Abstract PO5-12-11: Characterizing Symptom Alerts in Different Breast Cancer Regimens: A Remote Symptom Monitoring Study
Authors: Khoury Katia , Caston Nicole , Patterson Megan , Holmes Nancy , Seward Jena , Stringer-Reasor Erica , Jahan Nusrat , Rocque Gabrielle 
Published: May 2024

Abstract
Introduction: Remote symptom monitoring is becoming more common in the management of patients on active cancer treatments. The patterns of symptoms and subsequent alerts for specific types of treatment administered as part of standard of care remains unknown. This study aims to characterize the frequencies and types of symptom alerts among breast cancer patients receiving neoadjuvant and adjuvant therapy. Methods: This secondary analysis used data from a hybrid type 2 randomized controlled trial testing the implementation of remote symptom monitoring. For our analysis, we included women with breast cancer receiving (neo)adjuvant therapy. Enrolled patients received remote symptom monitoring surveys within 30 days of treatment initiation at the University of Alabama at Birmingham from 06/2021 to 05/2023. Self-reported symptoms were recorded via weekly electronic surveys for six months. The weekly survey used the PRO-CTCAE measurement tool and patients report frequency, intensity, and interference of the following symptoms: constipation, decreased appetite, diarrhea, cough, insomnia, nausea/vomiting, neuropathy, pain, urinary problems. Symptom alert severity is categorized as either moderate or severe. Self-reported race and treatment regimen (within the first 60 days) were abstracted from the electronic medical record. Regimens were grouped into three categories 1) trastuzumab-containing, 2) any regimen with pembrolizumab, 3) chemotherapy without trastuzumab or pembrolizumab. Descriptive statistics were calculated using frequencies and percentages for categorical variables and medians and interquartile ranges (IQR) for categorical variables. Results: A total of 108 women with breast cancer were included in our analysis. Overall, 54% were of White race, 36.1% were of Black or African American race, and 1.85% were of Asian race. The median age was 54 years (IQR 41-65). Fifty-one percent were prescribed a chemotherapy regimen, 33% trastuzumab-based regimen, and 15% pembrolizumab-based regimen. Symptom alerts were addressed supportively or escalated with nursing and treating oncologist via direct communication with patients. A total of 1438 symptom alerts were triggered with 55% of surveys generating an alert. The most reported symptom alert was pain, accounting for 30% of all alerts. Additionally, of all symptom alerts, 70% were moderate and 30% severe, with similar distributions across regimens. Patients receiving pembrolizumab regimen most often reported moderate pain compared to the other two regimens (35% vs 22% vs 23%). However, severe pain was most often reported by those receiving chemotherapy at 46%, trastuzumab-based regimen at 40%, and pembrolizumab-based regimen at 31%. Furthermore, patients on trastuzumab-based regimens reported severe diarrhea most frequently (11%) compared to 3% & 2% for the other two regimens. Discussion: Symptoms experienced during receipt of (neo)adjuvant breast cancer treatment are common, with the majority being moderate in nature. Differences in symptom profiles were observed across different treatment modalities, consistent with known side effect profiles. The higher prevalence of pain in patients receiving chemotherapy alone may be attributed to the use of growth factors in these regimens. Further exploration is warranted to investigate the use of supportive medications in managing these symptoms. Further evaluations are underway to evaluate how symptom alerts could potentially increase treatment adherence and decrease hospitalizations.
Citation Format: Katia Khoury, Nicole Caston, Megan Patterson, Nancy Holmes, Jena Seward, Erica Stringer-Reasor, Nusrat Jahan, Gabrielle Rocque. Characterizing Symptom Alerts in Different Breast Cancer Regimens: A Remote Symptom Monitoring Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-11.