Time Toxicity in Advanced Breast Cancer: Psychological Burden, Psychiatric Vulnerability, and Implications for Patient-Centered Decision-Making.

The paradigm shift toward precision oncology in advanced breast cancer has increased therapeutic complexity, prolonging survival for many patients while simultaneously expanding the temporal burden associated with cancer care. Time toxicity, defined as the cumulative time spent receiving, accessing, coordinating, and recovering from medical interventions, is increasingly recognized as a clinically meaningful but still under-assessed dimension of patient-centered value. Beyond its organizational and economic implications, time toxicity may exert profound psychological and psychiatric effects, particularly in patients with advanced disease, for whom time represents not only a practical resource but also an existential, relational, and emotional domain. This narrative review examines how objective and subjective dimensions of time toxicity may inform patient-centered decision-making in advanced breast cancer. We summarize current evidence on the temporal demands of cancer care in advanced breast cancer and their psychological and relational consequences, focusing on how these factors can be discussed in patient-centered treatment decisions. From a value-based oncology perspective, the review examines how treatment optimization, subcutaneous formulations, oral therapies, telemedicine-based surveillance, decentralized care models, and early psycho-oncological assessment may reduce non-value-added time in clinical settings while preserving quality of care. Methodological challenges in measuring time toxicity and correlating it with overall survival, health-related quality of life, anxiety, depression, demoralization, and illness-related distress are also discussed. Incorporating time toxicity into shared decision-making may help clinicians move beyond traditional efficacy endpoints. It may support a more comprehensive approach in which survival benefit, psychological well-being, personal priorities, and the subjective value of time are considered together.