Abstract PS5-11-26: Financial Toxicity and Patterns of Severe Symptom Burden in Patients with Breast Cancer Informed by Digital Remote Symptom Monitoring (RSM) Deployed in Clinical Practice

Abstract Background The negative effects of medical costs on patients, referred to as financial toxicity (FT), are associated with decreased quality of life, increased distress, and lower adherence to treatment (Lee 2025). Patients with breast cancer (BC) are at risk of poor financial outcomes (Huang 2024) as BC requires multimodal treatments. A recent JCO: Oncology Practice series underscored the need for highlighting patient experience and encouraged innovation to address FT across subgroups (Chino 2025). Digital remote symptom monitoring (RSM) platforms, with electronic patient-reported outcomes (ePROs)-driven alerts and baseline FT screening, provide a unique means to explore FT and outcomes. This study evaluated baseline FT and its association with severe symptom burden in women with BC informed by RSM deployed in clinical practice. Methods Patients with BC who enrolled in Carevive PROmpt®, a digital RSM platform, between 9/2020 and 5/2025 were included. Patients completed Comprehensive Score of Financial Toxicity (COST) at baseline, a 12-item survey with five-point Likert scale (“Not at all” to “Very much”). High FT (HFT) was defined as scores =24 and low FT (LFT) as scores 24. Patients completed weekly symptom (SX) reports measured by PRO-CTCAE®. Composite scores rated the SXs as mild, moderate, and severe, where moderate and severe SXs generated “alert” notifications to the care team. Baseline characteristics were described and compared by FT status. Severe symptom burden, defined as number of alerts per week and time to first alert, was analyzed. Multivariate analyses to assess the correlation between FT and severe symptom burden were conducted, with covariates including age, race, and frailty status. Results A total of 197 patients were included and stratified by HFT (n=101) and LFT (n=96). Overall median FT score was 24, median age was 54, 30.5% Non-white (57 Black, 3 Asian), and 49.2% late-stage disease. Median age of HFT group was younger than LFT (50 vs 61.5, p0.001). More Non-white patients reported HFT than Whites (67% vs. 41.5%, p=0.00174), and more patients in the Intermediate Fit/Frail group experienced HFT than the Fit group (65.9% vs. 40.4%, p=0.00163). FT was not statistically different by biomarker or stage. Median follow-up was 22 weeks with no difference by FT. A subset of 171 (86.8%) women reported moderate or severe symptoms that triggered an alert at least once. Median number of alerts per week was slightly higher in HFT compared to LFT (1.5 vs. 1.4, p=0.04). Patients with HFT showed directional triggering of initial alert earlier than LFT (median 35 vs. 49.5 days), but result was not statistically significant (p=0.08). Median number of SXs per week was higher in HFT than LFT (7 vs. 4.8, p0.001). This difference was confirmed in the multivariate model, where HFT (β=1.9, p=0.01) and frail (β=2.6, p=0.0003) increased the number of SXs per week. When examining the number of alerts per week, however, neither frail status nor HFT was significantly associated in the multivariate model. Similar results were observed when measuring time to first alert. Sensitivity analysis assessing a correlation between frailty and number of alerts showed that frail status increased the number of alerts (β=0.23, p=0.01), yet this effect was attenuated when FT status was added to the model. Conclusion We demonstrated the use of digital RSM with an ePROs-driven alert and FT screening in a multicenter BC practice setting. Results showed half of patients reported HFT at baseline, with younger, non-white, and intermediate fit/frail at higher risk. HFT and frailty were associated with higher volume of overall SXs. Results also raise the question of underreporting severe SX in HFT patients and avoidance of additional financial burden. Future studies exploring this topic are warranted. Citation Format: E. Rusli, A. Galaznik, D. Wujcik. Financial Toxicity and Patterns of Severe Symptom Burden in Patients with Breast Cancer Informed by Digital Remote Symptom Monitoring (RSM) Deployed in Clinical Practice abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-26.