LAUSR

e18583 Background: Psychological distress is key in cancer care. Non-fatal self-injury (NFSI) represents a patient-centred, objectively measured manifestation of the greatest level of distress occurring in 3 out of 1,000 patients after a new cancer diagnosis. How to identify patients at high risk for NFSI remains unknown. We examined the relationships between routinely collected patient-reported outcomes measures and the risk of subsequent NFSI following a cancer diagnosis. Methods: We conducted a population-based case-control study of patients with a new cancer diagnosis (2007-2019) reporting a Edmonton Symptom Assessment (ESAS) score within 36 months of diagnosis. Cases were patients with NFSI within 36 months of diagnosis and controls those without NFSI (assigned a dummy index date corresponding to the case’s NFSI). Cases and controls were matched 1:4 on time from cancer diagnosis, ESAS record in 180 days prior index, age, sex, cancer site, and history of self-injury. Multivariable conditional logistic regression assessed the association between moderate-to-severe ESAS symptoms and total ESAS (t-ESAS) score with NFSI within 180 days. Results: Of 408,858 patients reporting >1 ESAS within 36 months of cancer diagnosis, 748 patients had a NFSI, including 425 patients with an ESAS score within 180 days preceding the NFSI event. Of those 406 cases were matched to 1,624 controls without NFSI. Cases reported a higher proportion of moderate-to-severe symptoms and higher t-ESAS than controls prior to the event (p < 0.01 for all). After adjusting for psychiatric illness history and cancer therapy received, reporting of moderate-to-severe anxiety (odds ratio – OR 1.61, 95%CI 1.14-2.27), depression (OR 1.66, 95%CI 1.2-2.31), and shortness of breath (OR 1.65, 955CI 1.18-2.31) were independently associated with higher risk of NFSI within 180 days. Each 10-point increase in t-ESAS (score 0-90) was independently associated with increased risk of NFSI within 180 days (OR 1.51; 95%CI 1.40-1.63). Conclusions: Reporting moderate-to-severe anxiety, depression, and shortness of breath, and increasing t-ESAS after cancer diagnosis are associated with higher odds of NFSI in the following 180 days. These data support the prospective identification of patients at high risk for NFSI via routine ESAS screening to improve supportive care. Patients with at-risk ESAS scores should receive tailored assessment, management, and longitudinal follow-up.