J (2024) Patie nt Experience of Hepatocellular Carcinoma and Their Treatment Goals: An International Qualitative Study and Patient Journey Map. Adv Ther 41: 3598-361. Additional Declarations No competing interests reported. Supplementary Files Supplement1.docx Supplement2.docx Cite Share Download PDF Status: Published Journal Publication published 18 Sep, 2025 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 12 Aug, 2025 Reviews received at journal 12 Aug, 2025 Reviewers agreed at journal 21 Jul, 2025 Reviews received at journal 06 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers invited by journal 27 May, 2025 Editor assigned by journal 27 May, 2025 Submission checks completed at journal 28 Apr, 2025 First submitted to journal 20 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jie\",\"middleName\":\"\",\"lastName\":\"Jing\",\"suffix\":\"\"},{\"id\":462730489,\"identity\":\"c637ffbf-4f0c-4054-ba14-2c766c8496a5\",\"order_by\":1,\"name\":\"Mohan Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Drum Tower Hospital, Medical School of Nanjing University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mohan\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":462730490,\"identity\":\"8f6510ad-707b-4135-ab62-4699bfa44ac3\",\"order_by\":2,\"name\":\"Yehao Rui\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Zhongda Hospital, School of Medicine of Southeast University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yehao\",\"middleName\":\"\",\"lastName\":\"Rui\",\"suffix\":\"\"},{\"id\":462730491,\"identity\":\"e53e46c7-995d-499b-ab05-5cc7a34de0e4\",\"order_by\":3,\"name\":\"Danruo Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Drum Tower Hospital, Medical School of Nanjing University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Danruo\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":462730492,\"identity\":\"b2ee4a8e-cef5-4365-a02e-2e1fad7894b0\",\"order_by\":4,\"name\":\"Qiuchen Zhu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nanjing University Of Chinese Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Qiuchen\",\"middleName\":\"\",\"lastName\":\"Zhu\",\"suffix\":\"\"},{\"id\":462730493,\"identity\":\"a2d1fb56-4f14-4027-914c-eb17a4633d84\",\"order_by\":5,\"name\":\"Ling Yuan\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYLCCBwYMDPwMDAlAJjORWhKAWiQbSNMCxAYHwEwitBjcSH72IKHgjt3m2w3PJBgqrBMb2M8eIKAlzdwgweBZ8rY7B9IkGM6kJzbw5CUQ0JJgJpFgcDjZ7EZCmgRj2+HEBgkeAwJa0r+BtRjPAGn5R5SWHLAtdgYSIC0NRGiRPPOmDKQlQeJGQrJFwrF04zaeHPxa+I6nb5P48OewPf+MnMQbH2qsZfvZz+DXonAAQic2MPAkgCOIDa96IJBvgND2DAzsBwgpHgWjYBSMghEKANyBSHb0d9JaAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Affiliated Drum Tower Hospital, Medical School of Nanjing University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Ling\",\"middleName\":\"\",\"lastName\":\"Yuan\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-04-20 15:53:10\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6490205/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6490205/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1007/s00520-025-09904-w\",\"type\":\"published\",\"date\":\"2025-09-18T15:57:31+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":91889878,\"identity\":\"b182736c-a2e7-4cdc-89bc-81bd284a958f\",\"added_by\":\"auto\",\"created_at\":\"2025-09-22 16:03:07\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":613140,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6490205/v1/c79738a8-5346-475d-8b46-2555aa984cd8.pdf\"},{\"id\":83618557,\"identity\":\"b9ceca48-3722-4e84-98a4-e31bf34f824c\",\"added_by\":\"auto\",\"created_at\":\"2025-05-29 14:25:16\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":16006,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplement1.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6490205/v1/e7cf0d2d55e7df53684a7feb.docx\"},{\"id\":83618556,\"identity\":\"824f8fd0-01be-4cb4-b697-aaa6d333a924\",\"added_by\":\"auto\",\"created_at\":\"2025-05-29 14:25:16\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":14749,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplement2.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6490205/v1/b5599e8fa50b98b3de03c87b.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"The Weight of Time: Experience of time toxicity among advanced cancer patients and their family caregivers: A qualitative study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eWith the increase of treatment options for cancer patients, particularly the advent of immunotherapies and targeted therapies, the treatment of cancer patients is more complex and longer lasting, which leads to the need for patients to invest a lot of time in the treatment process, imposing negative impact on time and quality of life of patients[1,2]. While physical and psychological adverse events are commonly the primary endpoints in routine oncology care assessment[3], an important understudied outcome that should also be taken into account is treatment-related time toxicity[4]. Time toxicity has been defined as the large amount of time consumed by cancer patients during treatment due to frequent medical appointments, treatment, and their subsequent recovery[5,6]. Approximately 20-30% of the remaining lifespan in individuals diagnosed with advanced-stage solid malignancies is allocated to clinical engagements[7]. While certain therapeutic interventions may confer modest survival advantages, these benefits could be negated by treatment-related time burdens[8]. Notably, heightened time expenditure within healthcare systems correlates with diminished quality-of-life metrics[9,10].\\u003c/p\\u003e\\n\\u003cp\\u003eAs care increasingly prioritizes adapting treatments to patients' specific objectives, there has been growing awareness within the oncology community regarding the time burdens of cancer care[11-13]. Existing research has quantified the time-related burdens associated with both undergoing cancer treatment[14-16]. It was estimated that patients with stage IV spent 1 in 3 days with healthcare contact, following a U-shaped trajectory in the percentage of days of contact over time, with higher percentages after diagnosis and at the end of life[14]. Patients with metastatic lung cancer accumulated 56 days of in-person healthcare visits during the first year of survival following anticancer therapy initiation[15]. The time burden of clinical engagements may paradoxically diminish the perceived benefit of survival gains, as treatment-related time commitments can compromise the quality of extended life[17]. In addition, in the process of cancer treatment, the caregivers of cancer patients need to sacrifice their personal time to help patients make appointments, visit doctors, travel, medical examinations, and other care services, which has a negative impact on the quality of life of caregivers[18,19].\\u003c/p\\u003e\\n\\u003cp\\u003eMost of the existing studies focus on the management of physical symptoms or psychological pain of cancer patients, and there is a lack of attention to the subjective experience of time toxicity[20]. Although quantitative research can count the \\\"amount\\\" of time investment, it is difficult to reveal the perception, emotional response, and adaptive strategy of patients to time burden. To get a full view of time toxicity, a qualitative approach was used to explore the sources, populations affected, and consequences of time toxicity through the lens of advanced cancer patients and their caregivers.\\u003c/p\\u003e\"},{\"header\":\"Methods \",\"content\":\"\\u003cp\\u003eParticipants, Recruitment, and Setting\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants were recruited using purposeful sampling at a comprehensive hospital and a Community hospital in Jiangsu Province, China. Included participants were cancer patients undergoing treatment, over the age of 18 who could speak Chinese, and volunteered. Patients with psychiatric problems who are unable to communicate properly are excluded from this survey. Based on our study design, we explicitly stated in the recruitment announcement that this interview would not cause any harm to participants other than consuming 30-60 minutes. Oncology nurse leaders are very knowledgeable about their patients and can provide guidance to the research team to help us choose more appropriate subjects for the study. The first author contacted the oncology nurse managers at both institutions. They were asked to help distribute recruitment information. Oncology nurse leaders possess specialized insights into patient profiles, enabling them to enhance methodological rigor through targeted participant selection guidance. The research team initiated collaboration by contacting nurse managers at both institutions, who subsequently facilitated the dissemination of recruitment materials.\\u003c/p\\u003e\\n\\u003cp\\u003eWe conducted interviews in the Separate office of the host hospital between October 2024 and February 2025. This study was approved by the Medical Ethics Committee of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. (No. 2023-047-01). \\u0026nbsp;During the research process, the participants were always guaranteed to participate in the study voluntarily, and the participants could withdraw from the study at any time. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline[21].\\u003c/p\\u003e\\n\\u003cp\\u003eInterviews\\u003c/p\\u003e\\n\\u003cp\\u003eAn interdisciplinary study team, including Clinical Nurse Specialists, clinicians, and qualitative methodology experts, created interview guides for patients and caregivers after a literature review(The detailed interview guideline can be found in Supplement 1). We sampled 10-20 participants, and when the content of the interviews no longer appeared new topics, it was judged that the information was saturated and the interviews were terminated[22].\\u0026nbsp;Prior to the formal interview, participants were required to complete a general information questionnaire（Supplement 2).\\u0026nbsp;The interviews were conducted in a private room situated within a hospital office environment, with the specific location being determined by each participant\\u0026apos;s preference, and each participant engaged in a face-to-face in-depth semi-structuredinterview session lasting between 30 and 60 minutes to ensure comprehensive data collection while maintaining methodological consistency across all research subjects. Both quantitative and qualitative data were collected during the interview process. Two researchers conducted face-to-face interviews with the interviewees: both Li Mohan and Jing Jie are graduate nursing students trained in qualitative research, and both have many years of experience in qualitative research. Both researchers in the interviews, all of were conducted in the presence of only two researchers and one interviewee, with Li Mohan acting as the interviewer and guiding the interviews. Jing Jie was the recorder and observer, responsible for observing whether the conversation was off-topic and recording the talking points. All interviews were audio-recorded with the consent of the interviewees. Eventually all 16 participants were interviewed in full and no one dropped out.\\u003c/p\\u003e\\n\\u003cp\\u003eData analysis\\u003c/p\\u003e\\n\\u003cp\\u003eThe obtained data were analyzed using Colaizzi\\u0026rsquo;s phenomenological analysis[23]. Following the Standards for Reporting Qualitative Research (SRQR) guidelines, we implementedrigorous reporting protocols to ensure methodological transparency[24]. The audio recordings of the interviews were transcribed by one researcher and another researcher checked the accuracy of the transcription within 24 hours. The two researchers coded the datausing NVivo, version 15(Lumivero), and merged them into a shared codebook. We had regular discussions together to identify themes and sub-themes and map their relationships. The codes and themes were continuously refined until a consensus was reached.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eParticipant characteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOn the whole, 12 cancer patients and 6\\u0026nbsp;caregivers from the Oncology ward signed the consent and participated in this study.\\u0026nbsp;All of them Interviewed for 30-60 minutes.\\u0026nbsp;Of these 12\\u0026nbsp;patients,\\u0026nbsp;7\\u0026nbsp;were aged 60\\u0026nbsp;years or older;\\u0026nbsp;6\\u0026nbsp;were female and 6 were male.\\u0026nbsp;Three had colon cancer, three had gastric\\u0026nbsp;cancer,\\u0026nbsp;two had Rectal cancer, one had lung cancer, one had liver cancer, one had Breast cancer and one had pancreatic cancer.\\u003c/p\\u003e\\n\\u003cp\\u003eThe mean age of the included participants was 57（\\u0026plusmn;12）years old, and only one was unmarried. Among them,73% lived in rural and the average travel time to the hospital was 84(\\u0026plusmn;60) minutes. They and their caregivers come to the hospital once every 15（\\u0026plusmn;6）days on average. Detailed demographic and clinical characteristics of the participants can be seen in Table 1.\\u003c/p\\u003e\\n\\u003cp\\u003eTable 1: The demographic and clinical characteristics of the participants (n\\u0026thinsp;=\\u0026thinsp;18)\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"784\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003cp\\u003e(years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eSex\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eResidency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarital\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003estatus\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eEducational background\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eCancer type\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eTreatment options\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003eTravel time\\u003c/p\\u003e\\n \\u003cp\\u003e(Minutes)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003eFrequency of hospital admission(days)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eBreast cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eUniversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eColon cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eUniversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eColon cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eRectal cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eRectal cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003ePrimary\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eGastric cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eGastric cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eUniversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003ePancreatic cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eChemotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eColon cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eGastric cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003ePrimary\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eLiver cancer\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eP12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e74\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003ePrimary\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eLung cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eChemotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eC13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eC14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003ePrimary\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eC15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eUnmarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eUniversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e240\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eC16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eC17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003eUniversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42px;\\\"\\u003e\\n \\u003cp\\u003eC18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003ePrimary\\u003c/p\\u003e\\n \\u003cp\\u003eschool\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 86px;\\\"\\u003e\\n \\u003cp\\u003e70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eQualitative findings\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThematic analysis revealed 5 themes, (1) The experience of time toxicity stems from multi-dimensional contributing factors; (2)Time Toxicity has multiple negative impacts on patients and caregivers; (3) Strategies for coping with time toxicity in cancer patients and caregivers; (4) Clinical needs and expectations of cancer patients and caregivers regarding time burden.\\u003c/p\\u003e\\n\\u003cp\\u003eTheme 1: The experience of time toxicity stems from multi-dimensional contributing factors.\\u003c/p\\u003e\\n\\u003cp\\u003eThe complexity of ambulatory appointment procedures contributes to time burden\\u003c/p\\u003e\\n\\u003cp\\u003e(1) From the interview, It is known that cancer patients and their caregivers spend a lot of time traveling for ambulatory appointments, and this is especially bad in rural areas.\\u003c/p\\u003e\\n\\u003cp\\u003eP4:\\u0026ldquo;The whole process of my ambulatory appointment was inconvenient, we traveled from far away and had to drive to the hospital from 4:00 in the morning.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eC15:\\u0026ldquo;We live in a remote rural area that can be costly in terms of time and money.Ambulatory appointment consumes a lot of time.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP7:\\u0026ldquo;Looking back on the day I went from here to there, getting tests and going to the hospital, I think it was a huge waste of time.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e(2) In China\\u0026apos;s healthcare environment, medical resources in higher-level hospitals are not enough, often resulting in the phenomenon of \\u0026ldquo;hard to find a bed\\u0026rdquo; and a relative lack of medical equipment, which leads to patients traveling between hospitals and their homes and even spending the night in facilities, creating logistical burdens for the patients.\\u003c/p\\u003e\\n\\u003cp\\u003eP4:\\u0026ldquo;When I first came here I didn\\u0026apos;t realize it was so difficult to park here, it took me 2.5 hours to get my car in and that\\u0026apos;s not an exaggeration, it\\u0026apos;s really awful.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP12:\\u0026ldquo;Each time we drive to the hospital, passing through in the center of town is very congested and this wait is too long.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP8:\\u0026ldquo;Hospitals in Shanghai are more specialized, so I went there to seek treatment, but there were no beds, and we ended up going back to our hometown, which was a torturous process.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e(3) Patients consistently report difficulty in parking due to traffic congestion on the city\\u0026apos;s roads and a severe lack of infrastructure such as parking spaces.\\u003c/p\\u003e\\n\\u003cp\\u003eP1:\\u0026ldquo;It just doesn\\u0026apos;t have a hospital bed for me, it\\u0026apos;s too lacking. There\\u0026apos;s no way to do anything but spend time waiting.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eC13:\\u0026ldquo;Now that these beds are in short supply and we can\\u0026apos;t apply for award. We take him to the hospital for an infusion every day, and then we go home, for over a month.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eCancer is a complex procedure to diagnose and treat, adding to time burden.\\u003c/p\\u003e\\n\\u003cp\\u003e（1）Early diagnosis and decision-making on treatment options for cancer patients require the participation of patients, their families, and physicians, and repeated multidisciplinary consultations impose a time burden。\\u003c/p\\u003e\\n\\u003cp\\u003eP1:\\u0026ldquo;I think the process of getting a diagnosis of cancer is the biggest waste of time.how many times you need a doctor\\u0026apos;s consultation, how many times you need to do all kinds of screening. My gosh, it\\u0026apos;s really painful.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eC15:\\u0026ldquo;My father\\u0026apos;s case is so complicated that there were many consultations in the first place and it took a long time. Is there a more convenient way?\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e（2）Cancer patients due to untimely early screening and uncertainty in diagnosis, delay their optimal treatment time and make advanced cancer patients spend more time on treatment.\\u003c/p\\u003e\\n\\u003cp\\u003eC14:\\u0026ldquo;He felt sick in his chest, then i accompanied him to the hospital for screening but it was not found the laryngeal cancer. If it had been diagnosed earlier, we wouldn\\u0026apos;t have had to spend so much time on treatment.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eTime burden associated with cancer treatment and screening\\u0026nbsp;Cancer patients perceive time and energy as being consumed by treatment infusions, queuing for outpatient appointments, waiting for elevators, and untimely discharges with medications during treatment and examinations. Further time burdens are placed on the patient if post-test indicators do not meet the indications for medication.\\u003c/p\\u003e\\n\\u003cp\\u003eC16:\\u0026ldquo;The patient needs to be with me all the time while the infusion is going on. What\\u0026apos;s even more hopeless is that I have to accept that the size of the bag of medicine can\\u0026apos;t be changed and the speed of the infusion can\\u0026apos;t be changed.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP3:\\u0026ldquo;I find this really time-consuming: every time I go to line up for an appointment for an investigation. Once it even took three days to get in line for an MRI.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP11:\\u0026ldquo;When I was in the hospital for a screening, I needed to take the elevator because I was weak due to my illness. But elevators were full of people queuing up and the going up and down was slow.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP9:\\u0026ldquo;The pharmacy is not consistent in dispensing medications. When I was ready to be discharged, I could not leave if my medication was not available in the morning. It made my discharge a little more of a wait.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP2:\\u0026ldquo;My tumor markers keep going up, so I can\\u0026apos;t get chemotherapy.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eHealthcare system-related impacts\\u003c/p\\u003e\\n\\u003cp\\u003e(1) Cancer patients do not trust the standard of care in primary hospitals. They spend more time going to higher-level hospitals rather than wanting to receive care and treatment closer to home. Some patients are skeptical of remote visits and opt for more time-consuming face-to-face visits.\\u003c/p\\u003e\\n\\u003cp\\u003eP4:\\u0026ldquo;I came here for a lab test because I don\\u0026apos;t really trust the equipment or test results in my hometown. I know it\\u0026apos;s a waste of time but it has to be done.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP4:\\u0026ldquo;I don\\u0026apos;t trust telemedicine enough. Please don\\u0026apos;t consider my time, I think face-to-face diagnosis and treatment needs would be more careful.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e(2) Day clinics in most hospitals are closed on weekends, delaying the timing and availability of patient care. Especially for patients returning to work, who often have sufficient time to receive treatment only on weekends.\\u003c/p\\u003e\\n\\u003cp\\u003eP9:\\u0026ldquo;The hospital\\u0026apos;s day clinic is closed. It\\u0026apos;s going to be postponed until Monday, and this two-day window creates a sense of uncertainty for us, and we will always think that time is more pressing.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP10:\\u0026ldquo;I mainly want to be able to use the medication on Saturday and Sunday as well, so that I don\\u0026apos;t have to wait until Monday to get it done. For a portion of the workforceweekends may be the only ones that will be free and will have time to deal with a sickrelative.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e(3) The irrational layout of some hospitals and the lack of coordination among medical institutions have caused much inconvenience to cancer patients.\\u003c/p\\u003e\\n\\u003cp\\u003eP3:\\u0026ldquo;The layout of this hospital was very inconvenient for us, their pharmacy was in this building but the admission and discharge procedure was in another, although not far away, it took time to walk there each time, plus I was not feeling well, which was very unreasonable.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eLack of effective communication and bias in transmitting information between healthcare professionals, resulting in more time burden\\u003c/p\\u003e\\n\\u003cp\\u003eC16:\\u0026ldquo;The doctor may be too busy, I often can\\u0026apos;t find him in the ward, many times I need to show the doctor after the test report to further determine the treatment plan, but often I can\\u0026apos;t contact him, this is very consuming my time.\\u0026rdquo;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eP3:\\u0026ldquo;Once, I went to queue up for a test, and it was supposed to be a 20-minute affair, but due to a lack of communication between the medical personnel, they got my number plate wrong, resulting in me waiting for almost two hours and I didn\\u0026apos;t eat. I was really angry at that time.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eTheme 2: Time Toxicity has multiple negative impacts on patients and caregivers\\u003c/p\\u003e\\n\\u003cp\\u003eTime burden creates adverse mood swings for patients The burden associated with the timing of treatment for cancer patients can cause a range of adverse emotions. For example, anxiety and feelings of helplessness about scheduling appointments for checks or waiting for the results of treatment, feelings of guilt about not being able to take care of family responsibilities due to time conflicts, and feelings of uncertainty and fear.\\u003c/p\\u003e\\n\\u003cp\\u003eP4:\\u0026ldquo;I want to know the lab results report early every time, what exactly is the nature of this tumor? The waiting process makes me worried and anxious.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eC17:\\u0026ldquo;The last time we came in for an MRI, we waited close to three hours, and there was no way around it.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP3:\\u0026ldquo;When my child needs me to participate and accompany him to school, I feel a bit sad and guilty because I don\\u0026apos;t have time to accompany him/her due to treatment.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP10:\\u0026ldquo;There is still psychological pressure: it invisibly adds a sense of uncertainty and fear about time to you.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eThe patients\\u0026apos; life rhythm is disrupted, making it difficult to achieve social reintegration\\u0026nbsp;Cancer patients perceive very different time expenditures before and after anti-cancer treatment. Repeated radiation or chemotherapy treatments fill the patient\\u0026apos;s survival time,making it difficult to balance family and work, and forcing the patient to give up hobbiesand social activities.\\u003c/p\\u003e\\n\\u003cp\\u003eP2: \\u0026ldquo;Before my treatment, I was able to do chores and work, but now I don\\u0026apos;t have time to take care of things, It\\u0026apos;s painful!\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP6: \\u0026ldquo;Oh my god, my life is completely different now! I don\\u0026apos;t have time to play football or go to the gym anymore, let alone communicate with my former trainer and have coffee. My time is occupied by endless treatments...\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eSignificantly lower treatment adherence in cancer patients\\u0026nbsp;Partial cancer patients perceive the time and financial costs of treatment and screening. They tend to abandon treatment programs or undergo treatment in stages to enjoy the remaining time of survival.\\u003c/p\\u003e\\n\\u003cp\\u003eP5:\\u0026ldquo;I can\\u0026apos;t afford the money and time this treatment costs. I\\u0026apos;m already in an advanced stage, I want to spend the rest of my time with my family or traveling, so I don\\u0026apos;t really want to go to chemotherapy or radiation therapy.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eCaregivers are impaired in multiple dimensions, including physically, psychologically, and socially\\u003c/p\\u003e\\n\\u003cp\\u003e（1）The loss of self-care ability in cancer patients after treatment leads to a dramatic increase in the demand for care time. The majority of patients emphasize that the time burden of cancer is not only a negative experience for themselves, but also leads to impaired levels of physical and mental health, work limitations, and disruption in the lives of caregivers.\\u003c/p\\u003e\\n\\u003cp\\u003eC18:\\u0026ldquo;It takes a lot of time out of my life to transition between the hospital and home when you\\u0026apos;re constantly running around like that. It would also have an impact on my life, most of all the mental stress.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;P10:\\u0026ldquo;He (the caregiver) is more stressed, he\\u0026apos;s feeling sick, and I asked him to go for a checkup, but he won\\u0026apos;t go in order to spend time caring for me.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP9:\\u0026ldquo;After I became ill, I had to deal with the hospital more. Since I fell ill, my daughter always has to drive for over an hour to take me to the hospital each time, which greatly affects her work.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e（2）Caregivers of cancer patients also perceive accompanying the patients for treatments and screenings as imposing a significant time burden, with what seems like brief medical procedures turning into all-day affairs.\\u003c/p\\u003e\\n\\u003cp\\u003eC17:\\u0026ldquo;Even though it took just a few hours to accompany him to the blood draws and tests, I needed a lot of preparation and I felt exhausted. The whole day was wasted.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eTheme 3: Strategies for Coping with Time Toxicity in Cancer Patients and Caregivers\\u003c/p\\u003e\\n\\u003cp\\u003eSelf-regulation at the individual level\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e（1）Cancer patients alleviate anxiety caused by time pressure by distracting themselves to fill their time expenditure; some patients regain a sense of control over their lives during the intermission of recovery from symptom burden.\\u003c/p\\u003e\\n\\u003cp\\u003eP2:\\u0026ldquo;I would read novels or watch some videos to distract myself while undergoing treatment or waiting for test results, which helps reduce the sense of wasted time.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP2:\\u0026ldquo;My treatment cycle is 14 days at a time, I schedule work for the periods when I\\u0026apos;m comfortable, and when I feel bad I choose to lie down.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e（2）Some cancer caregivers reduce the number of nonessential readmissions by learning and developing caregiving skills, thereby easing time pressures on patients and themselves.\\u003c/p\\u003e\\n\\u003cp\\u003eC13: \\u0026ldquo;Cleaning his wound is really time-consuming and I get really anxious when I don\\u0026apos;t know how to handle it at first, and we\\u0026apos;re not close enough to the hospital to come over every day, so I\\u0026apos;m learning some skills to cut down on time wasted traveling and attending appointments.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eFull utilization of medical and social resources\\u003c/p\\u003e\\n\\u003cp\\u003e（1）Some cancer patients choose to have follow-up visits and treatment at nearby hospitals, and make full use of the advantages of the internet for telemedicine or convenient Oncology Day Care Unit, thereby reducing the time spent on accessing healthcare.\\u003c/p\\u003e\\n\\u003cp\\u003eP10:\\u0026ldquo;I just do blood routine tests at home to monitor my condition. When the results are not good, I take medications and injections. Generally, after such treatment, my indicators return to normal in about two or three days, and then I proceed with further treatment. However, this also takes up a lot of my time.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP9:\\u0026ldquo;The Oncology Day Care Unit provides us with great convenience. After the infusion is completed in the morning, we can go back in the afternoon, which basically does not consume too much time. It is very convenient.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e（2）Partial cancer caregivers seek support from family, friends, or volunteers.\\u003c/p\\u003e\\n\\u003cp\\u003eC13:\\u0026ldquo;I have three sisters, when I am short of time, I will ask for their help, and they will help me share some.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eP2:\\u0026ldquo;If there is something we need help with, the volunteers will guide us on the process we need to do, help us get a number, etc... saving us time!\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eTheme\\u0026nbsp;4: Clinical Needs and Expectations of Cancer Patients and Caregivers Regarding Time Burden\\u003c/p\\u003e\\n\\u003cp\\u003eEstablishing an interactive bond\\u003c/p\\u003e\\n\\u003cp\\u003e（1）Hope to establish contact with healthcare professionals who can help answer questions related to treatment indicators and provide ongoing professional support in a timely manner.\\u003c/p\\u003e\\n\\u003cp\\u003eC15:\\u0026ldquo;Patients can travel to a higher level hospital, and once diagnosed or post-treatment, they can apply treatment options to our nearest hospital while taking advantage of the Internet. We hope that all these resources can cooperate.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e（2）Cancer patients and their caregivers hope to have a clear understanding of the treatment cycle information to reduce unnecessary time burden.\\u003c/p\\u003e\\n\\u003cp\\u003eP2:\\u0026ldquo;It bothers me every day that I\\u0026apos;m curious as to why the Cycles of chemotherapy are so short. Can\\u0026apos;t you make me come in 21 or 30 days? Which factors actually determine the efficacy of a drug?\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003eMeet patient-centered needs\\u003c/p\\u003e\\n\\u003cp\\u003e（1）Cancer patients expect healthcare professionals to take the patient\\u0026apos;s perspective. Plan their time well and provide a consistent schedule of treatments and tests.\\u003c/p\\u003e\\n\\u003cp\\u003eP4:\\u0026ldquo;The doctor\\u0026apos;s schedule is very tight. For example, I needed to fast for the enhanced CT scan. After I had my blood drawn on an empty stomach, the time arranged by the doctor was exactly what I needed. You can go for a CT scan, which makes the process less painful for the patient. This is very humane.\\u0026rdquo;\\u003c/p\\u003e\\n\\u003cp\\u003e(2) Cancer patients hope healthcare professionals can pay attention to their time burden and treatment decision preferences, taking into account the Time Toxicity when choosing appointments and deciding on treatment plans.\\u003c/p\\u003e\\n\\u003cp\\u003eP9:\\u0026ldquo;The doctor would ask about financial pressure, but never mentioned the time spent. However, when I make choices, I do consider the time factor and want to make it as convenient as possible.\\u0026rdquo;\\u003c/p\\u003e\"},{\"header\":\"Discussion \",\"content\":\"\\u003cp\\u003eThis study employed a phenomenological qualitative approach to explore the perspectives and coping strategies of advanced cancer patients and family caregivers regarding current experiences of time toxicity. The findings indicate that the majority of cancer patients and their caregivers perceived sources of time toxicity, which exerted multifaceted negative impacts on their physical, psychological, and social well-being. Furthermore, they adopted both individual-level strategies and external support-seeking approaches to cope with the cascading effects of time toxicity. Crucially, healthcare professionals should promptly identify the experience of time toxicity in cancer patients, thoroughly consider patients' temporal needs and preferences, and subsequently provide adequate support to mitigate its detrimental effects.\\u003c/p\\u003e\\n\\u003cp\\u003eCancer patients and their caregivers report significant complexities in participating in frequent ambulatory appointments, encompassing challenges such as transportation, parking, and difficulties in securing appointments. These time and financial burdens are particularly pronounced for those residing in remote rural areas. In China's densely populated urban areas, heavy traffic congestion exacerbates transportation and parking challenges[25]. Unlike in developed countries, valet parking services are scarcely available across most regions in China[26]. Furthermore, over 60 minutes of travel time to medical facilities is common for the majority of patients, further escalating time-related costs. Therefore, enhancing infrastructure development—including dedicated green channels and valet parking services for patients—is critical to reducing healthcare access barriers[27]. Whitaker emphasized that early cancer diagnosis is crucial, as compared to patients diagnosed at an early stage, incurable advanced-stage cancer patients typically require treatment regimens that are more time-consuming, costly, and procedurally complex[28]. National and medical institutional authorities should prioritize the development of practical and actionable screening, early diagnosis, and treatment protocols for high-risk populations[29,30]. This includes establishing a more robust cancer screening network system, integrating high-incidence cancer screenings into government-led public welfare initiatives or public health service programs, and regularly providing free cancer screening examinations to high-risk groups[31]. Such measures would effectively prevent disease progression to advanced stages, thereby avoiding unnecessary medical resource depletion and alleviating the therapeutic burden on patients. For patients with advanced cancer, time represents a finite resource that can be further diminished by the cumulative burden of therapeutic interventions. Healthcare institutions should strengthen collaboration and coordination to enhance the efficiency and service precision of the healthcare system through innovative clinical pathways or by promoting the reform of medical service delivery models[32].\\u003c/p\\u003e\\n\\u003cp\\u003eOur qualitative findings in this article demonstrate concordance with published literature on cancer-related time-related toxicity among cancer patient survivors[33]. Participants acknowledged the necessity of certain time expenditures in cancer care and treatment, but highlighted that some therapeutic time investments were non-beneficial[10,34]. These time burdens exerted adverse effects on advanced cancer patients undergoing multiple treatment modalities, manifesting as adverse emotional experiences (anxiety, helplessness, guilt), disrupted daily rhythms, challenges in maintaining work-life balance, forced discontinuation of social engagements and decreased treatment adherence, along with consequent feelings of isolation and loss of autonomy. It is worth noting that these time burdens extend to friends and family, they face substantial unanticipated challenges across multidimensional domains encompassing physical, psychological, and social well-being, this is consistent with the perspective of Thana et al[35]. Healthcare professionals in oncology departments should dynamically assess and monitor time toxicity in both patients and caregivers, actively listen to their emotional needs and sources of time pressure, and implement tailored intervention plans. This can be achieved by coordinating examination and care schedules, optimizing medical and nursing workflows through enhanced clinical pathways, and providing psychosocial interventions such as cognitive behavioral therapy (CBT) or psychological counseling to deliver both emotional support and practical assistance[36,37]. These measures are crucial for alleviating treatment-related temporal burdens, helping individuals cope with the psychological impacts of time toxicity, and ultimately reducing psychosocial distress during cancer care.\\u003c/p\\u003e\\n\\u003cp\\u003eIn this study, we found that cancer patients and their caregivers adopt proactive coping strategies to address time toxicity. Cancer patients actively engage in self-perception adjustment and behavioral adaptation to mitigate the negative emotions caused by time toxicity, thereby rebuilding confidence and hope in social life. Meanwhile, caregivers alleviate their temporal and financial burdens by developing essential caregiving skills to reduce unnecessary hospitalizations. Additionally, both patients and caregivers utilize telemedicine to lower healthcare-related costs, which aligns with Brown's study suggesting that telemedicine effectively reduces travel[38], accommodation, and financial expenditures, particularly in rural areas, by bridging gaps in unequal healthcare resource distribution and saving time costs[39]. Furthermore, governments and healthcare institutions should collaborate closely to establish and improve a hospital-family-community multi-level social support system, providing sustainable assistance and support for them[40].\\u003c/p\\u003e\\n\\u003cp\\u003eFindings demonstrate that cancer patients desire proactive engagement with healthcare professionals to comprehend time commitments associated with treatment regimens and obtain professional support. Insufficient communication and coordination among healthcare providers lead to inaccuracies in information transfer, resulting in unnecessary treatments and outpatient appointments. With the continuous evolution of oncology care, oncology nurse specialists play a pivotal mediating role in clinician-patient interactions through their nuanced understanding of patient experiences and distinct positioning within healthcare teams. By collaborating with interdisciplinary teams, these nurses provide cancer patients and caregivers with information counseling and communication liaison services, while implementing systemic healthcare reforms to deliver streamlined, continuous, and accessible care plans that minimize temporal burdens[41]. Furthermore, our study reveals that time burden serves as a critical factor in patients' and caregivers' selection of treatment options. However, healthcare providers tend to prioritize financial toxicity while overlooking the potential impact of time toxicity[42]. Oncologists and nursing staff should actively listen to patients' perspectives, engage in regular goal-oriented dialogues, and develop personalized treatment schedules to ensure alignment with patients' values, personal preferences, and life goals. Additionally, oncologists should provide comprehensive estimates of overall time expenditure based on different treatment protocols and patients' travel time. They can use visual tools to design tailored temporal roadmaps taht could help patients intuitively understand time allocation strategies, thereby facilitating more informed medical and caregiving decisions[43].\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLimitation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study has several limitations. First, the heterogeneity of cancer types and treatment regimens may limit the generalizability of the findings, and the sample may not be fully representative. Second, the interview results were based on self-reported data from cancer patients and caregivers, which are subject to recall bias regarding the treatment process. Consequently, this study may carry potential subjectivity and bias. Future research should further focus on expanding the thematic scope and geographical coverage by incorporating perspectives from diverse regions and multiple stakeholders, including healthcare professionals, patients, and family caregivers. Furthermore, longitudinal qualitative studies should be conducted to explore temporal toxicity variations across different phases of patient care (diagnosis, treatment, and post-discharge periods), which could inform the development of personalized clinical interventions.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn conclusion, reducing time toxicity associated with cancer treatment and care is essential for improving disease outcomes and quality of life in cancer survivors, particularly those with incurable advanced malignancies. Understanding the experiences of time toxicity among cancer patients and their caregivers, as well as their corresponding coping strategies, will facilitate the development and refinement of healthcare policies that prioritize time burden mitigation and reduce its adverse impacts. Future research should prioritize patient-centered time needs and preferences to develop effective interventions and provide personalized support for this population to mitigate the effects of time toxicity.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u0026nbsp;\\u003c/strong\\u003eWe would like to thank all participants for their\\u0026nbsp;effort and time.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’ contributions\\u0026nbsp;\\u003c/strong\\u003eConceptualization and Methodology: Jie Jing, Mohan Li, and Ling Yuan;\\u003c/p\\u003e\\n\\u003cp\\u003eData Acquisition and Investigation: Jie Jing, Mohan Li, Yehao Rui\\u003c/p\\u003e\\n\\u003cp\\u003eData curation and Resources: Jie Jing, Mohan Li, Qiuchen Zhu, Danruo Wang\\u003c/p\\u003e\\n\\u003cp\\u003eFormal analysis: Jie Jing, Mohan Li, Qiuchen Zhu\\u003c/p\\u003e\\n\\u003cp\\u003eFunding acquisition: Ling Yuan, Danruo Wang\\u003c/p\\u003e\\n\\u003cp\\u003eWriting - original draft: Jie Jing, Mohan Li, Ling Yuan, Qiuchen Zhu\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e This work was supported by “Research project on Fine Management and Evaluation of Public Hospitals”（NIHA23JXH020）\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe dataset analyzed in this study is available upon reasonable request from the corresponding author during the submission process or after publication. The data are not publicly accessible due to confidentiality concerns associated with the qualitative data.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll methods used in this study involving participants and data analysis were conducted in accordance with the Declaration of Helsinki and its future amendments. This research was approved by the Medical Ethics Committee of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. (No. 2023-047-01). The authors highlighted the assurance of maintaining participants’ confidentiality and anonymity.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePrior to executing written informed consent, all participants (or their caregivers) underwent comprehensive protocol disclosure detailing the study objectives and procedures.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors reviewed the manuscript and approved the final version submitted for publication.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eAgrawal NY, Thawani R, Edmondson CP, Chen EY (2023) Estimating the Time Toxicit y of Contemporary Systemic Treatment Regimens for Advanced Esophageal and Gastric Cancers. Cancers (Basel) , 15(23).\\u003c/li\\u003e\\n\\u003cli\\u003eGupta A, Hay AE, Crump M, Djurfeldt MS, Zhu L, Cheung MC, Shepherd LE, Chen BE, Booth CM (2023) Contact Days Associated With Cancer Treatments in the CCTG LY.12 Trial Oncologist 28: 799-803.\\u003c/li\\u003e\\n\\u003cli\\u003eJitender S, Mahajan R, Rathore V, Choudhary R (2018) Quality of life of cancer patien ts. J Exp Ther Oncol 12(3):217\\u0026ndash;221.\\u003c/li\\u003e\\n\\u003cli\\u003eFundytus A, Prasad V, Booth CM (2021) Has the Current Oncology Value Paradigm Fo rgotten Patients\\u0026apos; Time?: Too Little of a Good Thing JAMA Oncol 7: 1757-1758.\\u003c/li\\u003e\\n\\u003cli\\u003eNwozichi C, Omolabake S, Ojewale MO, Faremi F, Brotobor D, Olaogun E, Oshodi-Ba kare M, Martins-Akinlose O (2024) Time toxicity in cancer care: A concept analysis usi ng Walker and Avant\\u0026apos;s method. 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Oncologist 29: 978-985.\\u003c/li\\u003e\\n\\u003cli\\u003eBanerjee R, Cowan AJ, Ortega M, Missimer C, Carpenter PA, Oshima MU, Salit RB, Vo PT, Lee CJ, Mehta RS, Kuderer NM, Shankaran V, Lee SJ, Su CT (2024) Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma. Clin Lymphoma Mye loma Leuk 24: 446-454.e443.\\u003c/li\\u003e\\n\\u003cli\\u003eHall ET, Sridhar D, Singhal S, Fardeen T, Lahijani S, Trivedi R, Gray C, Schapira L (2021) Perceptions of time spent pursuing cancer care among patients, caregivers, and oncology professionals. Support Care Cancer 29: 2493-2500.\\u003c/li\\u003e\\n\\u003cli\\u003eBange EM, Lin JK (2025) Time Toxicity of Clinical Trials-Better Than Feared. JAMA Netw Open 8: e255044.\\u003c/li\\u003e\\n\\u003cli\\u003eKatikaneni PS, Joung B, Jeon WJ, Agrawal N, Chitkara A, Thawani R (2025) HSR25- 147: Time Toxicity of Different Frontline Regimens in EGFR Mutated Non-Small Cell Lung Cancer. 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Cancer 130: 3961-3972.\\u003c/li\\u003e\\n\\u003cli\\u003eEspinoza MA, Zamorano P, Zu\\u0026ntilde;iga-San Martin C, Taramasco C, Martinez F, Becerra S, Letelier MJ, Armijo N (2025) Improving Efficiency in Healthcare: Lessons from Succ essful Health Policies in Chile. Arch Med Res 56: 103105.\\u003c/li\\u003e\\n\\u003cli\\u003eGupta A, Johnson WV, Henderson NL, Ogunleye OO, Sekar P, George M, Breininger A, Kyle MA, Booth CM, Hanna TP, Rocque GB, Parsons HM, Vogel RI, Blaes AH (20 24) Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care. JAMA Netw Open 7: e2447649.\\u003c/li\\u003e\\n\\u003cli\\u003eKoo Y, Kim E, Jo Y, Nam I (2023) Patient Experience Factors and Implications for I mprovement Based on the Treatment Journey of Patients with Head and Neck Cancer. Cancers (Basel) 15.\\u003c/li\\u003e\\n\\u003cli\\u003eThana K, Lehto R, Sikorskii A, Wyatt G (2021) Informal caregiver burden for solid t umour cancer patients: a review and future directions. Psychol Health 36: 1514-1535.\\u003c/li\\u003e\\n\\u003cli\\u003ePetre I, Barna F, Gurgus D, Tomescu LC, Apostol A, Petre I, Furau C, Năchescu ML, Bordianu A (2023) Analysis of the Healthcare System in Romania: A Brief Review. Hea lthcare (Basel) 11.\\u003c/li\\u003e\\n\\u003cli\\u003eNakao M, Shirotsuki K, Sugaya N (2021) Cognitive-behavioral therapy for managemen t of mental health and stress-related disorders: Recent advances in techniques and techno logies. Biopsychosoc Med 15: 16.\\u003c/li\\u003e\\n\\u003cli\\u003eBrown E, Fisher GA, Jr., Shelton A, Chang DT, Pollom E (2024) Advancing clinical t rial equity through integration of telehealth and decentralized treatment. JNCI Cancer Sp ectr 8.\\u003c/li\\u003e\\n\\u003cli\\u003eJohnson WV, Blaes AH, Booth CM, Ganguli I, Gupta A (2023) The unequal burden o f time toxicity Trends. 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Patient Educ Couns 125: 108285.\\u003c/li\\u003e\\n\\u003cli\\u003eW\\u0026ouml;rns MA, Burns D, Paskow M, Makin H, Miller J, Turner LM, Sah J (2024) Patie nt Experience of Hepatocellular Carcinoma and Their Treatment Goals: An International Qualitative Study and Patient Journey Map. Adv Ther 41: 3598-361.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"supportive-care-in-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jscc\",\"sideBox\":\"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)\",\"snPcode\":\"520\",\"submissionUrl\":\"https://submission.nature.com/new-submission/520/3\",\"title\":\"Supportive Care in Cancer\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"cancer, caregivers, time toxicity, time burden, qualitative study\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6490205/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6490205/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSubstantial time investments are required from patients and caregivers due to cancer management and treatment demands. These cumulative time burdens can lead to the disruption of daily life order, aggravation of psychological distress, and economic burden. However, time toxicity is often overlooked in the current healthcare environment. Therefore, this study examined perceptions of time toxicity from advanced cancer patients and their family caregivers.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA qualitative study based on semi-structured interviews was conducted among 12 advanced cancer patients and 6 family caregivers at Oncology departments in a tertiary hospitals \\u0026nbsp;and a community hospital. The interviews were analyzed according to thematic analysis. The reporting of this qualitative research conformed to the COREQ consolidated criteria.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings of this study have revealed four key themes: (1) \\u003cstrong\\u003eThe experience of time toxicity stems from multi-dimensional contributing factors; (2)\\u003c/strong\\u003eTime Toxicity has multiple negative impacts on patients and caregivers; (3) Strategies for coping with time toxicity in cancer patients and caregivers; (4) Clinical needs and expectations of cancer patients and caregivers regarding time burden.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHealthcare professionals should receive training to identify time toxicity manifestations and their cascading effects on patient distress, systematic time burden assessments must be initiated at cancer diagnosis, coupled with implementation of time-saving care pathways and continuous evaluation of temporal resource adequacy.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The Weight of Time: Experience of time toxicity among advanced cancer patients and their family caregivers: A qualitative study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-29 14:25:12\",\"doi\":\"10.21203/rs.3.rs-6490205/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-08-12T22:00:45+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-08-12T21:54:13+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"249347237477857194098165767862177694747\",\"date\":\"2025-07-21T18:46:19+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-06-06T19:22:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"212049963758769015423324726870715654427\",\"date\":\"2025-06-05T15:44:53+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-05-27T19:48:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-05-27T19:46:51+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-04-28T10:08:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Supportive Care in Cancer\",\"date\":\"2025-04-20T15:41:45+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"supportive-care-in-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jscc\",\"sideBox\":\"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)\",\"snPcode\":\"520\",\"submissionUrl\":\"https://submission.nature.com/new-submission/520/3\",\"title\":\"Supportive Care in Cancer\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"0653fa41-abc0-4a47-baf6-02c43a5cb398\",\"owner\":[],\"postedDate\":\"May 29th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-09-22T16:01:07+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-6490205\",\"link\":\"https://doi.org/10.1007/s00520-025-09904-w\",\"journal\":{\"identity\":\"supportive-care-in-cancer\",\"isVorOnly\":false,\"title\":\"Supportive Care in Cancer\"},\"publishedOn\":\"2025-09-18 15:57:31\",\"publishedOnDateReadable\":\"September 18th, 2025\"},\"versionCreatedAt\":\"2025-05-29 14:25:12\",\"video\":\"\",\"vorDoi\":\"10.1007/s00520-025-09904-w\",\"vorDoiUrl\":\"https://doi.org/10.1007/s00520-025-09904-w\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6490205\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6490205\",\"identity\":\"rs-6490205\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}