SUPPORT+ digital self-management and clinical support for advanced cancer: A randomized controlled trial.

Abstract

LBA12008 Background: Patients with advanced cancer often experience distressing symptoms that impair HRQoL and lead to emergency department (ED) visits and hospitalizations. Digital symptom-monitoring tools enable earlier detection of symptoms, yet evidence in palliative care remains limited. This study evaluated whether SUPPORT+, a mobile app incorporating weekly symptom reporting using the Integrated Palliative Care Outcome Scale (IPOS), automated self-management guidance, and nurse follow-up for severe symptoms, improves outcomes when added to usual care for community-dwelling patients with advanced cancer. Methods: A multi-centre RCT was conducted across 6 palliative care clinics in Hong Kong (Jan 2023–Feb 2025). Patients with advanced cancers no longer receiving systemic treatment were randomized 1:1 to SUPPORT+ or usual care for 18 weeks. The primary outcome was change in HRQoL (EQ-5D-5L). Secondary outcomes included ECOG PS, ED visits, and hospitalizations. Results: A total of 633 patients were enrolled (315 intervention; 318 control), median age 79 (range 31–103), with 47.4% male. HRQoL was better maintained in SUPPORT+: EQ-5D-5L index declined from 0.59 at baseline to 0.52 at week 18 vs. 0.62 to 0.37 in usual care (mean difference −0.18; p<0.001). EQ-VAS remained more stable (68.7 to 65.8 vs. 68.9 to 59.5; mean difference −6.54, p<0.001). ECOG PS deterioration was less common (12.4% vs. 18.9%; p=0.016). ED visits were similar. Hospitalization outcomes favoured SUPPORT+, with more reductions in admissions and shorter lengths of stay (both p≤0.001). Conclusions: SUPPORT+ maintained HRQoL, preserved PS, and reduced hospitalizations in advanced cancer. Digital symptom monitoring with automated self-management and timely healthcare support is a promising strategy to strengthen community-based supportive care. Clinical trial information: HKUCTR-3116. Proportion of patients in the SUPPORT+ arm and control (usual care) arm with changes in HRQoL, self-efficacy, emergency department visit, hospitalization episodes and duration. Intervention Group N=315 Control Group N=318 P-value no. % no. % Primary Endpoint: EQ-5D-5L index (change ≥0.11) Improved 59 18.73% 14 4.4% <0.001 No change 137 43.49% 129 40.57% Worsen 119 37.78% 175 55.03% EQ-5D-5L VAS (change ≥6) Improved 80 25.40% 48 15.09% 0.002 No change 114 36.19% 112 35.22% Worsen 121 38.41% 158 49.69% Secondary Endpoints: Self-efficacy Improved 121 38.41% 65 20.44% <0.001 No change 18 5.71% 26 8.18% Worsen 176 55.87% 227 71.38% Emergency Department Visits Reduced 85 26.98% 76 23.90% 0.167 No change 171 54.29% 163 51.26% Increased 59 18.73% 79 24.84% Hospitalization Episodes Reduced 89 28.25% 70 22.01% 0.001 No change 174 55.24% 157 49.37% Increased 52 16.51% 91 28.62% Hospitalization Days Reduced 98 31.11% 70 22.01% <0.001 No change 162 51.43% 136 42.77% Increased 55 17.46% 112 35.22% ECOG Improved 6 1.90% 13 4.09% 0.016 No change 270 85.71% 245 77.04% Worsen 39 12.38% 60 18.87%