Impact of Remote Symptom Monitoring on Acute Care Utilization in Patients with Advanced Cancer Undergoing Phase I Therapies: Secondary Analysis of a Randomized Clinical Trial

Purpose: Patients undergoing phase I cancer therapies experience high symptom burden and complications that may lead to emergency department (ED) visits and hospitalizations. It is unclear whether remote symptom monitoring (RSM) reduces acute care utilization. We conducted a secondary analysis of a randomized clinical trial to determine if incorporating RSM into specialist palliative care (SPC) would reduce ED visits/hospitalizations. Methods: Patients with advanced cancer undergoing phase I therapies were randomized to SPC alone or SPC+RSM. Primary outcomes were ED visit and hospitalization frequencies over 6 months. We also assessed presenting concern, presentation etiology, and potential avoidability with two independent reviewers. Results: Among 100 patients (mean age 56, 63% female, median survival 221 [95% CI 171, 271] days), 43 were in the SPC group and 57 were in the SPC+RSM group. A total of 22/43 (51%) SPC patients and 30/57 (53%) SPC+RSM patients had at least one ED visit over 6 months (p = 0.58), while 18/43 (42%) SPC patients and 21/57 (37%) had at least one hospitalization over 6 months (p = 0.56). The most common presenting symptoms were pain (ED 27%, hospitalizations 29%) and respiratory symptoms (ED 22%, hospitalization 22%). The main reasons for acute care encounters were disease progression (ED 49%, hospitalizations 58%) and acute complications (ED 26%, hospitalizations 28%). Only 4/84 (5%) ED visits and 0/57 (0%) of the hospitalizations were deemed avoidable. Conclusions: Acute care utilization was high in phase I patients. RSM did not reduce ED visits/hospitalizations, which were mostly unavoidable. Our findings highlight the need for novel strategies to support this population.