Abstract PS5-09: Feasibility of an Interactive Care Plan for Self-Management of Toxicity Symptoms and Surveillance for Non-Metastatic Disease in Breast Cancer Survivors

Abstract Purpose: To assess the feasibility of an app-based interactive care plan (ICP), a self-management and surveillance tool, in breast cancer (BC) survivors, after completion of active medical treatments. Methods: A single arm feasibility trial of patients who recently completed active BC treatments was conducted. ICP tasks were delivered for 12 months, and included: (1) daily “Be active at least 20 minutes today” activity reminders; (2) monthly assessments of four treatment-related toxicity symptoms: fatigue, insomnia, sexual dysfunction, and hot flashes (Likert scale 0-10); (3) monthly surveillance questionnaires assessing for symptoms of recurrence; and (4) quarterly quality of life (QOL) PROMIS 29 s (scored on a T-score metric with 50 being the mean of a general US adult reference population, 10 is the standard deviation and higher scores denote more of the tested outcome). On-demand education was available for the four self-reported toxicity symptoms. Positive answers to recurrence assessments and high anxiety and depression subscale scores of the PROMIS questionnaires escalated through decision trees embedded in the ICP to nurses who contacted the patient. The primary outcome was feasibility defined as 75% ICP tasks completion rate and <1 escalation/participant. Secondary outcomes were changes in toxicity symptom burden and in QOL. PROMIS scores were assessed between baseline and 6-months using paired t-tests tests. Results: 101 patients were enrolled between August 2020 and May 2022, and the intervention was completed on May 2023. Three withdrew during the study period. Mean participant age was 56 years (range 30-78) and 97% were white. Of the daily “Be active” reminders, a median of 26.6% were checked (53.3% at month 1 decreasing to 6.7% at month 12). Similarly, 53.8% of the monthly toxicity and surveillance symptoms questionnaires were answered (84.7% at baseline to 6.1% at month 12) and 40.0% of the quarterly QOL questionnaires were answered (66.3% at baseline and 18.4% at month 12). The care team received 251 messages over the 1 year intervention, of which 90 (0.9/participant) were escalations related to symptoms worrisome for recurrence (68) and to anxiety or depression (22). The remainder 161 messages were related to restarting the ICP after dismissal from a hospital admission (52) and the need to discontinue the ICP at the completion of the intervention (106). Among the treatment-related symptoms assessed at baseline, hot flashes was most frequently endorsed (48.2%), followed by fatigue (34.9%), insomnia (22.9%), and sexual dysfunction (13.3%). At baseline, 34.9% of participants noted treatment-related fatigue (average intensity of 4.6 on a 0-10 point scale), and this endorsement was near 30% for the first few months before dropping gradually. Among those reporting fatigue at baseline, 54% of them requested additional information to help better understand and manage the symptom. Similar trends were observed for the other treatment related symptoms. At baseline, the PROMIS T-scores were generally near the population average of 50. Comparing baseline to month 6 among 24 participants with complete data at both time points, the average physical function T-score increased from 47.9 to 50.5 (p=0.03), depression T-score decreased from 49.3 to 46.0 (p=0.006), and social roles/activities T-score increased from 53.7 to 56.3 (p=0.02). Conclusion: Implementation of an app-based ICP in BC survivors was feasible although engagement decreased over time. The impact of escalation messages to the care team was minimal, therefore clinical implementation of the ICP is acceptable. Findings were difficult to compare over time due to a drop in response rate for the monthly surveys. Further improvement of the ICP with patient input is needed, to increase engagement and interest. Citation Format: Marcia Venegas Pont, Aparna Kaur, Samatha Mannion, Jennifer L. Ridgeway, Summer Allen, Lisa Ahlberg, Kathryn J. Ruddy, Stephanie Lindeen, Sarah Jenkins, Tufia C. Haddad, Daniela L. Stan. Feasibility of an Interactive Care Plan for Self-Management of Toxicity Symptoms and Surveillance for Non-Metastatic Disease in Breast Cancer Survivors [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS5-09.