12074 Background: Routine early palliative care (EPC) for patients with advanced cancer improves quality of life. To increase scalability, models of triggered EPC have been encouraged. We assessed feasibility of hybrid virtual/in person Symptom screening and Targeted Early Palliative care (STEP2) to provide EPC triggered by symptoms. Methods: Patients with advanced cancer, ECOG 0-2, prognosis 6-36 months, were recruited from lung, gastrointestinal, genitourinary, breast and gynecology outpatient oncology clinics. Symptoms were screened virtually/in person ≤48 hours before oncology visits using Edmonton Symptom Assessment System-revised (ESAS-r+). Moderate to severe symptom scores (“screen positive”) triggered an alert to a nurse, who called the patient, offering an EPC visit (in-person/virtual, as per patient preference). Participants completed measures at baseline, 2, 4, and 6 months. The primary endpoint was feasibility, with the following criteria: ≥40 patients accrued in 4 months; ≥60% complete screening for ≥70% of visits; ≥50% triggering a call have ≥1 EPC visit; ≥60% complete all measures. Results: From 30/03/2025-26/06/2025 40 patients were enrolled (median age range, 62 39-88; 21/40 53% female). Disease site distribution was: 12/40 (30%) lung, 9/40 (23%) gynecology, 8/40 (20%) genitourinary, 6/40 (15%) gastrointestinal, 5/40 (13%) breast. Of the 40 patients enrolled, 36 (90%) completed screening for ≥70% of visits and 29 (73%) screened positive: 18 at baseline and 11 later during the trial. The most common triggering symptoms were anxiety (18/29, 62%), sleep (17/29, 59%), depression (10/29, 35%), pain (8/29, 28%), and dyspnea (8/29, 28%) ; 21/29 (72%) screen-positive and 0 screen-negative patients received EPC before trial end. Measure completion at 2, 4, and 6 months was 90% (36/40), 85% (34/40), and 83% (33/40). Initial EPC visits were in person for 14/21 (67%) and virtual for 7/21 (33%) ; 20/21 (95%) of patients received ≥2 follow-up visits. Results for measures at baseline and at trial end are shown in the Table. Conclusions: Virtual/in person STEP2 is feasible and directs EPC to those who most need it, with most screen-positive patients accepting EPC. A phase III trial is underway. Clinical trial information: NCT06326554. Variable Measure (score range) Time point N Mean Standard Deviation Difference, 6 mo. vs. baseline (95% CI) Quality of life FACITPAL14 Baseline 40 42. 2 7. 2 0. 3 (0-56; higher is better) 6 mo. 34 42. 7 7. 7 (-0. 9, 1. 6) Symptom ESASEDS Baseline 40 17. 5 12. 9 0. 3 Control (0-90; higher is worse) 6 mo. 33 18. 9 13. 2 (-3. 1, 3. 7) Depression PHQ-9 Baseline 40 5. 4 3. 4 -1. 0 (0-27; higher is worse) 6 mo. 34 4. 6 3. 1 (-1. 9, 0. 0) Anxiety GAD-7 Baseline 40 4. 9 3. 8 -1. 4 (0-21; higher is worse) 6 mo. 34 3. 7 3. 5
Zimmermann et al. (Wed,) studied this question.