Neuropathy trajectory informed by algorithm-based alerts from remote symptom monitoring (RSM) tool in breast cancer practice.

11114 Background: The prevalence of chemotherapy-induced peripheral neuropathy (CIPN) ranges from 19% to over 85% 1 . In breast cancer (BC) adjuvant treatment, 40% of women report numbness and tingling after two years with 10% stating the symptoms are severe 2 . Risk factors include age, pre-existing neuropathy (PN), and treatment with taxanes and platinum-based drugs. This study explored the trajectory of neuropathy in data from remote symptom monitoring (RSM) in breast cancer practice. Methods: Women undergoing BC treatment who enrolled in Carevive PROmPT, an RSM tool, between 9/1/2020 and 11/29/2023 were included. A composite score (derived from PRO-CTCAE) using presence, severity, and interference reports symptoms as mild, moderate or severe. Mild symptoms are discussed at the next clinical visit while moderate/severe symptoms trigger an alert to the care team for immediate evaluation and mitigation. Analysis of neuropathy trajectory was conducted in patients who did not have PN at baseline, examining time to first neuropathy report and time to alert trigger due to severity. Age at first neuropathy, duration of therapy, cancer stage, race, CIPN drugs use, and the level of neuropathy interference was explored. Results: A total of 519 BC patients with one or more alerts were included, of whom 177 (34.1%) reported moderate/severe neuropathy at least once. Of 7,641 total alerts generated, 10.5% were associated with neuropathy. Nearly 40% (n=74) of patients had PN, with median age was 58.5, 31% late stage, 32% Black/African American, and 61% having prior CIPN treatment. About 58.2% of patients (n=103) did not have PN at baseline; of whom neuropathy was first reported over a median of 42 days (IQR: 17.5, 70.5) from baseline and 53.4% of patients (n=55) had mild neuropathy at first report, which then progressed to moderate/severe at a median of 28 days (IQR: 14, 79). About half of patients (52%) described the first neuropathy interference to be a little bit or somewhat. Patients with mild first occurrence of neuropathy (n=55) were then stratified by time to first neuropathy alert (moderate/severe) from first report: 0-28 days (n=28) and >28 days (n=27). For the two groups, median age at first neuropathy was 51 and 49, duration of treatment was 2.4 and 4.4 months, late stage was 18% and 15%, Black/African American 32% and 22%, and receiving CIPN drugs at alert was 24% and 29%, respectively. The most prevalent level of interference upon alert was described as somewhat (32% vs. 28%, respectively). Conclusions: Breast cancer patients are at risk for developing severe and sustained neuropathy. Patients without PN whose first report of neuropathy was mild, quickly progressed to moderate/severe neuropathy. Physician notification at first report of neuropathy rather than with an alert of moderate/severe neuropathy provides opportunity for earlier intervention and better outcomes.