Background: Guidelines recommend systematic evaluation of distress screening and referral for cancer patients. Implementation remains a notable gap for cancer centers serving disadvantaged communities. We present the implementation of a distress screening program within a Veterans Affairs hospital oncology clinic, serving a majority African American (AA) male population of low socioeconomic status (SES). Methods: The Coleman Foundation funded this program supporting a palliative care physician and psychologist to implement screening in a phased approach as follows: (1) Organizing key stakeholders, (2) educating clinical staff, (3) delivering distress screening, (4) generating documentation, and (5) implementing clinical action and referral pathways. We utilized validated measures in the "Patient Screening Questions for Supportive Care" screening tool. Results: This program was unsuccessful in screening all veterans with cancer; however, we were able to implement 3 years of longitudinal screening. In distress screens from the initial program period (n ¼ 253), patients were primarily males (95.6%) of older age (m ¼ 70, standard deviation ¼ 9.45), AA (76.4%), with various cancers of advanced disease (69%). Males reported moderate psychosocial distress and elevated financial needs. For males with elevated psychosocial distress (n ¼ 63, PHQ-4 ≥3), 36% were previously connected with psychosocial services. Following screening, engagement increased as the majority (77%) established psychosocial care. Conclusions: This screening program had mixed success. Centralized program staff and available supportive care referrals were critical for program implementation. Screening may have increased engagement in social work/mental health services for males of low SES. Screening programs should be tailored to the needs of underserved communities with accessible housing/food subsidies.

The purpose of this study was to document the functional severity of DSM-5 IED in a clinical research sample. IED and control groups were compared on psychosocial functioning, life satisfaction, and on a variety of cognitive and behavioral issues. IED study participants reported significantly worse psychosocial function, quality of life, and higher job dysfunction than both psychiatric and healthy control study participants. The presence of DSM-5 IED is associated with significant psychosocial and functional impairment. Early intervention may aid in minimizing the consequences of impulsive aggressive behavior, and improving psychosocial functioning and quality of life.

Patients presenting with psychiatric comorbidities or limited social support at any phase of the lung transplant process should be monitored closely. This case report draws into focus the need for systematic and ongoing psychological evaluation following lung transplantation.

6569 Background: The Coleman Supportive Oncology Collaborative for Adolescents and Young Adults (CSOC AYA) is a multi-institution Chicago-based quality improvement collaborative consisting of representation from AYA-focused oncology teams at six hospitals and national patient advocacy organizations. Coping with cancer as an AYA is challenging given their complex and unique phases of life and dichotomy between pediatric and adult care. AYAs with cancer are a recognized underserved population within the cancer community and have unique supportive care needs that are often unmet. The CSOC AYA focuses on improving access to resources for supportive care. Methods: We implemented an online survey across six cancer treatment centers (5 academic, 1 community) engaging 50 AYAs. Participants were newly diagnosed (2), currently on treatment (18), or off treatment (30). Participant age range was representative of AYAs ( < 18years: 2%, 18 – 24: 36%, 25 – 34: 55%, and 35-39: 7%). Reported race was 60% Caucasian, 10% Black, 18% Latino, 8% Asian, 2% American Indian, and 2% other. Questions were asked to inform which supportive resources were desired by patients, when the resources would be most useful during the care continuum, and the preferred methods to receive information. Results: Greater than 54% percent of respondents desire social/emotional resources and peer connection at diagnosis. During treatment and after treatment, > 71% and > 56% respectively, desire guidance regarding nutrition/diet and physical activity/exercise, in addition to social/emotional support and peer connection (See table). Preferred methods to receive information were identified: 72% via email or text, 60% in person, and 45% via a patient portal. Conclusions: The CSOC AYA survey identified the type of supportive care resources AYAs need, when they are wanted, and their preferred methods for receiving them. Optimizing accessibility and availability of supportive care resources can enable AYA self-management and has the potential to improve quality of life. These survey results will serve as the basis for a patient-facing online intervention implemented throughout the care continuum with the intent to improve supportive care access for AYAs with cancer. [Table: see text]

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567 Background: The Loyola University Chicago Cardinal Bernardin Cancer Center multidisciplinary Breast Oncology Center evaluates new patients (pts) for cancer-related distress using a needs-based screening tool, in accordance with Commission on Cancer (CoC) Standard 3.2. Identifying distress among newly diagnosed pre-surgical and pre-neoadjuvant pts allows for comprehensive treatment planning and establishment of a baseline for repeated assessments. Methods: Pts with newly diagnosed BC between May 2017 and June 2018 completed the “Patient Screening Questions for Supportive Care” (Coleman Supportive Oncology Collaborative, 2017), a consolidated screening tool based on validated instruments (NCCN Distress, PHQ-4, PROMIS), prior to initial provider visit. Cancer staging, demographics, and supportive oncology referrals were obtained from medical records. Descriptive statistics and chi-square were used. Results: 100 pts aged 30-94 (mean(SD) = 61.56(12.03)) completed the screening tool; 14.9% had Stage 0, 43.6% Stage I, 34.0% Stage II, 3.2% Stage III, and 4.3% Stage IV disease. 39% of pts screened positive for anxiety on the PHQ-4, and over 20% for depression. Anxiety was associated with cancer stage ( X2(df) = 12.20(4), p = .016). The most common practical concerns included living alone (19%), issues with work/school (16%), and paying for medical care (12%). Common physical concerns included difficulty with sleep (40%) and concentration/memory (17%), and tingling hands or feet (14%). Poor sleep was associated with depression ( X2(df) = 6.50(1), p = .011) and anxiety ( X2(df) = 7.17(1), p < .01). 57.7% reported at least "a little bit" of fatigue and 17.7% reported moderate to very severe pain. Nearly all pts wanted to better understand their diagnosis (87.8%), prognosis (87.8%), or treatment (91.8%). Conclusions: Pts with newly diagnosed, early stage BC experience high levels of physical and emotional distress at the earliest point in the treatment trajectory. This study captures BC patients at a unique time point and provides support for conducting routine screening for supportive oncology needs at initiation of care. Further studies should reassess needs sequentially to determine changes across the care continuum.

Background: In accordance with Commission on Cancer (CoC) Standard 3.2, the Loyola University Chicago multidisciplinary Breast Oncology Center evaluates every new patient (pt) for cancer-related concerns and makes supportive oncology referrals accordingly (CoC Standard 3.2). We previously reported that pts with newly diagnosed early-stage BC experience high levels of physical and emotional distress (Rynar 2019, ASCO abstract 269661). This study expands upon those findings by examining relationships between psychological distress and other cancer-related concerns and referrals to supportive services in a larger cohort of pts with newly diagnosed BC. Methods: The "Patient Screening Questions for Supportive Care" (Coleman Supportive Oncology Collaborative, 2017), an aggregate of validated screening tools, was implemented across 200 new pts from April 2018 thru August 2018. Demographic information and supportive oncology referrals were obtained from medical records. Descriptive statistics and chi-square were used to assess frequencies and relationships among variables. Results: 200 female pts aged 26-94 (mean (SD) = 61.39(12.90)) completed the screening tool; 16.5% had Stage 0, 40% Stage I, 34.5% Stage II, 4.5% Stage III, 2.0% Stage IV. Commonly reported psychosocial and physical complaints included concerns about work and paying for medical care, poor sleep, tingling in hands or feet, and concerns about weight gain. 47% of pts met the threshold for referral to psychology based on a positive screen for anxiety (n=65) or depression (n=28); the majority (92.8%) had at least 1 contact with a psychologist within 12 days. 51.5% of pts screened positive for a practical need triggering a referral to social work; 72.8% of consults were completed within 3 days. 27% had nutrition concerns triggering referrals to dietician services; 77.8% completed contact within 3 days. Pts who screened positive for anxiety were significantly more likely (p&lt;.01) to also have ≥2 physical concerns, nutrition concerns, fatigue, and concerns about physical function (p=.04). Screening positive for depression was significantly associated (p&lt;.01) with ≥2 physical concerns, family concerns, spiritual concerns, fatigue, and pain (p=.03). Conclusions: Newly diagnosed BC pts who screen positive for anxiety or depression are more likely to report concerns across multiple biopsychosocial domains. This finding lends support for CoC, NCCN, and ASCO supportive care guidelines to evaluate and address patient reported concerns beyond psychological distress. Further, we highlight the importance of assessment and triage at the start of the cancer care continuum. Future studies should reevaluate distress at pivotal points in care to determine the impact of early interventional supportive oncology services in this population. Citation Format: Lauren Z. Rynar, Blaine A. Knox, Kristen B. Wendell, Patricia B. Mumby, Kathy S. Albain, Cathy Grace-Louthen, Hahn P. Mai, Patricia A. Robinson, Shelly S. Lo. Triaging cancer-related distress at the time of breast cancer (BC) diagnosis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-10-01.