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Article(id=1322168100741562887, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167989802217791, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.04.025, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1731772800000, receivedDateStr=2024-11-17, revisedDate=1769616000000, revisedDateStr=2026-01-29, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159039911, onlineDateStr=2026-10-28, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159039911, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159039911, creator=13701087609, updateTime=1793159039911, updator=13701087609, issue=Issue{id=1322167989802217791, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='4', pageStart='529', pageEnd='704', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159013461, creator='13701087609', updateTime=1793159013461, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=689, endPage=694, ext={EN=ArticleExt(id=1322168100980638217, articleId=1322168100741562887, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on time toxicity in cancer patients, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This paper provided a comprehensive review of temporal toxicity in cancer patients,including its conceptual framework,current research status,influencing factors,consequences,and potential intervention strategies,so as to offer valuable insights for healthcare professionals in China to enhance their understanding of temporal toxicity, develop effective interventions, and promote further academic inquiry into this emerging domain.

, authors=Renjie ZHANG1, Qiyang HUAI1, Luhao LIU2, Lijuan YANG3, authorsList=Renjie ZHANG, Qiyang HUAI, Luhao LIU, Lijuan YANG, authorCompany=null, correspAuthors=Lijuan YANG, authorNote=null, correspAuthorsNote=
YANG Lijuan， E-mail：
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针对癌症病人时间毒性的概念、现状、影响因素、危害、干预措施进行综述，以期为我国医护人员更好地认识癌症病人的时间毒性、制定时间毒性干预策略、开展癌症病人时间毒性相关研究提供参考。

, authors=张仁杰1, 怀其阳1, 刘路浩2, 杨丽娟3, *, *, authorsList=张仁杰, 怀其阳, 刘路浩, 杨丽娟, authorCompany=null, correspAuthors=杨丽娟, authorNote=

张仁杰，护士，硕士研究生

, correspAuthorsNote=
杨丽娟，E-mail：
YANG Lijuan， E-mail：
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张仁杰，护士，硕士研究生

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癌症病人时间毒性的研究进展
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张仁杰 1 , 怀其阳 1 , 刘路浩 2 , 杨丽娟 3, *, *
护理研究 | 科研综述 2026,40(4): 689-694
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护理研究 |科研综述 2026 , 40 (4) : 689 -694
癌症病人时间毒性的研究进展
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张仁杰1, 怀其阳1, 刘路浩2, 杨丽娟3, *, *
作者信息
  • 1山东第二医科大学，山东 261053
  • 2山东第一医科大学
  • 3山东第一医科大学附属省立医院
通讯作者:
杨丽娟，E-mail：
YANG Lijuan， E-mail：
作者简介:

张仁杰，护士，硕士研究生

Research progress on time toxicity in cancer patients
Renjie ZHANG1, Qiyang HUAI1, Luhao LIU2, Lijuan YANG3
Affiliations
  • 1Shandong Second Medical University, Shandong 261053 China
  • 2Shandong First Medical University
  • 3Shangdong Provincial Hospital Affiliated to Shandong First Medical University
    • Corresponding Author:
    YANG Lijuan， E-mail：
出版时间: 2026-02-25 doi: 10.12102/j.issn.1009-6493.2026.04.025
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摘要
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针对癌症病人时间毒性的概念、现状、影响因素、危害、干预措施进行综述，以期为我国医护人员更好地认识癌症病人的时间毒性、制定时间毒性干预策略、开展癌症病人时间毒性相关研究提供参考。

癌症  /  时间毒性  /  影响因素  /  干预策略  /  护理  /  综述

This paper provided a comprehensive review of temporal toxicity in cancer patients,including its conceptual framework,current research status,influencing factors,consequences,and potential intervention strategies,so as to offer valuable insights for healthcare professionals in China to enhance their understanding of temporal toxicity, develop effective interventions, and promote further academic inquiry into this emerging domain.

cancer  /  time toxicity  /  influencing factors  /  intervention strategies  /  nursing  /  review
张仁杰, 怀其阳, 刘路浩, 杨丽娟. 癌症病人时间毒性的研究进展. 护理研究, 2026 , 40 (4) : 689 -694 . DOI: 10.12102/j.issn.1009-6493.2026.04.025
Renjie ZHANG, Qiyang HUAI, Luhao LIU, Lijuan YANG. Research progress on time toxicity in cancer patients[J]. Chinese Nursing Research, 2026 , 40 (4) : 689 -694 . DOI: 10.12102/j.issn.1009-6493.2026.04.025
正文
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随着我国癌症发病率和死亡率持续增加，癌症目前已成为我国人口死亡的主要原因之一[1]。随着癌症研究的深入，免疫疗法和靶向治疗等新兴治疗方式已广泛应用于癌症治疗中，显著改善了病人的预后状况，但这些治疗方式也给病人带来沉重的时间负担，甚至可能抵消了新疗法中的获益。癌症治疗中频繁的医疗预约、治疗以及后续恢复产生的时间负担，对病人的生活质量以及心理健康造成严重负面影响[2-3]。因治疗时间成本对癌症病人产生的负面影响称之为时间毒性（time toxicity，TT）。本研究对癌症时间毒性的相关概念、现状、影响因素、危害以及应对措施进行综述，旨在协助我国临床医护人员更准确地识别癌症病人的时间毒性，并为国内相关研究的开展提供参考。
1　癌症病人时间毒性相关概念
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时间毒性概念最早由Daily[4]于2018年提出，用于描述那些由于癌症治疗活动的低效率给病人造成的时间负担。此后，学者们在研究中进一步丰富其定义，Gupta等[5]将时间毒性定义为一种综合指标，将病人的时间毒性天数定义为与医疗保健系统接触的时间，包括门诊就诊、影像学及血液检查、输液以及在治疗场所过夜的时间等。Nwozichi等[6]对癌症照护中的时间毒性进行了概念分析，将其定义为癌症病人在治疗相关活动上花费时间产生的累计负担，认为时间毒性是一种机会成本，可进行定性和定量测量，是病人在接受长期复杂的癌症治疗中产生的累积时间负担，对病人的生活质量、治疗依从性、情绪和心理状态产生负面影响，时间毒性的体验因人而异，受个人生活环境的影响。尽管各学者对时间毒性的描述有许多共同之处，但目前尚未形成统一的标准定义，未来需要更多学者对癌症病人时间毒性相关概念进行深入研究。
2　癌症病人时间毒性现状
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国外关于癌症病人时间毒性的研究起步较早，癌症病人在长期治疗中普遍存在时间毒性。Nindra等[7]研究发现，在一个治疗周期内病人在医疗保健行为中花费的时间高达40%。一项来自美国的研究同样显示，癌症病人花费10%~20%的剩余寿命用来接受治疗[8]。时间毒性在患病的初始阶段最高，随着疾病进展以及病人完成更多治疗而逐渐下降，完成≥10个周期治疗的病人医疗接触时间占总生存期的14%，而完成≤2个周期治疗的病人该比例达35%以上[7,9]。不同癌症类型病人的时间毒性水平存在差异，胃肠道癌、头颈癌以及乳腺癌的病人时间毒性更高[9]，这一结果与安德森癌症中心的报告结果[10-11]一致。癌症的治疗方式也会影响时间毒性的发生，接受靶向治疗、化疗的病人往往存在更高的时间毒性[9,12]。
3　癌症病人时间毒性的影响因素
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3.1　社会人口学因素
心理弹性和居住地是影响癌症病人时间毒性水平的重要因素，现有研究结果表明其他社会人口学因素如年龄、性别、吸烟与否、文化程度与时间毒性无明显相关性[7]。不同病人面对治疗方案的感受不同，心理弹性差的病人在面对长期复杂的治疗时，更容易出现焦虑、抑郁的情绪[13]，具有较高心理弹性的病人往往认为治疗中投入的时间是有价值的，他们不认为治疗给自己的日常生活带来了时间上的负担，因此，他们不会表现出时间毒性的特征。居住在偏远地区的病人，由于距离医疗机构过远且依赖公共交通，就诊的交通成本高，交通成本被认定为癌症治疗的直接成本，由病人及其家属承担，交通成本会对癌症诊断和治疗构成重大障碍，具有高交通成本的病人更易遭受时间毒性的影响[14-15]。同一种疾病的病人，尽管具有相似的临床和病理特征，具有较高交通负担的病人治疗依从性低、预后差，生存率也相对较低[16]。目前相关研究相对较少，现有研究结果的准确性还需进一步验证，还需进行更多研究，探究其他社会人口学因素对病人时间毒性水平是否存在影响。
3.2　疾病特点
疾病病程长、易复发、癌症类型、癌症分期、癌症合并症与时间毒性相关。癌症慢性病化越来越普遍[17]，疾病病程长，治疗时间所需时间也随之增多，有些病人甚至需要终身进行治疗[18]。癌症治疗无法完全清除癌症细胞以及癌细胞可能出现耐药性，导致癌症易复发，复发后的治疗方案更加复杂，明显导致病人时间毒性水平升高[19-20]。不同肿瘤类型病人的时间毒性水平存在差异，胃肠道癌、头颈癌以及乳腺癌的病人具有更高的时间毒性水平[9]。癌症分期影响治疗方案的选择，早期癌症可以接受高效、短期以及低成本的癌症治疗，晚期癌症病人治疗的时间负担更重[21]。随着疾病进展，病人出现乏力、消瘦、贫血等全身症状，病人免疫力失衡易出现各种合并症，有1种及以上合并症的病人，他们的治疗方案更复杂，治疗周期长，病人的时间毒性水平明显升高[22]。此外，研究发现，较高的肿瘤预后评分（RMH）与体力状况评分（PS）受损与时间毒性存在明显相关性[9]。
3.3　疾病治疗因素
确诊时间、治疗方式、治疗并发症、诊断后的检查与癌症病人的时间毒性密切相关。癌症诊断复杂且诊断周期较长，早期诊断出癌症，医疗保健成本以及时间毒性都有可能降低，癌症的延迟诊断则会导致病人生存率下降以及时间毒性感受严重[21,23]。癌症治疗多为综合性治疗，治疗方式复杂，治疗时间长，病人时间负担重。癌症治疗方式中化疗所需的时间最长，病人接受化疗的时间约占其总生存天数的10%，因此，接受化疗的病人具有更高的时间毒性[24]。治疗相关并发症也是导致病人时间毒性的一大重要因素，癌症各种治疗方式并发症多，需要进行观察治疗[25]，住院时间较长。此外，治疗产生的并发症是导致计划外访视的主要因素，计划外访视会给病人造成极大额外时间负担[7]。诊断后的治疗会花费病人大量时间[24,26]，除了检查治疗时间外，预约等待时间也是时间毒性重要的影响因素，病人3 h的预约检查中，与医务工作者接触的时间只有20 min[27]。一项回顾性研究结果显示，胰腺癌病人在治疗周期内，平均需要花费53.2 h用于通勤或等待治疗[28]，当病人接受多个周期治疗时，这种时间毒性负担会不断累积。
4　癌症病人时间毒性的危害
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4.1　影响病人生活质量
病人平均生活质量是癌症病人评估的重要结局指标之一。癌症病人随着疾病进展出现疲劳、恶心、呕吐等躯体症状[29]，严重影响了病人的健康状况且随着治疗计划越来越复杂，导致病人的生活质量持续下降。研究表明，疾病持续时间会影响病人的生活质量，80%的癌症病人平均生活质量明显降低[30]，癌症治疗的时间需求干扰了病人的个人与职业生活，病人牺牲了与家人相处、社交、工作、旅行的时间，扰乱了他们正常的生活节奏。
4.2　影响病人心理健康
时间毒性对癌症病人会产生重大的心理压力，研究显示，有28%的癌症病人处于高压力状态[31]，45.71%的病人在面对长期的治疗计划时出现明显的焦虑、抑郁等负面情绪[32]。随着疾病的不断进展，时间毒性的影响在癌症病人中逐渐出现，引发不同的心理问题，71%的病人会出现自我概念降低、身体形象障碍、性功能障碍等严重心理问题[33-34]，同时，这些心理问题也会加剧时间毒性对病人的影响。
4.3　影响病人治疗依从性
病人治疗依从性降低、预后不良与治疗期间产生的各种毒性存在潜在相关性[35]。高时间毒性导致病人治疗依从性降低或延迟就医，面临复杂的治疗方案以及较长的治疗时间，一些病人可能会放弃治疗，具体表现为减少接受检查、辅助治疗以及随访次数。一项多中心研究显示，有明显时间负担的病人拒绝接受治疗的比例更高[2]。一项研究发现，某些能够延长无进展生存期（PFS）的抗癌药物可能会给病人带来过高的时间成本，进而引发病人对治疗效果的疑虑[36]。病人延迟就医、治疗依从性下降，会降低医疗护理质量，增加疾病转移及进展的风险，对病人预后产生不良影响。
4.4　造成照护者负担
照护者们经历了与癌症病人相同的压力与负担，研究表明，病人及其照护者同时经历着痛苦，这种痛苦是同步发生的[37]。照护者在病人治疗期间，需要负责预约检查、陪同治疗以及安排出行等事宜，繁重的照护任务直接导致陪护者经历了显著的时间毒性影响，即使是采集静脉血这样看似简单的检查，也需要花费几个小时的时间，无疑增加了照护者的时间成本[5,38]。这些时间损失不仅影响了他们的个人与职业生活，还对他们的生活质量产生了负面影响[39]，癌症病人的照护者往往为其配偶，由于长期疾病治疗及陪护对工作的影响，导致家庭收入下降，不仅影响了家庭的经济状况，还会导致家庭关系紧张，进而影响家庭的情感交流、休息和娱乐功能[40]。
4.5　加剧病人经济负担
一项队列研究结果显示，长期癌症治疗导致医疗费用随时间推移而不断累积，进而使得病人的医疗保健支出显著上升[23]。对于低收入群体来说，频繁就诊导致的时间毒性可直接导致经济毒性[41]。研究显示，超过70%的病人在确诊癌症以及治疗过程中遭遇过工作时间减少、就业中断或变动[42]；癌症诊断后，病人在治疗与康复期间不能继续工作，癌症病人失业率高达33.8%[43]。患病后大部分病人不能获得带薪病假，加之出现失业或者就业中断的情况，病人的经济负担进一步加重[39]。此外，对于居住在偏远地区的病人来说，除了医疗费用外，交通费、住宿费、时间成本等非医疗费用也会增加，这些额外支出导致病人面临巨大的经济压力[44]，进一步增加病人在时间毒性下面临的挑战。
5　癌症相关时间毒性应对措施
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5.1　选择合适的治疗方案
选择治疗方案前对病人进行全面评估，对病人开展涵盖心理和医疗需求的多维度评估，并依据评估结果制订综合治疗计划，可以降低病人计划外住院次数以及治疗相关毒性，这种基于综合评估的治疗计划能够更有效地满足病人的个性化需求，从而改善治疗效果和病人生活质量[45-46]。选择治疗方案时，除了要考虑治疗的潜在获益外，还需要衡量治疗的时间毒性，尽管某些治疗可以减缓疾病进展或延长病人生存期，但伴随治疗所产生的时间毒性可能会抵消这些益处。因此，制定治疗方案时需要综合考虑治疗效果与时间成本，以确保治疗方案可以有效控制疾病，且不会过度增加病人的时间负担。研究发现，不同个体对癌症相关治疗活动所花费时间的感受存在明显差异[47]。有的病人希望医护人员定期进行随访，而有的病人则感觉频繁的随访是一种负担，对他们的生活造成了压力，这种异质性的感受提示医疗提供者在制订随访计划时需要考虑到病人的个体化需求和偏好，以确保治疗计划既能满足病人的医疗需求，又不过度增加他们的时间负担。针对病人特点合理选择药物用量和用药方式，以及合理降低化疗剂量，可有效降低化疗毒性和住院率。Jiang等[48]针对老年病人特点，选择治疗方案时侧重于口服治疗而非化疗，口服用药方便快捷，简化了治疗流程，减轻了病人的时间负担。免疫疗法比单独化疗具有更高的治疗收益，且病人的时间毒性未见明显升高[49]。因此，在治疗方案的选择中需要关注更多的免疫治疗组合方案，而不是依赖那些需要长期静脉输注、频繁监测的常规细胞毒性药物。
5.2　医护人员提供帮助
为了有效应对病人面临时间毒性的风险，医护人员需要给予病人专业的帮助。首先，护士在癌症病人时间毒性问题的研究和干预中发挥重要作用，护士掌握病人的第一手资料，能够及时识别病人的时间毒性负担，护士通过进行健康教育，提供心理护理，缓解病人的焦虑情绪，使病人正确认识癌症及其治疗带来的时间负担。此外，护士还可以协助病人接受复杂的治疗方案，鼓励病人表达对治疗时间需求的担忧，并与他们共同制定个性化的治疗方案，将时间毒性的影响降到最低。护士通过与癌症病人照护者的有效沟通，及时为照护负担较重的个体，提供技能与情感支持，了解并满足其照护需求。临床医生作为治疗方案的制定者，应积极与病人讨论癌症不同治疗方案的风险、益处以及预期的治疗周期[7]，在治疗方案实施过程中避免进行重复检查。同时，考虑病人及照护者因治疗产生的交通负担，推行不过夜治疗，减少因治疗产生的交通及住宿成本。在临床工作中，需要医护人员紧密协作，共同努力优化时间毒性的干预策略，减轻病人时间负担。
5.3　提高医疗保健系统效率
高效和可及的医疗保健系统可以最大限度地减少治疗耗时，降低病人时间毒性[22]。医疗保健系统效率低下，如等待时间长、护理路径脱节、缺乏科室之间的调度等现象，都会增加病人的时间毒性水平，所有病人都希望减少在输液室以及检查中的等待时间[50]。医院应积极努力简化医疗程序，优化科室之间的调度，减少不必要的预约。随着信息技术的发展并广泛应用于临床工作中，电子分诊工具可以优化就诊流程，辅助判断病人在治疗前是否需要临床医生亲自评估，从而减少病人不必要的就诊时间[51]，大力建设智慧化医院，推行分时段预约诊疗和集中预约服务，推广移动支付、线上查询等服务，提升服务便捷性，有效减轻病人的时间成本。
5.4　构建远程医疗体系
远程医疗在降低病人时间毒性中发挥重大作用，特别是对于居住地偏远的病人来说，通过远程医疗咨询可以减少病人就诊次数以及交通成本[52-53]。此外，远程医疗有助于优化医疗资源配置，身处偏远地区的病人，也可以获得专业的治疗指导。Wardley等[54]引入灵活护理的概念，在初级医疗保健机构（如社区医院），为病人提供就近医疗服务，为病人提供癌症管理与服务，待确诊后转诊至上级医院进一步治疗，待手术或治疗后可返回居住地附近接受后续治疗，可为上级医院有效分流，缓解医疗资源紧张的局面。
6　小结
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时间毒性作为癌症护理中一个关键的概念，对病人的身心健康及预后产生重要影响，目前，我国学者对癌症病人治疗中的时间毒性相关研究相对较少，且尚未开发出时间毒性的特异性评估工具。为了应对癌症病人治疗中的时间毒性，本研究通过综述时间毒性的概念、影响因素及危害等，可以帮助我国学者继续深入研究癌症病人的时间毒性，开发出时间毒性的特异性评估工具，制定更多减轻时间毒性的干预措施，探索时间毒性在不同癌症群体中的影响，进一步明确其对癌症治疗的影响，以更好地指导临床护理实践。

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2026年第40卷第4期
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doi: 10.12102/j.issn.1009-6493.2026.04.025
  • 接收时间：2024-11-17
  • 首发时间：2026-10-28
  • 出版时间：2026-02-25
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  • 收稿日期：2024-11-17
  • 修回日期：2026-01-29
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    1山东第二医科大学，山东 261053
    2山东第一医科大学
    3山东第一医科大学附属省立医院

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杨丽娟，E-mail：
YANG Lijuan， E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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