Abstract PS1-03-14: Spire-bc: a clinically-integrated prognostic tool to identify breast cancer patients in need of early supportive care

Abstract Background: Early supportive care integration improves quality of life and may enhance survival in patients with advanced breast cancer. However, identifying the right timing and patient subset for such interventions remains a challenge in routine clinical settings. SPIRE (Supportive care & Prognostic Insights in Risk Evaluation) is a pragmatic screening tool that incorporates clinician judgment and key clinical variables to stratify oncology patients into risk groups for targeted early supportive care intervention. Methods: We performed a subgroup analysis of breast cancer patients (ICD code 50) within a prospective departmental implementation of SPIRE from April to June 2025 at the Medical oncology clinic, University Hospital of Oncology Prof. Ivan Chernozemski, Sofia. The SPIRE score integrates the surprise question (12-month mortality), ECOG status, metastatic burden, brain metastases, and comorbidities. Patients were stratified into low (0-1), medium (2-3), or high (≥4) risk categories. Referral to supportive care and preliminary follow-up status were tracked. A prospective validation strategy was pre-planned with three time-based cutoffs (month 4, 8, and 12) to evaluate the prognostic value of SPIRE in predicting 12-month mortality. Due to the prospective, pragmatic design, data reflects visit-level documentation; patient-level analyses are planned as the dataset matures. Results: Across 1,711 recorded visits between April and June 2025 (representing 737 unique breast cancer patients), 1,279 visits (74.7%) were categorized as low risk, 342 (20.0%) as medium risk, and 85 (5.0%) as high risk. Metastatic disease was present in 946 visits (55.3%), brain metastases in 86 (5.0%), and clinically significant comorbidities in 313 (18.3%). ECOG ≥2 was recorded in 89 visits. Referral to supportive care was documented in 190 visits (11.1%). Follow-up SPIRE score transitions were analyzed in 969 instances. Preliminary trend analysis showed worsening in 131 cases (13.5%) and rapid deterioration (defined as ≥2-point score increase within ≤7 days) in 8 patients. The mean normalized score change was +0.03 (SD ±2.74). These findings support the tool’s dynamic tracking potential, pending formal prospective validation. Conclusions: SPIRE is feasible to implement in routine breast cancer care and effectively stratifies patients based on prognosis and complexity. Its prospective validation will assess real-world prognostic performance, with the goal of enhancing timely and personalized supportive care delivery. Early findings suggest that SPIRE may serve as a valuable clinical trigger for palliative care referrals in breast cancer patients. Citation Format: T. Yordanov, P. Spasov, M. Musin, I. Pandzharova, S. Tuncheva, T. Karanikolova, S. Velchova, A. Konsoulova. Spire-bc: a clinically-integrated prognostic tool to identify breast cancer patients in need of early supportive care [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 PS1-03-14.