Impact of a patient-facing app to address surgical oncology patients’ social determinants of health: Preliminary results of a phase II clinical trial.

Abstract

1570 Background: Unmet Social Determinants of Health (SDH) needs, including housing, transportation, food insecurity, utilities, and social support, are associated with adverse outcomes in cancer care, including delays in treatment, missed appointments, and hospital readmissions. Few interventions have been rigorously evaluated to address these SDH needs in surgical oncology populations. We conducted a Phase II randomized controlled trial to evaluate whether a patient-facing mobile application (Carealth), integrated with a follow-up resource referral platform (findhelp.org), could improve clinical and process outcomes compared to a “sham” app that included an attention-control (static CDC site). Methods: We enrolled adult patients with cancer (or suspected cancer) scheduled for surgery at three large U.S. centers. Participants were randomized to Carealth (intervention) or sham (control). We assessed 30-day readmission after surgery, distribution of where resources were sought among interventions clients (among those with baseline needs), time from consultation to surgery, and missed/rescheduled visits within 90 days. Analyses used descriptive statistics, Fisher’s exact tests and crude odds ratios for readmission, Kaplan–Meier/log-rank methods for time to surgery, and proportional odds models for missed visits, under an intention-to-treat framework. Results: Of 585 patients screened, 161 were randomized (81 intervention, 80 control). Baseline characteristics were well balanced, with 17% reporting at least one SDH need at baseline. App uptake was 80% overall. Thirty-day readmissions were rare and similar between groups, occurring in 5 of 80 patientsOR 1.64, p = 0.72). Median time to surgery was 45 days in the intervention group vs 49 days in controls (log-rank p = 0.42). Missed/rescheduled visits within 90 days did not differ (proportional OR 1.28, p = 0.79). Among participants with SDH needs, multiple resource pathways were used, including counselor or patient navigator services, community or online resources, and the Carealth app; a subset reported partial or complete resolution of needs through the app. Conclusions: In this Phase II trial, an SDH-focused patient-facing app achieved outcomes comparable to standard-of-care navigation with respect to readmissions, time to surgery, and appointment adherence. While underpowered for rare clinical events, the intervention demonstrated high uptake and sustained patient engagement, supporting its potential role as a scalable, low-resource adjunct to existing support and navigation services. Larger trials enriched for patients with unmet SDH needs are warranted to assess clinical and health-system impact. Clinical trial information: NCT06688513 .