Background: Financial costs from cancer treatment are increasingly recognized, but what has historically been underrecognized is the time cost of therapy. We sought to estimate the time burden of anti-cancer drugs approved based on comparisons to best supportive care (BCS), with the assumption that without this drug, a patient could have been treated with observation, home palliative care or hospice services, with minimal time seeking medical care. Methods: We searched all FDA approvals (2009 - March 2022) for randomized trials that used BCS as a treatment option for an anti-tumor drug in the metastatic setting and abstracted data on treatment related activities. We then estimated time spent on these activities using previously calculated times. Results: Of the 13 drugs tested against BSC, nine studies demonstrated an improvement in median OS (median 2.1 months). The median monthly time spent for patients in the intervention arm of BSC trials was 15.8 hours. Conclusion: Time is a valuable resource for people who have cancer, but especially for patients who may have few to no remaining treatment options, and yet, we found that patients can spend up to 16 hours in anti-cancer drug related activities per month.

Vinay Prasad's Disclosures; (research funding) Arnold Ventures; (royalties) Johns Hopkins Press, Medscape (honoraria) Grand Rounds/lectures from universities, medical centers, non-profits, professional societies, Youtube, and Substack (consulting); UnitedHealthcare; (speaking fees) Evicore; (other) Plenary Session podcast has Patreon backers. All other authors have no financial nor non-financial conflicts of interest to report.

This project was funded by Arnold Ventures

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