6596 Background: The oncological day hospital (ODH) at IOHM carries out 80 chemotherapies per day with 6 certified oncological nurses as staff. Human resources allocation in oncology has not been formally studied in relation to treatment risks. The objective of this paper is to present a risk assessment model for the rational allocation for human resources in the ODH using the KGD scale. Methods: The KGD scale was designed through a retrospective evaluation of more than 15,000 treatments (Tx). Between November 1st and December 1st, 2012, this instrument was validated with all new patients (Pt) beginning Tx at IOHM. The KGD scale evaluates risk according to: Five Pt characteristics (Elderly, Polymedicated, Without symptom control, Neuropsychiatric problems, Presence or absence of family members); Four Tx characteristics (New drugs, Complex protocol, High risk of acute toxicity, Infrequently used) and workplace context(New personnel, Holiday absences, With or without close medical support). The KGD scale was determined for each Tx and applied as follows: Low Risk (0-3 points): two nurses in the ODH, supervision is at the patient’s request and the chemotherapy can be administered at the beginning or end of the workday; Intermediate Risk (4-5 points): three nurses in the ODH, supervision is mandatory and the treatment can take place at any time in the workday; High Risk(6 or more points): four nurses in the ODH, supervision must be constant and the Tx must take place in the middle of the workday. The chemotherapy outcome was observed. Results: One hundred and thirty patients were admitted. Sex fem 74 (59%), male 56 (41%): age: 49y (range 22-87). Diagnosis: breast 40, colon: 21, lung: 16, ovaries:11, lymphoma: 11, testis:7, sarcoma: 5 ; others: 19 KGD risk assessment: Low Risk 25 pts (19 %); Intermediate Risk 77 pts (59%); High Risk 28 pts (21%). There were no complications in any of the 312 chemotherapy treatments administered to this cohort. Conclusions: 1) The KGD scale has shown to be a useful aid in the treatment risk assessment. 2) Use of the KGD scale allows for an efficient personnel allocation at the ODH according the Tx risk 3) The academic qualification of the nurses staff are mandatory to control the risk.

e16075 Background: For the past three decades, it has been observed in developed countries an increase in the incidence of RCC, at the expense of small tumors incidentally found. This study compares the epidemiology, treatment and evolution of the patients (pt) with incidental RCC (Group A) or clinical RCC (Group B). Methods: Between 1/1/2001 and 11/30/2016, 29,440 new pt with histological diagnosis of cancer were incorporated to the IOHM database. We selected all those coded under the WHO ICD10 code C64. The medical records were reviewed, registering the epidemiological data, treatments and evolution of each patient Results: We identified 828 pt out of 29,940 pt (2.8%) who met the inclusion criteria. Group A = 507 pt (61%) and Group B = 321 pt (39%). The table below shows the characteristics of both groups. Conclusions: 1) In this cohort the incidental diagnosis of RCC represented 60% of the cases and correlated with early stages and less aggressive tumors. 2) The appropriate selection of patients allowed partial nephrectomies in 103/828 Pt. (12% of the cases). 3) With a median follow-up of 30 months the survival rate of this population exceeded 90% in the early stages and was close to 50% in advanced cases. [Table: see text]

6594 Background: "Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes" ( Br J Clin Pharmacol 80:6, 1254. 2015). The aim of this paper is to present a model for deprescribing used at IOHM. Methods: Between 09/26/2012 and 09/26/2016, 10,053 pt filled out a Past Medical History Form, listing all the medications they were taking regularly. We selected all the pt. with advanced solid tumors (AST). In each pt the expected survival was established in order to evaluate the usefulness of the Tx. The drugs were classified in three groups: A) Green: Adequate (must be maintained); B) Yellow: Questionable (could be maintained or removed) or C) Red: Avoidable (must be removed). Results: We registered 2,103 pt who met the inclusion criteria. Sex F/M: 905 /1198. Median age 63 y (r = 19-99). A total of 1,629 pt. (77%) were taking medications on a regular basis. The total amount of medications was 5,679 . Median medications per patient: 3 (range: 1-14). Eighty percent of the pt (1,298 pt) were receiving questionable of avoidable medications. The following table shows the distribution of medications per group. Conclusions: A) In this cohort of 2,103 pt with AST, half of them had an average life expectancy of less than one year. B) 1,298 out of 1,629 pt (80%) were receiving a questionable medication C) 596/5,769 (10%) of the registered drugs, had to be suspended immediately and at least a thousand more could be eliminated. d) Obstacles to deprescribing were essentially medical ignorance, fear and inexperience. [Table: see text]

e20656 Background: As it is very important for Doctors, Patients (Pt) and Family to know everything related to end of life we thought it was unavoidable to develop a survey for that purpose. Methods: Between Oct 15th and Nov 15th, 2012, 1003 Pt out of 3795 Pt that were assisted at the IOHM were given the option to participate in an anonymous survey about diagnosis, prognosis, efficacy and toxicity of treatments, as well as interest in palliative care (PC), clinical investigation (CI), psychological support (PS), spiritual care (SC) for an eventual situation of coping with the end of life dilemma. Results: A total of 845 out of 1,003 (84%) Pt elected to participate. Population: Sex: fem: 332, male: 207, left blank (LB): 306. Mean age 58y (range 18 – 94). Married: 355, unmarried: 211, LB: 279. Children Yes 460 No/LB: 385. Highest educational level achieved: primary Studies:186, high School: 348, universitary:216. LB: 98. Employed:382, retired: 240, unemployed: 112, LB 111. Disclosed diagnostic and stage of disease: 470 (56%). The following results are expressed as a percentage of 845 pt: Are aware of the diagnostic (82%); Pt interested in knowing everythingabout their prognosis (85%) or their treatment’s efficacy (67%) or toxicity (52%). Pt interested in: PC (85%), CI (80%), PS (74%), SC (58%). If they were to choose a place for dying: 40% chose to die in the hospital, 30% at home, 29% did not answer and 1% was indifferent. It was possible to detect a marked increase in the amount of answers with regards to last wishes as the stage of the disease worsened (Chi square= 0.011). Pt were asked to rate the survey: 95% considered it good or very Good, 56% found it useful, 36% thought it necessary, while 23% would recommend it. Conclusions: 1) Most of the pt know their diagnosis, would like to know their prognosis and need to know everything about efficacy and toxicity of treatments. 2) 40% of the pt would prefer to die in the hospital, but analyzing this choice at earlier stages of disease may be inappropriate. 3) PC and CI are of interest to both sexes but women are more likely to request PS and SC. 4) Although the survey was considered good by 95% of pt and more than 50% found it useful, only 23% would recommend it, which speaks about the sensitive quality of these topics.

e23173 Background: “The suicide rate in cancer patients is twice that observed in the general population in the United States” (JNCI vol 100, 24, page 1750, 2008). This paper focuses ona population with great psychological risk: cancer patients (Pt) with previous suicide attempts (SA) or a family history of suicide (FS); both grouped under SAFS for the purpose of this study. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions. The database was locked and anonymized. Those with a history of SAFS before cancer diagnosis were selected. Results: Out of 15,617 Pt, 184 Pt (1.2%) were SAFS(141 Pt were SA, 39 Pt were FS and 4 Pt were both). The relative risk ofSA was ten times larger for those with FS. Psychiatric Medication: Antipsychotics: 15Pt (8%), Antidepressants: 23 Pt (12%) and Benzodiazepines 45 Pt(24%), No treatment 101 Pt (55%). Population Characteristics: Sex: F:144 Pt . M: 40 Pt. Age: 56y (r = 26-88). Tumor Dx: Breast (65 Pt ) - Gastrointestinal (24 Pt) - Urological (21 Pt ) - Lung (21 Pt ) -Gynecological (19 Pt) - Hematological (11 Pt) -Head &Neck (8 Pt) - Endocrine (7 Pt) - Other (8 Pt). Stages: Early (0-I-II-III): 130 Pt, Advanced: 54 Pt. Ob-Gyn history:25 Pt (17%) nulliparous, 18 Pt (12%) with one child, 77 Pt (53%) with 2 or 3 children and 24 Pt (17%) with more than 3 children; 62 Pt (43%) had previous abortions. Average severe comorbidities (respiratory and psychiatric) was 3 per Pt (r = 0-18). Toxic habits: Smoking: 120 Pt (65%), Alcohol: 37 Pt (20%) and Illicit Drugs: 4 Pt (2%). Follow-up: 19 months (r = 0-70). No Pt had any SA, or commited suicide, during the follow-up.Living patients:177 (96%). Conclusions: 1) In our vast cohort, 184 Pt (1.2%) were identified as highly vulnerable psychiatric Pt due to SAFS. 2) Given the high psychological risk and stressful cancer diagnosis, 83 Pt (45%) were prescribed psychiatric drugs. 3) Follow-up of SAFS Pt by a multidisciplinary team is requiredfor adequate Pt and family support.