An SMS-enhanced supportive program to improve treatment management and communication during active cancer treatment.

e13714 Background: Patients undergoing active cancer treatment have high symptom burden and psychosocial distress that often go under-addressed between clinic visits. We implemented a prospective, SMS-based supportive care program to improve real-time communication and timely intervention by social workers. Methods: Adult patients receiving active cancer therapy enrolled in a text-messaging platform. Baseline measures included psychological distress (PHQ-4), quality of life (FACT-G), and cancer coping self-efficacy (CBI-B). For three months, patients received alternating weekly surveys: the Distress Thermometer and a 10-domain toxicity survey capturing symptom frequency, severity, and interference. Predefined thresholds triggered alerts to social workers. Patients could also send free-text SMS about symptoms, care coordination, practical needs, or emotional support. A secure provider dashboard allowed daily review and bidirectional SMS. Engagement and symptom reporting were summarized descriptively; Spearman correlations assessed associations between baseline factors and engagement. Results: We report the first three months for 116 patients. Demographics: 49.1% had high school education or less, 58.6% married, 41.4% retired. Baseline PHQ-4 mean = 2.6 (low distress); FACT-G mean = 51.9 (moderate QOL). Engagement was high: 100% sent ≥1 SMS; 56.6% sent ≥6 messages in three months. Distress: 57.4% (65/116) reported DT ≥4 at least once; among these, 69.2% reported DT ≥6. Toxicity reporting: 57.4% completed ≥1 toxicity survey; 51.4% of those reported at least one severe toxicity. In 36 patients with severe toxicity, common symptoms were fatigue (47.2%), muscle/joint pain (36.1%), insomnia (25.0%), and constipation (22.2%). Higher baseline distress correlated with more frequent distress reporting (ρ = 0.30, p = 0.01). Greater coping self-efficacy (CBI-B) and higher FACT-G correlated with more frequent toxicity reporting (ρ = 0.32, p < 0.01; ρ = 0.26, p = 0.03). Qualitative analysis of patient-initiated SMS showed most messages concerned care coordination/navigation, medication management, and symptom/toxicity issues; others addressed practical needs, education, psychosocial support, and acknowledgments. Conclusions: An SMS-enhanced supportive care program is feasible and yields sustained patient engagement during active cancer treatment. Structured distress and toxicity monitoring identified meaningful symptom burden, and bidirectional messaging enabled timely supportive care. Baseline psychosocial factors differentially predicted engagement: higher coping self-efficacy and quality of life were associated with greater participation in proactive toxicity reporting.