Predictors of engagement and healthcare resource utilization in chemotherapy patients using a text message response system

Background: Patients receiving chemotherapy face a high risk of treatment-related complications, often leading to increased healthcare resource utilization (HCRU). Mercy Hospital, St. Louis, implemented a text message response system (TRS) to proactively capture patient-reported symptoms and facilitate timely nursing interventions. We evaluated demographic and clinical factors associated with TRS engagement and their relationship to HCRU. Methods: We analyzed data from 3,899 patients across hospitals in three states (January-July 2025), including 2,750 TRS responders and 1,149 non-responders. Variables assessed included age, sex, ethnicity, comorbidities (cerebrovascular disease [CVD], chronic obstructive pulmonary disease [COPD], renal disease), cancer type, and HCRU (emergency department [ED] visits, inpatient [IP] admissions). Statistical analyses employed Welch t-tests, Pearson χ² tests, odds ratios (OR) with 95% confidence intervals (CI), and Holm correction for multiple comparisons. Results: Responders were slightly younger than non-responders (mean age 67.22 vs. 67.91 years, p=0.111). Female patients were more likely to respond (73.2% vs. 67.5%; OR=1.31, 95% CI 1.15-1.51, p=0.00010). Response rates did not differ significantly by ethnicity or comorbidities. Cancer type showed modest variation (χ²=19.77, p=0.011, Cramér's V=0.065), though no pairwise differences remained after correction. ED utilization was higher among responders (14.33% vs. 10.71%; OR=1.39, 95% CI 1.12-1.73, p=0.0014), while IP admission rates were similar (15.96% vs. 16.10%, p=0.915). Leading IP diagnoses included sepsis (41.94%) and anemia (38.4%), while pain (48.41%) and nausea (14.96%) dominated ED visits. Conclusions: TRS engagement was higher among female and younger patients, while older adults were less likely to respond, suggesting the need for alternative outreach strategies such as direct telephone calls. Responders demonstrated greater ED utilization, primarily for pain and nausea, but comparable IP admission rates. These findings underscore the importance of targeted interventions-such as infusion center support and palliative care integration-to proactively manage chemotherapy-related symptoms and reduce HCRU in the outpatient setting.