The hidden burden: Quantifying administrative time costs and distress for patients with metastatic breast or advanced stage ovarian cancer.

601Background: Cancer care imposes not only physical and emotional burdens, but also a significant administrative workload on patients through tasks such as scheduling appointments, managing bills, or arranging transportation. This time cost is rarely measured, but represents a modifiable source of distress and inefficiency. We sought to measure the time spent on administrative tasks related to cancer care among individuals receiving treatment for metastatic breast cancer or advanced-stage ovarian cancer. Methods: We recruited individuals with metastatic breast cancer or advanced stage ovarian cancer receiving treatment at the University of Minnesota (UMN) and University of Alabama-Birmingham (UAB). Participants utilized a mobile application for 28 days, reporting healthcare encounters and completing daily surveys regarding time spent on cancer-care related activities outside of the healthcare appointments, including administrative tasks such as scheduling appointments, managing insurance and medical bills, and arranging transportation and other help, and daily distress. Results: 60 individuals provided data for this analysis: 32 (53%) with metastatic breast and 28 (47%) with advanced stage ovarian cancer. Median age was 59 years, 42% were employed, and 57% were on treatment for recurrent or progressive disease. Participants reported spending a median of 13 minutes per week (range 0-242 minutes) scheduling appointments, managing medical bills and insurance claims or arranging transportation or assistance; while some participants spent little time on these tasks, the top quartile spent one hour or more on these tasks per week. Individuals without reliable transportation reported on average more time spent on administrative tasks per week (78.4 minutes vs. 30.6 minutes, p=0.03). Other demographic and clinical factors such as age, employment status, insurance type, cancer type, disease status, and time spent on direct healthcare were not associated with time spent on administrative tasks. Participants completed at least one cancer-related administrative task on 18% of days, and those days were associated with significantly higher distress compared to days without administrative tasks (p<0.0001). Conclusions: Engaging in cancer-related administrative tasks is associated with higher distress among patients. While these tasks may seem minor in isolation, cumulatively they take valuable time from patients and can reduce quality of life. As administrative burden represents an actionable target, future research should concentrate on identifying effective and scalable strategies to reduce its impact within healthcare and related settings.