Proactive response initiative for symptom management (PRISM): A multi-institutional symptom monitoring program for veterans receiving systemic cancer therapy.

Abstract

11115 Background: Symptom assessment and management in cancer care are challenging. Within the Veterans Health Administration (VHA), gaps remain in widescale implementation of standardized symptom assessment, technology support, and adaptable workflows. PRISM was developed as a multi-institutional, technology-enabled clinical program to improve early identification and treatment of cancer-related symptoms for Veterans with the ultimate goal of system-wide implementation. Methods: We adapted an evidence-based proactive symptom intervention for the Long Beach VA with a working group of clinicians, pharmacists, social workers, case managers, and ancillary staff. The intervention involved a peer specialist conducting weekly telephone-based assessments using a modified Veteran Symptom Assessment System (VSAS) for Veterans initiating systemic anti-cancer treatment. Symptom scores ≥4 on a scale of 0-10 or a score increase by 2 points automatically triggered Nurse Practitioner (NP) review and follow up. We conducted an evaluation of our first PRISM site and assessed Veteran retention, symptom burden, interventions, and process metrics to inform scale and spread for two future VHA sites this quarter. Results: From May 22, 2025 to December 1, 2025, 30 patients (pts) enrolled in PRISM; 4 (13%) withdrew < 1 month, 2 (6.7%) withdrew > 1 month, 2 (6.7%) completed the program, and 1 (3.3%) died. Frequently reported symptoms of any score were fatigue (n = 14; 61%), dyspnea on exertion (n = 6; 26%), and pain (n = 6; 26%). Of the 412 times symptoms were reported as ≥4 on a scale of 0-10, the most frequent were fatigue (22%), dyspnea with exertion (13%), and drowsiness (13%). For the 23 pts who remained in the program for > 1 month there were 308 peer specialist encounters and 205 NP encounters. NPs intervened in 91% (186/205) of encounters with a total of 961 interventions. The mean number of interventions per NP encounter was 3.67. The most frequent intervention was pt education 86% (827/961), medication prescriptions 13% (123/961), and alerting the primary oncology team 4.2% (41/961). The mean time interval between a VSAS survey and indicated NP follow up was 1.06 days. The call duration was a mean 9.25 minutes per encounter with the peer specialist and 17.3 minutes per encounter with the NP. Documentation and chart review took a mean of 10.5 minutes per peer specialist encounter and a mean of 14.4 minutes per NP encounter. Conclusions: Early results from our first real world PRISM implementation in the VHA demonstrate feasibility, retention, and frequent early identification of and intervention for symptoms using this proactive symptom management program embedded within existing pt oncology care. The process metrics regarding capacity for peer support and NP effort will inform our expansion to two implementation sites by June 2026 and an additional 10 sites by 2027.