Background: Patients with metastatic or unresectable gastroesophageal cancers (mGECs) have poor prognosis and often face high symptom burden and high rates of disease-related complications. Treatments in the second-line setting offer modest survival gains, which need to be balanced with treatment toxicities. Time toxicity (TT) has become increasingly recognised as a hidden toxicity of cancer therapy and thus the aim of this study was to quantify TT to patients undergoing second-line treatment for mGECs.

Methods: This was a 10-year multicentre retrospective cohort study across three major Sydney hospitals. Records for all patients who received second-line systemic therapy for mGECs. Time toxicity was defined as the number of days patients spent physically interacting with the healthcare system.

Results: Eighty patients were identified with the majority male (83%) and a median age of 64 (30-83 years). The median time on second-line treatment was 2.4 months, and median overall survival from commencement of second-line treatment was 5.8 months. Patients spent a median of 25% of days in physical contact with the healthcare system, of which 20% were planned encounters such as clinic appointments, scheduled investigations, or treatment days. TT was lower in patients who remained on second-line treatment for more than two months versus those on treatment less than two months (29% vs. 23%). Sixty percent of hospital admissions were due to malignancy, and 29% were due to treatment-related complications. One in eight patients died within thirty days of receiving second-line treatment.

Conclusion: Patients on second-line treatment for mGEC spent 1 in 4 days in contact with the healthcare system, and thirty-day mortality following systemic treatment was high. These findings may help guide decisions and informed consent surrounding second-line treatment in mGECs.