Ronald Chow

DPhil in Evidence-Based Health Care

Thesis

Measuring and Defining Time Toxicity in Cancer Pharmacologic Trials

Research abstract

Each year, approximately 20 million cancer cases are diagnosed globally. Of these, nearly 60% benefit from pharmacotherapy. While pharmacotherapy offers survival benefits and reduces recurrence risk, it also causes significant toxicity. Common physiologic toxicities such as nausea and vomiting, fatigue, and dyspnea have been well-documented for decades. Unmanaged, these can lower quality of life and lead to non-adherence, diminishing treatment effectiveness.

Recently, attention has turned to non-physiological toxicities of pharmacotherapy. Two important examples are financial and time toxicity. These reflect the economic and temporal burdens of care, both of which can affect whether patients are able to start, continue or complete treatment. Patients may spend much of the survival time gained from novel therapies in healthcare facilities, with considerable personal cost.

Financial toxicity is increasingly recognised, with validated instruments available to assess it. By contrast, time toxicity is a newer concept, poorly defined, and lacks a validated framework. Most existing work on non-physiological toxicity has focused on patients receiving routine care. Yet clinical trials are the foundation of drug approval and often impose additional visits, investigations and monitoring beyond routine care, which may amplify both financial and time toxicities. Understanding these burdens is essential, as they can deter enrolment, contribute to attrition, and limit the equity and generalisability of trial findings.

Given this gap, the research question is: How much time toxicity do cancer patients experience in trials, and how can it be measured? My thesis will review existing evidence and contribute primary research on time toxicity, and measurement tools

Supervisor(s)

Georgia Richards (https://www.phc.ox.ac.uk/team/georgia-richards)

Carl Heneghan (https://www.phc.ox.ac.uk/team/carl-heneghan)

Biography

Ronald Chow is a DPhil student at the University of Oxford and a resident physician at the University of Toronto (Canada).

He studied epidemiology at Yale University. He trained as a research intern/fellow at Mass General Brigham, Harvard University, and New York Proton Center, Memorial Sloan Kettering Cancer Center. He is an accredited statistician. He is a Fellow of the American College of Epidemiology, and Fellow of the Royal Society for Public Health

He studied biomedical engineering at the University of Toronto. He is a Member of the Institute of Healthcare Engineering and Estate Management.

Publications

List available at: https://grabify.link/FPEM5G

Research interests

  • Clinical epidemiology
  • Oncology
  • Evidence synthesis
  • Software as medical device