Symptom burden and interventions in veterans enrolled in the Proactive Response for Individual Symptom Management (PRISM) program.
Year: 2026
Type: conference-abstract
Abstract: 575 Background: Proactive Response for Individual Symptom Management (PRISM) is a Veterans Health Administration (VHA) program designed to improve early identification and management of cancer-related symptoms among Veterans receiving systemic anti-cancer therapy. Peer-support specialists conduct weekly telephone assessments and triage moderate, severe, or worsening symptoms to a nurse practitioner (NP) for intervention. We evaluated symptom burden and NP intervention frequency and types to inform program scale. Methods: We performed a retrospective analysis of PRISM documentation, including peer assessments, symptom scores, NP follow-up, and interventions. NP interventions were categorized as patient education, medication or laboratory management, referral to a new specialty or higher level of care, and notification of oncology or other specialty teams. Encounters with multiple intervention types were classified accordingly. Descriptive analyses characterized symptom frequency, NP interventions, and referral patterns. Results: From May 22, 2025, to June 10, 2026, 43 Veterans were enrolled. Peer specialists completed 734 surveys using the Veteran Symptom Assessment System (VSAS), with 452 assessments (61.6%) requiring NP intervention. The most common symptoms were fatigue (475/734, 64.7%), dyspnea on exertion (378/734, 51.5%), and drowsiness (345/734, 47.0%). Mental health symptoms were frequent, including anxiety (216/734, 29.4%), distress (199/734, 27.1%), and depression (172/734, 23.4%). Patient education alone was the most common NP intervention (313/452, 69.2%), followed by education with medication or laboratory management (101/452, 22.3%). Sixteen encounters (3.5%) required no intervention after NP review. Referrals included optometry (n=4), social work (n=2), dermatology (n=2), nutrition (n=2), occupational therapy (n=1), mental health (n=1), physical therapy (n=1), prosthetics (n=1), and one emergency department referral. Detailed categories are shown in Table 1. Conclusions: PRISM enabled proactive symptom monitoring and timely intervention between oncology visits. Veterans reported substantial physical and psychological symptom burden. Most NP encounters involved education, with others requiring medication management, referrals, or care coordination. These findings support a feasible, team-based model to enhance supportive oncology care and improve identification of unmet needs. Distribution of nurse practitioner interventions in PRISM (patient education included in all interventions). Type of NP Intervention # Interventions Education only 313 Meds/Labs 101 Meds/Labs + Primary Care 1 Meds/Labs + Oncology 1 Meds/Labs + Referral to New Specialty 3 Alert to Oncology 4 Alert to Established Specialty 2 Referral to New Specialty 11 No intervention 16 Total 452
Source: JCO Oncology Practice
Language: English
Topic: Cancer survivorship and care
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7221679202
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