Impact of remote symptom monitoring on acute care utilization in phase I cancer patients: Secondary analysis of a randomized clinical trial.

1505 Background: Patients with advanced cancer undergoing Phase I therapies often experience high symptom burden and complications, which may result in acute care encounters (i.e., emergency department ED visits and hospitalizations). Few studies have characterized these acute care encounters in Phase I patients. Furthermore, it is unclear if these encounters were avoidable and whether remote symptom monitoring (RSM) could reduce acute care utilization. We performed a secondary analysis of a randomized clinical trial to assess the impact of RSM on ED visits and hospitalizations in Phase I patients. Methods: This is a secondary analysis of a randomized clinical trial comparing specialist palliative care (SPC) alone and SPC+RSM in patients with advanced cancer enrolled in Phase I trials at MD Anderson Cancer Center. The key outcomes were the frequency of ED visits and hospitalizations over 6 months following enrollment. We documented the main presenting symptoms and reasons for acute care encounters. Additionally, two independent reviewers assessed whether these encounters were potentially avoidable, defined as whether timely outpatient involvement (e.g., nursing telephone call, clinic visit) could have prevented the encounter. We compared the outcomes between the two study groups using Fisher’s exact test. Results: Among 100 enrolled patients (mean age 64, 63% female, 33% gastrointestinal cancers, median survival 221 95% CI 171, 271 days), 43 were in the SPC group and 57 were in the SPC+RSM group. 22/43 (51%) SPC patients and 30/57 (53%) SPC+RSM patients had at least one ED visit over 6 m (P=0.61, Table). 15/43 (35%) SPC patients and 21/57 (37%) had at least one hospitalization over 6 m (P=0.63, Table). Only 4/84 (5%) ED visits and 0/100 (0%) of the admissions were deemed avoidable. The most common presenting symptoms were pain (ED 27%, hospitalizations 30%) and respiratory distress (ED 23%, hospitalization 23%). The main reasons for acute care encounters were disease progression (ED 49%, hospitalizations 58%), acute complications (ED 26%, hospitalizations 28%) and treatment-related complications (ED 13%, admissions 11%). Conclusions: Phase I patients had high rates of ED visits and hospitalizations even when they were followed by SPC. The addition of RSM did not reduce the rates of these encounters. A vast majority of these visits were deemed unavoidable, attributed to disease progression and acute complications. These findings underscore the need for novel interventions to support Phase I patients as they navigate the acute care system near the end of life. Clinical trial information: NCT04989556 . Frequency of acute care utilization over 6 months in phase I patients. ED Visits ED Visits Hospitalizations Hospitalizations # of visits SPC n=43 (%) SPC+RSM n=57 (%) SPC n=43 (%) SPC+RSM n=57 (%) 0 21 (49) 27 (47) 25 (58) 36 (63) 1 16 (37) 16 (28) 14 (33) 12 (21) 2 4 (9) 8 (14) 3 (7) 7 (12) 3 1 (2) 5 (9) 1 (2) 1 (2) 4 0 0 0 0 5 1 (2) 1 (2) 0 1 (2)