473 Background: Despite the inclusion of mind-body approaches, such as yoga, meditation, exercise, and music therapy, into various clinical guidelines for managing cancer-related symptoms, there is no scalable approach to integrate these guidelines into oncology care delivery. This study aimed to evaluate the effectiveness of Integrative Medicine at Home (IM@Home), a virtual mind-body fitness program, on unplanned hospitalizations and urgent care visits among patients undergoing active cancer treatment. Methods: We conducted a pragmatic randomized clinical trial using a novel basket study design among patients with a diagnosis of breast, thoracic, gynecological, head/neck, or melanoma cancer who reported moderate or greater fatigue while receiving active cancer treatment. Eligible participants were randomized to IM@Home (choice of 20+ weekly virtual live mind-body and fitness classes) or enhanced usual care (EUC; standard of care plus access to 20+ pre-recorded online meditation resources) and were on the study for 12 weeks. Utilization of hospital services over the study period was collected from electronic medical records and compared between arms. Results: Among 200 patients (mean age 59.9 years) 181 (90.5%) were female, 155 (77.5%) white, 18 (9.0%) Black, 14 (7.0%) Asian, and 178 (89.0%) non-Hispanic. 73 (36.5%) patients had breast, 49 (24.5%) thoracic, 43 (21.5%) gynecological, 25 (12.5%) head/neck, and 10 (5.0%) melanoma cancer. 99 patients were randomized to IM@Home and 101 to EUC. During the study period, patients in the IM@Home group were less likely to be hospitalized (5 [5.1%] vs. 14 [13.9%], p=0.034) and spent fewer days in the hospital (5.4 vs. 9.4 days per patient, p=0.009). The proportion of patients with urgent care visits was similar between the study arms (9 [9.1%] IM@Home vs. 12 [11.9%] EUC, p=0.52), but the number of urgent care visits per patients was almost half in IM@Home vs. in the EUC arm (rate ratio=0.52, 95% confidence interval: 0.26, 0.98). Conclusions: Participation in the virtual IM@Home program reduced unplanned hospitalizations, number of hospitalization days, and urgent care visits among people with cancer undergoing active treatment. Future research with long term follow-up is needed to determine whether IM@Home may be a scalable solution for implementing evidence-based mind-body fitness programing to improve patient survival outcomes and reduce health care costs. Clinical trial information: NCT05053230 .