Impact of proactive callback in patients with solid tumors receiving systemic therapy: A meta-analysis

BackgroundProactive callback comprises unsolicited assessment of symptom burden and is utilized frequently to deliver symptom management interventions in many cancer systems worldwide. Evidence supporting the efficacy of proactive callback in improving patient outcomes is limited and variable. Here we report on a meta-analysis of randomized trials (RCTs) exploring proactive callback in cancer patients.MethodsA literature search identified RCTs evaluating the impact of proactive callback versus usual care on quality of life (QoL), symptom burden, healthcare utilization, and overall survival (OS) in patients with solid tumors receiving systemic therapy. QoL data were assessed as changes from baseline to 3 months or end of study utilizing common QoL questionnaires. Symptom burden was assessed as commonly reported individual adverse events. Healthcare utilization comprised emergency department (ED) visits and hospital admission. OS was defined as the number of deaths reported over the course of each study. QoL was assessed using meta-regression weighted by study sample size.ResultsOf 7,759 studies identified initially, 17 RCTs were included in the analysis. There were no differences in ED visits (n=5 studies, OR 0.95, p=0.44) or in hospitalization (n=7 studies, OR 0.96, p=0.44). The impact on specific toxicity is shown in the Table. Differences in QoL met neither the minimum clinically significant difference nor statistical significance of the tools utilized (EORTC QLQ C30 p=0.34, FACT-G p=0.46, and EQ 5D5L p=0.25). OS was significantly improved with proactive callback (n=7 studies, OR 0.79, 95% CI 0.63 – 0.99, p=0.04), an observation driven by data from trials in metastatic disease. Table: 1905P Association between proactive callback and individual symptoms Symptom n OR p Nausea 4 0.86 0.35 Vomiting 4 0.80 0.26 Fatigue 4 0.64 0.004 Diarrhea 4 1.00 0.99 Constipation 3 0.72 0.06 Mucositis 4 1.20 0.29 Pain 3 0.86 0.29 ConclusionsDespite its extensive use in cancer systems worldwide, data available from RCTs do not suggest an impact of proactive callback on healthcare utilization, QoL, or on most individual symptoms. Improved OS in metastatic disease warrants further study.Legal entity responsible for the studyUniversity Health Network.FundingSimpson Family Breast Cancer Research and Detection Fund.DisclosureAll authors have declared no conflicts of interest.