How Philadelphia Researchers Are Reducing Medicine's Hidden Time Burden
Explore the ResearchImagine planning your life around medical appointments. For thousands of cancer patients in Philadelphia and worldwide, this isn't just an occasional inconvenience—it's a relentless reality.
Beyond the physical discomfort and emotional turmoil of treatment lies a hidden cost that often goes unrecognized: the staggering amount of time spent commuting to clinics, waiting for appointments, and receiving care. Researchers now call this "time toxicity"—the precious hours, days, and months that cancer steals from patients' lives, time that could be spent with loved ones, pursuing passions, or simply enjoying meaningful moments 2 .
The hidden burden of healthcare time commitments
Focusing on what matters most to patients
Evidence-based interventions for real problems
The term "bench-to-bedside" describes medical discoveries that travel from the research laboratory (the bench) directly to patient care (the bedside). But according to Nobel Prize winner Dr. Michael Brown, this process might be more accurately described as "bedside to bench to bedside" .
First, clinicians identify a real-world problem they observe in patients. Then, researchers study that problem in depth within laboratory settings. Finally, those insights are translated into practical solutions that return to benefit patients.
| Phase | Primary Focus | Key Activities | Outcome |
|---|---|---|---|
| Bedside Observation | Identifying unmet patient needs | Clinicians document challenges in patient care; patients report difficulties | Clear problem definition based on real clinical experience |
| Laboratory Research | Fundamental understanding | Studying disease mechanisms; developing interventions; preliminary testing | Evidence-based interventions ready for clinical testing |
| Clinical Trials | Safety and effectiveness | Phase I (safety), Phase II (efficacy), Phase III (comparison), Phase IV (long-term monitoring) | Data proving intervention safety and effectiveness |
| Implementation | Integrating into routine care | Training clinicians; developing protocols; measuring patient outcomes | Widespread availability of new treatment approaches |
This approach has proven particularly valuable in addressing not just medical symptoms but the entire patient experience, including challenges like time toxicity that traditional research might overlook .
How can we possibly give patients time back? Researchers at Penn Medicine in Philadelphia designed an elegant solution using something nearly everyone has in their pocket: a mobile phone with text messaging capability 2 .
In a pioneering study conducted between December 2021 and December 2022, researchers tested whether a simple text-messaging system could safely identify patients who could skip their pre-treatment office visit and proceed directly to their infusion therapy 2 .
The study focused on patients with solid tumors receiving immunotherapy, which typically has fewer side effects than traditional chemotherapy. The approach was simple yet innovative: 96 hours before their scheduled treatment, patients received a text message with 16 questions about potential symptoms, modified from the National Cancer Institute's standard toxicity assessment tool 2 .
Patients receive text message with 16 symptom questions
Patients report any new or worsening symptoms
Normal bloodwork + no symptoms = fast-track eligibility
Eligible patients skip office visit, proceed directly to treatment
The outcomes were remarkable. Patients participating in the e-triage system spent an average of 66 minutes less per care encounter—saving more than an hour each time they came for treatment. Wait times decreased by approximately 30 minutes per visit, a meaningful reduction in the frustrating "hurry up and wait" experience so common in healthcare settings 2 .
Perhaps most importantly, these time savings came without compromising safety. The e-triage system successfully identified patients without symptoms of drug toxicity with 100% negative predictive value and 0% false negative rate—meaning no concerning symptoms were missed 2 .
minutes saved per care encounter
false negative rate
| Time Component | Usual Care | E-Triage Intervention | Time Saved |
|---|---|---|---|
| Total Care Time | Baseline | 66.0 minutes less | ~1 hour per visit |
| Wait Time | Baseline | 30.1 minutes less | ~30 minutes per visit |
| Commuting | Unchanged | Unchanged | 0 minutes |
| Treatment Time | Unchanged | Unchanged | 0 minutes |
Beyond the numbers, the intervention received positive feedback from both patients and clinicians. Oncologists found the approach acceptable, appropriate, and feasible, scoring it highly on standardized implementation measures 2 .
What does it take to develop and implement these innovative healthcare solutions? Successful practice-based interventions typically incorporate several key components, each serving a specific function in the research and implementation process.
| Component | Function | Example from Featured Research |
|---|---|---|
| Digital Platforms | Enable remote patient monitoring and communication | Way to Health's two-way texting system for symptom reporting |
| Patient-Reported Outcome Measures | Capture symptoms and experiences directly from patients | 16-question instrument based on National Cancer Institute's PRO-CTCAE |
| Clinical Validation | Ensure safety and accuracy of new approaches | Laboratory testing combined with symptom screening to confirm patient eligibility for fast-tracking |
| Implementation Science Frameworks | Guide effective rollout and adoption of innovations | Use of Enola Proctor's conceptual model to assess acceptability, appropriateness, and feasibility |
| Stakeholder Engagement | Incorporate perspectives of all parties involved | Surveys and focus groups with treating oncologists to identify barriers and facilitators |
These components work together to create interventions that are not only scientifically sound but also practical and sustainable in real-world clinical settings 2 .
Text messaging systems and digital tools enable efficient communication between patients and healthcare providers, reducing the need for in-person visits.
Standardized instruments allow patients to directly report their symptoms and experiences, providing valuable data for clinical decision-making.
The text messaging intervention represents just one approach to addressing time toxicity in cancer care. Other innovative strategies are emerging from the bench-to-bedside pipeline.
Just as cancer treatments affect patients differently, exercise interventions need tailoring to individual needs and circumstances. Researchers are developing personalized exercise therapies that account for specific cancer types, treatments received, and individual patient characteristics. This approach moves beyond "one-size-fits-all" exercise recommendations to create targeted regimens that address specific challenges, such as cardiovascular toxicity caused by certain cancer treatments 1 .
The success of text-based triage opens the door to broader applications of digital technology in healthcare. Future interventions might incorporate:
These technologies could further reduce the time burden on patients while providing clinicians with richer, more continuous data about patient health 2 .
Even the most promising interventions face hurdles in widespread adoption. Researchers identified several potential barriers to implementing the e-triage system, including:
Acknowledging and addressing these practical concerns is essential to moving innovations from research settings into routine practice 2 .
The pioneering work happening in Philadelphia represents a fundamental shift in healthcare philosophy—from a system focused solely on medical outcomes to one that considers the full human experience of illness and treatment.
Recognizing the hidden burden of healthcare time commitments
Translating research into practical patient benefits
Focusing on what matters most to patients' quality of life
By recognizing time toxicity as a legitimate concern worthy of scientific attention, researchers are acknowledging that quality of life matters just as much as quantity of life.
As Dr. Brown reminds us, "We cannot treat a disease when we do not have a solid understanding of it" . The understanding that has emerged from this research is clear: the time patients spend navigating healthcare represents a significant dimension of their overall experience and well-being.
The journey from bench to bedside continues, with researchers and clinicians working together to ensure that new discoveries translate into tangible benefits for patients. In this evolving landscape, the most successful interventions will be those that treat patients not as collections of symptoms, but as whole people with limited time and competing priorities—people who deserve medical care that fits into their lives, rather than consuming them.