Abstract
11001 Background: Patients (pts) receiving cancer treatment frequently experience burdensome symptoms that compromise outcomes and necessitate acute care. Prior clinical trials have demonstrated that electronic patient-reported outcome (ePRO)-based symptom management programs improve outcomes in controlled settings. Deploying these programs in routine care settings remains challenging. With funding from the Cancer Moonshot IMPACT Consortium, we created eSyM – an ePRO-based, EHR-integrated symptom management program – to facilitate the widespread adoption of active symptom management efforts. Methods: eSyM was deployed across six health systems from September 2019-August 2022 via a modified stepped-wedge cluster randomized pragmatic trial. Pts starting chemotherapy (CHEM) or undergoing surgery (SURG) for a suspected or confirmed thoracic, gastrointestinal, or gynecologic cancer were prompted to complete symptom questionnaires regularly; those reporting symptoms were offered additional supports. To assess eSyM efficacy, we studied pts who were eligible to use the program – comparing those who completed at least one symptom questionnaire to those who did not. Outcomes included emergency department (ED) visits and inpatient encounters (INPT) at 30 and 90-days. Odds ratios with 95% CIs were derived after adjusting to account for the propensity to report ePROs as a function of age, sex, race/ethnicity, employment, marital status, poverty, rurality, insurance, comorbidity, cancer, treatment goal, institution, and calendar time. Results: Among eSyM-eligible pts, 51% (N = 10,454/20,471) completed at least one symptom questionnaire (median 4 reports/patient) – 47% (3815/8187) for CHEM and 54% (6639/12,293) for SURG. Comparing symptom reporters to non-reporters, the proportion of CHEM+SURG pts experiencing an ED event was 5.3% vs. 7.1% at 30 days and 10.0% vs. 12.9% at 90 days; and the proportion experiencing an INPT event was 6.7% vs. 11.3% at 30 days and 14.0% vs. 19.5% at 90 days ( p< 0.001 for all). Adjusted ORs appear in the. Conclusions: After accounting for propensity to report symptoms, completing at least one symptom questionnaire was associated with lower odds of experiencing an ED or INPT encounter among CHEM and SURG pts across six diverse health systems. eSyM engagement reduced acute care utilization. This EHR-integrated symptom management solution is broadly available to health systems that use Epic. Clinical trial information: NCT03850912 . [Table: see text]
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