Randomized trial of a telehealth post-discharge supportive care intervention for hospitalized patients with advanced cancer.

355 Background: Hospitalized patients with advanced cancer face a challenging post-discharge care transition due to their high symptom burden. Post-discharge interventions are needed to address the unique needs of this population. Methods: We conducted a randomized controlled trial of CONTINUUM (Continuity of Care Under Management by video visits), a post-discharge telehealth intervention for patients with advanced solid tumors. The primary aim was to assess the effect of CONTINUUM on the Patient Activation Measure-13 (PAM-13), a measure of patients’ confidence in managing their health condition, which is associated with decreased health care utilization. From 12/2021-01/2025, we approached English-speaking patients with advanced solid tumors during their first unplanned hospitalization since advanced cancer diagnosis who were preparing for discharge to home without hospice. Enrolled patients were randomized 1:1 to CONTINUUM or usual care. Those assigned to CONTINUUM received a telehealth visit with an oncology nurse practitioner within 3 business days of hospital discharge to address symptoms, in addition to usual scheduled oncology appointments. Patients in the control group attended their usual appointments. Participants completed questionnaires at baseline and 10-20 days post-discharge. Secondary outcomes included physical symptoms (Edmonton Symptom Assessment System-physical [ESAS-p]), psychological distress (Patient Health Questionnaire-4[PHQ-4]), satisfaction with communication (Consumer Assessment of Healthcare Providers and Systems Communication Subscale [CAHPS]), and 30-day hospital readmissions. We used analysis of covariance to assess the between-group differences in post-discharge outcomes, adjusting for baseline scores, and Fisher’s exact test to compare the proportion with hospital readmission. Results: Of 286 enrolled patients (mean age: 64.5 years; 50.0% female; 85.3% White; 46.2% gastrointestinal cancers), the most common reason for admission was symptom management (62.5%). Patient activation declined between time points in both groups, but post-discharge PAM-13 scores did not differ between intervention and control group (adjusted mean: 62.5 vs. 65.3, respectively, p = 0.162). Physical and psychological symptoms did not differ between groups (ESAS-p adjusted mean: 26.6 vs. 25.1, P = 0.368; PHQ-4 adjusted mean: 2.7 vs. 2.3, p = 0.245). CAHPS scores were similar between groups (unadjusted mean: 18.9 vs. 18.8, p = 0.839). We found no significant difference in the 30-day hospital readmission rates (27.7% vs. 29.2%, p = 0.794). Conclusions: CONTINUUM did not improve patient-reported outcomes or hospital readmission rates in recently hospitalized patients with advanced cancer. Future studies should explore targeted home-based and longitudinal interventions to enhance post-discharge care for this patient population. Clinical trial information: NCT05142345 .