What the Oncology Field Can Learn from The White Lotus
Expert Perspectives · Rahul Banerjee, MD, FACP · 2025-04-30
In 2024, I wrote an Oncology Data Advisor® Letter From the Editor about what the oncology field can learn from former president Jimmy Carter. The title of this column, pertaining to Season 3 of a wildly popular TV show, seems more flippant in comparison, but truly no less heartfelt.
In brief, some things in both Thailand-based TV and reality-based cancer care are clearly toxic to all: take, for example, the pong-pong fruit introduced in the first episode of this season. For just about everything else, the perceived toxicity of any activity varies immensely from person to person. A cruise on a private yacht can be quite relaxing for some but lorazepam-invoking for others. This same principle applies for the choice between a relaxing versus a more music-filled resort, even within a like-minded “cohort” of vacationers traveling together.
There are parallels between this observation and “time toxicity” in oncology, which is defined as the presence of frequent healthcare-related interactions that can interfere with patient wellbeing. For many patients with cancer, time toxicity is a key determinant of decision making for treatment preferences. While quantifying the number of healthcare-related interactions for a patient living with cancer is perhaps an easier task, predicting a time-toxicity grade for any given interaction can be tough. The perceived time toxicity of an interaction will depend heavily on patient values, disease status, the opportunity cost of traveling, and more.
I have thought about this topic a fair amount recently, given repeated uncertainty about Medicare coverage for telehealth visits (now guaranteed through September of this year). How important is it for a patient to see me in person rather than via telehealth—or not at all—on a day where they wouldn’t otherwise be coming into clinic? I have been pleasantly surprised by the number of my patients who would unhesitatingly choose in-person visits even with the increased time toxicity that comes from driving, parking, and waiting for my often-behind clinic to catch up. Some patients prefer seeing doctors in person out of habit, others feel that in-person visits allow for more natural discussions, and some patients just prefer having a reason to get out of the house. Of course, other patients may prefer more of a hybrid approach. The answer will vary from patient to patient and even from month to month.
There is thus, of course, no easy answer for predicting what permutation of in-person and telehealth visits a patient will find the most appealing—or to be accurate, the least unappealing—when navigating cancer care. The only solution is to ask the patient preemptively and periodically about what is working well versus not so well. After all, time toxicity can only be recognized when it is inquired about. The same can be said about a recurring character in The White Lotus across all three seasons, but to learn more, you’ll have to watch the show…
About Dr. Banerjee
Rahul Banerjee, MD, FACP, is an Assistant Professor in the Division of Medical Oncology at the University of Washington. He also holds a faculty appointment at the Fred Hutchinson Cancer Center in Seattle, Washington. Dr. Banerjee previously completed his Hematology/Oncology Fellowship and Advanced BMT/CAR-T Fellowship at the University of California, San Francisco. His clinical interests are in multiple myeloma, AL amyloidosis, and CAR-T therapy. His research interests are in toxicity management, digital health, and the patient experience.