Article(id=1322168471157325948, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168387082502716, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.06.026, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1744819200000, receivedDateStr=2025-04-17, revisedDate=1770912000000, revisedDateStr=2026-02-13, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159128225, onlineDateStr=2026-10-28, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159128225, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159128225, creator=13701087609, updateTime=1793159128225, updator=13701087609, issue=Issue{id=1322168387082502716, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='6', pageStart='881', pageEnd='1056', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159108180, creator='13701087609', updateTime=1793159108180, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1053, endPage=1056, ext={EN=ArticleExt(id=1322168471425761405, articleId=1322168471157325948, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress and implications of time toxicity in cancer patients, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This paper provided an overview of the concept and measurement methods of time toxicity,and summarized its influencing factors and coping strategies.The aim was to help clinical healthcare professionals in China to better understand the connotation of time toxicity,to offer reference for further develop effective measurement tools,and conduct relevant clinical practices and scientific research.

, authors=Jing WANG, Siming YE, Dandan KE, Yiying HONG, Jie LUO, authorsList=Jing WANG, Siming YE, Dandan KE, Yiying HONG, Jie LUO, authorCompany=null, correspAuthors=Jie LUO, authorNote=null, correspAuthorsNote=
LUO Jie, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168471983603838, articleId=1322168471157325948, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=癌症病人时间毒性的研究进展及启示, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

对时间毒性的概念、测量方法进行概述,并总结时间毒性的影响因素及应对策略,旨在为我国临床医护人员更好地理解时间毒性内涵,进一步开发有效的测量工具、开展相关临床实践和科学研究提供参考。

, authors=王净, 叶思铭, 柯丹丹, 洪轶颖, 罗洁*, *, authorsList=王净, 叶思铭, 柯丹丹, 洪轶颖, 罗洁, authorCompany=null, correspAuthors=罗洁, authorNote=

王净,护师,硕士研究生

, correspAuthorsNote=
罗洁,E-mail:
LUO Jie, E-mail:
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癌症病人时间毒性的研究进展及启示
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王净 , 叶思铭 , 柯丹丹 , 洪轶颖 , 罗洁 *, *
护理研究 | 科研综述 2026,40(6): 1053-1056
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护理研究 |科研综述 2026 , 40 (6) : 1053 -1056
癌症病人时间毒性的研究进展及启示
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王净, 叶思铭, 柯丹丹, 洪轶颖, 罗洁*, *
作者信息
  • 1浙江大学医学院附属第一医院,浙江 310000
通讯作者:
罗洁,E-mail:
LUO Jie, E-mail:
作者简介:

王净,护师,硕士研究生

Research progress and implications of time toxicity in cancer patients
Jing WANG, Siming YE, Dandan KE, Yiying HONG, Jie LUO
Affiliations
  • 1The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang 310000 China
  • Corresponding Author:
    LUO Jie, E-mail:
出版时间: 2026-03-25 doi: 10.12102/j.issn.1009-6493.2026.06.026
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对时间毒性的概念、测量方法进行概述,并总结时间毒性的影响因素及应对策略,旨在为我国临床医护人员更好地理解时间毒性内涵,进一步开发有效的测量工具、开展相关临床实践和科学研究提供参考。

癌症  /  时间毒性  /  护理  /  综述

This paper provided an overview of the concept and measurement methods of time toxicity,and summarized its influencing factors and coping strategies.The aim was to help clinical healthcare professionals in China to better understand the connotation of time toxicity,to offer reference for further develop effective measurement tools,and conduct relevant clinical practices and scientific research.

cancer  /  time toxicity  /  nursing  /  review
王净, 叶思铭, 柯丹丹, 洪轶颖, 罗洁. 癌症病人时间毒性的研究进展及启示. 护理研究, 2026 , 40 (6) : 1053 -1056 . DOI: 10.12102/j.issn.1009-6493.2026.06.026
Jing WANG, Siming YE, Dandan KE, Yiying HONG, Jie LUO. Research progress and implications of time toxicity in cancer patients[J]. Chinese Nursing Research, 2026 , 40 (6) : 1053 -1056 . DOI: 10.12102/j.issn.1009-6493.2026.06.026
癌症是我国主要的公共卫生问题之一。近年来,随着免疫治疗和分子靶向治疗等方法的兴起,癌症病人在延长生存期和改善症状方面投入了大量时间成本,被概念化为“时间毒性”。时间毒性是指癌症病人花在治疗和护理相关活动上的时间累计负担[1],包含病人就医通勤、等待、随访检查、接受治疗和管理副作用等花费的时间。时间毒性在癌症晚期和生存期较短的病人中最为显著。已有研究显示,晚期实体瘤病人有20%~30%的时间与医疗保健系统接触,病人日常生活和职业生活中断,幸福感降低,收入损失增加,生活质量和治疗依从性受到严重影响[2-3]。目前,国外研究者已对多种肿瘤病人的时间毒性特征进行了积极探索,而我国关于癌症病人时间毒性的相关报道较少。现对相关研究进行综述,旨在为临床医护人员更好地理解时间毒性内涵、进一步开发有效的测量工具、制定干预方案提供参考。
时间毒性是癌症治疗和护理中的一个重要、但未被充分探索的概念,目前仍缺乏标准化定义。健康成本效益小组建议将病人时间相关成本纳入干预措施的成本效益分析[4],但已有研究较少涉及,从而使较高负担的干预措施成本被低估。Gelber于20世纪90年代提出质量调整的无症状和无毒时间(Q-TWiST)[5]方法,旨在通过结合临床试验的不良事件发生率和生存数据表征病人在有或没有癌症/治疗症状的情况下花费的时间,为当前时间毒性的发展奠定了基础。Nwozichi等[1]将时间毒性定义为癌症病人花在治疗相关活动上的时间累计负担,其特征是日常生活中断、失去有意义活动的机会和情绪压力增加。传统形式的毒性侧重治疗身体副作用(如恶心、疲劳或器官损伤),而时间毒性明确了频繁就诊的负担,如治疗延迟以及长时间输注、随访预约、监测和恢复期等,均会扰乱病人日常生活并影响其整体健康状况。在姑息治疗环境中,提高病人生活质量通常优先于延长生命,然而在临床实际中,频繁的治疗与护理给病人带来较重的时间负担,其较小的治疗相关生存获益可能会被时间毒性抵消。因此,在医护人员为癌症病人制定个性化的治疗和护理方案时,不仅需要考虑临床益处、经济毒性和治疗毒性,还应评估时间毒性。
当前,癌症病人时间毒性的测量方法大致可分为3类。1)Q-TWiST[5]:Q-TWiST是最早提出用于评估接受治疗的癌症病人进出医疗机构时间的方法,其将病人生存时间划分为毒性期、无症状毒性期和复发/进展期,通过量化病人处于不同健康状态的时间比例,间接反映治疗对病人生活质量的综合影响。对于频繁就诊或治疗疗程较长的病人,可能导致毒性期延长或无症状毒性期缩短,从而降低Q-TWiST值。虽然Q-TWiST已在癌症和非癌症环境中被广泛应用,但其作为一种研究方法,仍需要使用效用系数方程确定质量时间权衡,从而限制了不熟悉的临床医生和病人的可及性,且由于其未单独衡量时间资源消耗对病人生活的影响,故具有临床应用有限、直观性较差的局限性。2)医疗保健系统接触天数:该方法是当前最实用、最直观和应用最广泛的测量方法。其将病人有或没有与医疗保健系统接触分别标记为“接触日”或“在家日”,其中“接触日”包括与卫生系统的任何身体接触,如门诊就诊、接受治疗、检查检验随访或住院等。目前,研究者多从电子病历系统提取接触时间数据,部分研究者会根据医疗保险索赔量化医疗保健接触。“接触日”被用作量化时间毒性的首选方法,主要得益于其简单、易量化与易解释的特点,但该方法本身也存在一定的局限性,包括高估了病人时间投入的风险、由于混杂因素低估了医疗保健接触时间(如由于获得护理的机会有限而减少预约)等。3)实时位置系统和地理定位数据:部分研究通过实时位置系统和地理定位数据计算病人就诊时间、通勤时间和停车时间的总和。在医院入口处为病人提供实时定位系统徽章,离开医院时摘下并归还徽章,通过遍布医院的环境传感器(接收器)检测到的红外脉冲记录病人位置,以计算病人就诊花费的时间。通勤时间根据医疗记录中报告的家庭邮政编码并使用地图的SAS函数估计。停车时间通过计算车库停车时间的中位数表示。虽然该方法可对癌症病人接受治疗和护理投入的时间进行全面量化,但其步骤较多、信息化设备需求较大,可能限制其在临床的实施与普及。未来需进一步研究探索智能手机和其他可穿戴技术如何更好地记录数据。
人口学因素主要包括病人的性别、经济状况和居住地等。1)性别:Johnson等[6]研究结果显示,女性更容易存在时间毒性,这可能是由于女性与男性相比承担着更多家庭照护任务和家务负担,时间相对匮乏。2)经济状况:Johnson等[6]研究结果显示,经济状况越差的病人越有可能存在时间毒性,这可能是由于经济状况较差的病人负担不起节省时间的一些资源,如可靠的托儿服务和最便捷的通勤方式。一项针对转移性乳腺癌病人的横断面调查显示,20%的病人无法负担每个月支出的费用,超过40%的癌症幸存者在诊断出癌症后会换一份要求较低的工作,其时间毒性因经济压力而加剧[7]。3)居住地:与居住在城市的病人相比,居住在农村或距离医疗机构较远地区的病人需要投入更多时间接受相同的护理[8]。Rocque等[9]对23 382例老年癌症病人进行回顾性分析,结果发现,病人就医通勤时间越长住院风险越高,通勤时间>1 h的病人比通勤时间≤30 min的病人住院率高4%~13%。
癌症病人的疾病诊断时机、治疗方案、给药方式、合并症和并发症等均会影响其时间毒性。1)疾病诊断时机:疾病诊断时机对癌症病人时间毒性起着至关重要的作用。晚期或转移性癌症通常需要更复杂的治疗方案和更长的治疗时间,早期诊断可以带来更好的结果并减轻治疗的总体时间负担[10]。2)治疗方案和给药方式:癌症病人时间毒性因治疗方案和给药方式存在差异,如与未接受放疗的病人相比,接受放疗的病人与更多的就诊天数相关[11];与接受口服药物治疗的病人相比,接受静脉输液/皮下注射治疗的病人在门诊护理中花费的时间更长[12];与接受激素药物治疗的病人相比,接受化疗的病人医疗保健接触时间更长。Sentana-Lledo等[13]研究后发现,晚期肾细胞癌治疗病人存在多种疗效相近的一线疗法,病人可选择静脉输注检查点抑制剂或口服酪氨酸激酶抑制剂,提出临床医护人员应为病人提供不同治疗方案的医疗保健接触时间,为病人的治疗决策提供参考。3)合并症:已有研究结果显示,≥2种合并症的癌症病人住院时间延长,医疗保健接触率较高[11,13-14]。针对肺癌病人的研究结果显示,合并症数量与再住院率呈正相关[15-16]。这可能是因为有合并症的癌症病人免疫系统对肿瘤产生有效反应的能力受损,对各种治疗的耐受性更差。4)并发症:并发症会导致病人计划外就诊、急诊就诊和再入院治疗,从而增加病人的时间毒性。关于癌症病人全身治疗和放疗相关并发症的系统评价表明,接受联合治疗的病人并发症数量更多,至少有1种并发症的病人住院率超过50%[17]。
医疗保健系统效率低会加剧癌症病人的时间负担。美国国家综合癌症网络调查报告显示,病人在输液中心的平均等待时间为25~102 min[18]。且研究发现,病人单次门诊就诊的平均时间约为2 h,其中只有20 min用于病人与临床医生面对面的直接互动,即使是简单的抽血项目也需要花费至少2 h,这对于有家属陪同的病人来说,时间损失会成倍增加[19-20]。此外,一项研究调查了胰腺癌病人姑息性化疗相关的时间毒性,结果显示,病人10%的生存时间花费在门诊医疗保健上,其中一半以上的时间花在通勤和等待护理上[21]。可见,高效和可及的医疗保健系统在减轻病人时间负担方面具有重要作用。
制定标准化的评估工具是量化每种治疗方案时间毒性的关键,也是为病人提供治疗益处与潜在毒性相关信息的前提,有利于辅助病人治疗决策。如当病人知晓选择治疗方案A剩余的9个月中平均有3个月将离家度过(门诊输液或住院治疗等),但选择治疗方案B剩余的7个月均将在家中度过时,病人可能会以不同的方式看待治疗。然而,临床医生通常缺乏相关信息,无法帮助病人根据时间对他们的影响做出充分、明智的决策[22]。因此,未来研究需进一步开发标准化和全面性的评估工具,包括病人就医通勤、随访检查、输液治疗、取药、候诊、门诊就诊、急诊科就诊、住院治疗、在护理/康复机构的时间、家庭护理和协调护理(如与保险公司通电话)等时间,通过标准化评估工具比较不同病人所经历的时间负担,并用于评估减少时间毒性干预措施的有效性。
就医通勤负担是改变病人治疗决策的重要因素之一[23],可导致病人延迟干预、焦虑增加和生活质量降低。推行就近医疗、远程医疗和“互联网+护理服务”相结合的新模式可有效增加病人就医灵活性,缩短就医通勤时间,降低延迟治疗发生率。对于居住在偏远地区、交通不便的病人,可推荐其采用就近医疗(初级保健机构)或远程医疗等方式,最大限度地减少不必要的行程和通勤时间。Patel等[24]基于综合癌症中心进行数据统计,结果显示,11 688例癌症病人共进行了25 496次远程医疗就诊,节省了相当于绕地球152.2圈的往返里程,门诊就诊时间额外节省29 626 h。在安全、经济状况可行及符合病人偏好的情况下,可选择“互联网+护理服务”。Bange等[25]对345例癌症病人进行家庭静脉采血服务,使病人在家中即可获取血液检查结果,避免到医院随访后因血液检查结果不达标而延迟治疗,优化了病人日程安排,节省了病人就医通勤和等待时间,提高了病人诊疗便利性。然而,当前还存在初级保健机构专业人才匮乏、老年病人对智能设备使用不佳等问题,未来需进一步通过城乡医疗资源下沉与管理帮扶、简化“互联网+护理”平台操作方法、加强病人线上医疗的健康教育等措施,减轻病人的时间负担。
在不影响病人治疗效果的情况下,可采用缩短化疗周期、调整治疗方案、改变给药途径等方式减轻病人时间负担。Franken等[26]针对化疗周期的研究结果显示,在低危Ⅲ期结直肠癌病人中,辅助化疗6个月与3个月疗效相当,3个月化疗组的病人时间毒性降低50%,神经毒性发生率下降。Wong等[27]对晚期前列腺癌病人的治疗偏好进行调查,共制定3种治疗方案,即每天口服A药物、每个月皮下注射1次B药物、每6个月皮下注射1次C药物,结果显示,尽管使用C药物后心血管并发症发生风险较高,病人仍因便利性将C药物作为首选。一项针对不同给药途径的研究结果显示,与静脉内给药相比,皮下注射是癌症病人和医疗保健提供者的首选,不仅可以缩短治疗时间,还可以减少经济成本[28]。Gupta等[29]研究后发现,几乎一半的晚期癌症病人在考虑治疗方案时会自发提出治疗相关的时间负担问题。鉴于国内外文化存在差异,未来我国研究者可进一步探索基于我国癌症病人的时间毒性主观体验研究,了解病人对癌症治疗的偏好,制定个性化的治疗方案和给药方式,减少药物治疗带来的时间负担。
医疗保健效率低包括等待时间长、护理路径脱节以及缺乏以病人为中心的调度实践,解决这些障碍需要努力简化护理流程,并优化调度实践。已有研究表明,接受输液治疗的病人门诊花费时间最长[20],这是由于临床实际中,癌症病人输液治疗前需要经过较多步骤,如实验室检查、等待结果、临床医生评估等。已有研究结果显示,基于问卷等方式的分诊工具可用于确定病人是否需要进行治疗前临床医生面对面的评估,允许实验室检验结果正常的病人省略临床医生评估,从而减少不必要的就诊[30-31]。脑转移肿瘤切除术后较短时间间隔内进行切除腔放疗对降低疾病复发风险至关重要,Moss等[32]通过多学科团队方式简化了术后至放疗期间的护理流程,使病人手术至放疗的时间间隔从27 d下降为14 d,手术和放疗间进行>1次磁共振成像/计算机断层扫描的病人比例从45%下降为13%,手术和放疗之间的就诊次数从5次下降为4次,有效减轻了病人和医疗保健系统的负担。在临床实践中,可设立肿瘤多学科诊疗中心,整合各项检验、检查预约系统,智能分配相邻时间段进行检查,并通过分诊工具减少不必要的就诊,减少病人多次往返。
在病人生存期有限的情况下,时间毒性可能会影响病人生活质量和治疗决策。我国研究人员可参考已有研究经验,积极分析我国不同群体病人的时间毒性现状,并采用离散选择实验等联合分析技术,进一步探索时间毒性对癌症病人姑息治疗偏好的影响,更深入地了解癌症病人面临的时间负担,从而及时干预。

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doi: 10.12102/j.issn.1009-6493.2026.06.026
  • 接收时间:2025-04-17
  • 首发时间:2026-10-28
  • 出版时间:2026-03-25
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  • 收稿日期:2025-04-17
  • 修回日期:2026-02-13
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    1浙江大学医学院附属第一医院,浙江 310000

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罗洁,E-mail:
LUO Jie, 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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