806P - Pilot ambulatory malignant bowel obstruction (MBO) electronic monitoring program in patients with gynecologic cancers

Background

MBO is a severe complication of advanced cancer. An interprofessional ambulatory outpatient MBO program with nurse-led proactive call management was established to support patients (pts) with gynecologic cancers at Princess Margaret Cancer Centre, showing reduction of hospitalization needs and improved outcomes.

Methods

“My Bowels on Track” is a pilot ambulatory electronic monitoring program for pts with gynecologic cancers with or at risk of MBO. Educational materials, secure messaging systems and ≤13 questions (Q) are offered weekly/biweekly. Based on Q answers, an alerting system flags pts with symptoms (yellow and red alerts indicate moderate and high concern, respectively) and no response to Q. Pts are contacted by nurses following clinical or compliance alerts. The primary objective is to assess the adherence (≥70% Q completion considered adherent) on the first two months on the program. A secondary objective is to assess the sensitivity of the alerts to trigger recommendations. Adherence was calculated as a rate. Alert sensitivity was assessed with a generalized estimation equation.

Results

40 pts enrolled between 08/21 and 09/22. Median age was 64.5 years (range 29-79). Primary diagnosis was ovarian (75%), uterine (17.5%) or cervical (7.5%) cancer, and 92.5% of pts were on systemic therapy. Clinical/radiological active MBO was present in 30% and 12.5% of pts prior to and at enrollment, respectively. Median duration of the program was 55 days (range 8-121). The two-month adherence was 65% (95% CI 50-80%), and the overall adherence was 60% (95% CI 43-75%). 65 symptom related alerts (75% yellow; 25% red) were reported in 60% (24/40) of pts. There were 59 recommendations triggered by alerts (29% dietary, 22% laxatives, 20% clinic assessment, 16% other medication, 8% emergency department referral, 5% other). The sensitivity of the alerts to trigger actions was 72% (95% CI 58-82%).

Conclusions

This pilot electronic MBO monitoring program with real-time patient reported outcome assessment was feasible, with 65% adherence at two months. Based on questionnaire answers an alerting system flagged symptoms of concern in 60% of participants, with a high sensitivity to provide actions or recommendations as a response to alerts.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

ASCO Conquer Cancer Young Investigator Award (Ainhoa Madariaga).

Disclosure

A. Madariaga Urrutia: Financial Interests, Personal, Advisory Role: AstraZeneca, GSK, PharmaMar; Financial Interests, Personal, Invited Speaker: Clovis, AstraZeneca, GSK. N.C. Dhani: Financial Interests, Speaker, Consultant, Advisor: AstraZeneca, Merck. R. Grant: Financial Interests, Personal, Advisory Board: AstraZeneca, Eisai, Knight Therapeutics; Financial Interests, Personal, Other, Graduate scholarship: Pfizer; Non-Financial Interests, Advisory Role: Tempus, Incyte. V. Bowering: Financial Interests, Personal, Advisory Board: AstraZeneca; Non-Financial Interests, Personal, Advisory Board: GSK, AstraZeneca. A.M. Oza: Non-Financial Interests, Personal, Advisory Board: AstraZeneca, GSK, Clovis; Other, Personal, Research Funding: AstraZeneca, GSK, Clovis; Non-Financial Interests, Personal, Leadership Role: Ozmosis Research. A. Berlin: Other, Personal, Advisory Role: AbbVie, Ferring, Astellas Pharma. S. Lheureux: Financial Interests, Personal, Advisory Board: AstraZeneca, GSK, Eisai, Merck, Novartis; Financial Interests, Personal, Invited Speaker: GSK, Roche; Financial Interests, Institutional, Research Grant, Academic trial: GSK; Financial Interests, Institutional, Local PI: Repare Therapeutics, Merck, AstraZeneca, Regeneron, GSK, Roche, Seagen; Financial Interests, Institutional, Research Grant: Roche. All other authors have declared no conflicts of interest.