700 Section - Clinical and sociodemographic characteristics associated with physical function trajectories among participants in the E2C2 pragmatic trial

Objectives : Disablement in patients with cancer is often preventable, yet rehabilitation services are underutilized. Prior studies identifying risk factors for functional decline rely on small, unrepresentative samples. We conducted post hoc analyses of a large, population-level cohort to identify sociodemographic and clinical predictors of cancer-related disablement.

Design: The Enhanced EHR-facilitated Cancer Symptom Control (E2C2) cluster-randomized pragmatic trial compared electronic patient-reported outcome (ePROM) surveillance plus a collaborative care intervention with ePROM surveillance alone to reduce symptoms among patients receiving care in oncology clinics across a multi-state health system. Patients were enrolled irrespective of cancer type, treatment, or disease phase. Sleep interference, pain, impaired physical function, anxiety, depression, and energy deficit/fatigue (SPPADE) were assessed using 0–10 numerical rating scales. Latent trajectory modeling was used to characterize patterns of change in physical function NRS scores.

Results: Between March 2019 and January 2023, 50,207 patients completed ePROMs during oncology visits, of whom 14,590 provided at least three symptom assessments in the first year.   Four distinct trajectory patterns were identified that may permit patient selection for proactive delivery of services to maintain and enhanced function.  Sociodemographic factors and social determinants of health were as strongly, or more strongly, associated with physical function trajectories than cancer-related factors. Readily available patient characteristics identified individuals at risk for persistently poor or worsening function. Potential intervention targets include strengthening social and domestic support and promoting patient portal engagement.

Conclusion: Four distinct physical function trajectory patterns were identified, providing a framework for early patient selection and proactive deployment of rehabilitation and supportive services to prevent or mitigate functional decline.