Background The aim of this study was to test the efficacy of a tailored cognitive‐behavioral therapy (CBT) mobile application (app) to treat anxiety in patients with incurable cancer. Materials and Methods Patients with incurable cancers (n = 145) who reported elevated anxiety symptoms at two cancer centers were randomized to receive either the CBT mobile app for anxiety or a mobile health education program (control) delivered via tablet computers, which patients self‐administered over 12 weeks. To assess anxiety, depression symptoms, and quality of life (QOL), we used the Hamilton Anxiety Rating Scale (HAM‐A, primary outcome), Clinical Global Impression Scale, Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire‐9, and Functional Assessment of Cancer Therapy‐General at baseline and 12 weeks. Analysis of covariance models were calculated to assess intervention effects on patient outcomes. Results Patients (73.8% female; 91.0% white; mean age = 56.45 years, SD = 11.30) in both study groups reported improvements in anxiety, depression symptoms, and QOL from baseline to postassessment, with no significant differences in any outcome measure between groups. Secondary analyses showed that, among the subgroup of patients with severe baseline anxiety, those randomized to the CBT app had greater improvements on the HAM‐A (Mean Difference = 7.44, standard error [SE] = 3.35, p = .037) and HADS‐Anxiety Subscale (Mean Difference = 4.44, SE = 1.60, p = .010) compared with the control group. Conclusion Both the tailored CBT app for anxiety and the health education program were associated with improvements in anxiety, mood, and QOL, but these outcomes did not differ between study groups. The CBT app was more beneficial than health education for patients with severe baseline anxiety. Implications for Practice A cognitive‐behavioral therapy mobile application tailored to treat anxiety in patients with advanced cancer helps improve access to evidence‐based supportive care in a convenient, private, and timely manner.

10055 Background: As patients with cancer are increasingly prescribed oral chemotherapy, they share greater responsibility for ensuring adherence and monitoring side effects. The aim of this study was to test the effect of a smartphone mobile app to improve adherence and symptom management in patients prescribed oral chemotherapy. Methods: From 2/15 to 12/16, 181 patients with diverse cancers prescribed oral chemotherapy were randomized to receive either the smartphone mobile app or standard care. The mobile app included a medication treatment plan with alerts, symptom reporting module, education library, and cancer-specific resources. The primary outcome was adherence, measured by electronic pill cap (MEMS) and self-report (Morisky Medication Adherence Scale; MMAS). To assess symptoms, mood, and satisfaction with care, participants completed the MD Anderson Symptom Inventory, Hospital Anxiety & Depression Scale (HADS); and Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction (FACIT-TS) at baseline and 12 weeks. General linear models were used to assess intervention effects on patient outcomes. Results: Study groups did not differ across outcome measures from baseline to week 12. Secondary analyses showed that baseline adherence (MMAS) and anxiety (HADS) were moderators of intervention effects on adherence and treatment satisfaction. Among patients who reported adherence problems, those assigned to the mobile app had better average MEMS adherence (Mean Diff = 19.30, 95% CI = 0.09-38.51, p = .05) and satisfaction with clinician explanations per the FACIT-TS (Mean Diff = 1.69, 95% CI = 0.25-3.13, p = .02) compared to standard care. Also, among patients with higher anxiety, those in the mobile app group reported better adherence on the 12-week MMAS (95.2% vs. 68.0%, OR = 0.11, 95% CI = 0.01, 0.94, p = .04) and satisfaction with interpersonal treatment per the FACIT-TS (Mean Diff = 0.76, 95% CI = 0.13-1.39, p = .02) compared to standard care. Conclusions: Although potentially not for everyone taking oral chemotherapy, a smartphone mobile app to improve adherence and treatment satisfaction may be useful for patients with certain risk factors, such as those struggling with adherence or anxiety. Clinical trial information: NCT02157519.

Background: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. Patients and methods: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). Results: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B ¼ 0.12, P ¼ 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment Systemphysical symptoms (B ¼ 0.07, P ¼ 0.138). Intervention patients had lower readmission risk (hazard ratio ¼ 0.68, P ¼ 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B ¼ 0.16, P ¼ 0.862). Conclusions: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk. ClinicalTrials.gov identifier NCT02891993

Background: Symptom monitoring interventions enhance patient outcomes, including quality of life (QoL), health care utilization, and survival, but it remains unclear whether older and younger patients with cancer derive similar benefits. We explored whether age moderates the improved outcomes seen with an outpatient electronic symptom monitoring intervention.Patients and methods: We carried out a secondary analysis of data from a randomized trial of 766 patients receiving chemotherapy for metastatic solid tumors. Patients received an electronic symptom monitoring intervention integrated with oncology care or usual oncology care alone. The intervention consisted of patients reporting their symptoms, which were provided to their physicians at clinic visits, and nurses receiving alerts for severe/ worsening symptoms. We used regression models to determine whether age (older or younger than 70 years) moderated the effects of the intervention on QoL (EuroQol EQ-5D), emergency room (ER) visits, hospitalizations, and survival outcomes. Results: Enrollment rates for younger (589/777 ¼ 75.8%) and older (177/230 ¼ 77.0%) patients did not differ. Older patients (median age ¼ 75 years, range 70e91 years) were more likely to have an education level of high school or less (26.6% versus 20.9%, P ¼ 0.029) and to be computer inexperienced (50.3% versus 23.4%, P < 0.001) compared with younger patients (median age ¼ 58 years, range 26e69 years). Younger patients receiving the symptom monitoring intervention experienced lower risk of ER visits [hazard ratio (HR) ¼ 0.74, P ¼ 0.011] and improved survival (HR ¼ 0.76, P ¼ 0.011) compared with younger patients receiving usual care. However, older patients did not experience significantly lower risk of ER visits (HR ¼ 0.90, P ¼ 0.613) or improved survival (HR ¼ 1.06, P ¼ 0.753) with the intervention. We found no moderation effects based on age for QoL and risk of hospitalizations. Conclusions: Among patients with advanced cancer, age moderated the effects of an electronic symptom monitoring intervention on the risk of ER visits and survival, but not QoL. Symptom monitoring interventions may need to be tailored to the unique needs of older adults with cancer.