Background. The early integration of supportive care in oncology improves patient-centered outcomes. However, data is lacking regarding how to achieve this in resourcelimited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. Materials and Methods. This randomized controlled trial was conducted between 08/17 and 04/2018 at a public hospital in Mexico City. Patients aged ≥18 with metastatic tumors ≤six weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. Results. 134 patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm vs. 24% in usual care (difference 0.50, 95% CI 0.34-0.62; p<0.0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared to 0% in usual care (p<0.0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10 vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = 0.006), without differences in quality of life between arms. Conclusions and Relevance. Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. The Oncologist 2020;9999:• •

Background: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. Methods: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. Results: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). Conclusion: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

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programme for outpatient and medical records was consulted. Data collected for each patient were: sex, age, menopause status, performance status (PS), cancer stage, presence of visceral metastatic disease, therapeutic scheme and number of cycles received. The safety profile was assessed from the number of adverse events (AE), and the severity of AEs was graded on the basis of the common terminology criteria for adverse events, V.5.0. Number of patients and reasons for delays and dose reductions were also determined. Results 34 patients, 100% women, were included, with an average age of 60 (47-81) years, of whom 71% were postmenopausal. 29 patients presented at the beginning of treatment with PS £1. The percentage of patients with metastatic disease was 100%, of whom 76% had visceral metastases. The schemes, average numbers and range of cycles were: palbociclib 125 mg every 3 weeks, 7 (1-17) cycles. 105 AE occurred in 31 patients (91%): 54 haematological, 23 metabolic, 10 digestive, 7 asthenia, 2 cases of infections and 9 other causes. The degree of severity was: anaemia, anorexia asthenia, diarrhoea, dysgeusia, increased levels of GGT/AST/ALT/LDH, mucositis, nausea, neutropenia, itching, palmar-plantar erythrodysaesthesia syndrome, thrombopenia, urticaria and vomiting, grade 1 (59%); anaemia, anorexia, asthenia, headaches, GGT increased, infections, mucositis, nausea, neutropenia and vomiting, grade 2 (30%); and asthenia, neutropenia and GGT increased, grade 3 (12%). There were 13 patients who delayed treatment, and neutropenia was the reason in 85% of patients. 6% of patients had reduced doses of palbociclib because of neutropenia or mucositis. Conclusion and relevance There was a high incidence of AE, the most frequent being grade 1. The most common AE were haematological, with neutropenia being the highest degree. Our studies suggested a high percentage of delays and dose reductions.

11505 Background: Early integration of SC to the treatment of advanced cancer can improve outcomes, but this may be challenging in developing countries due to a lack of resources and knowledge. In this RCT, we examined whether PN could improve early access to SC among Mexican patients with metastatic solid tumors as recommended by ASCO guidelines. Methods: Adult patients with newly-diagnosed metastatic cancer were randomly assigned to PN or standard oncologic care. At baseline, a navigator assessed the patients’ SC needs (depression, anxiety, fatigue, pain, caregiver burden) using validated questionnaires administered with an electronic tablet. For those in the PN arm, a personalized SC plan was created and implemented by a multidisciplinary team (palliative care, physical therapy, geriatrics, psychology, psychiatry). The primary outcome was access to SC, defined as receipt of SC interventions in the first 3 months (mo) after diagnosis. Secondary outcomes included advanced directive (AD) completion (for patients with expected survival ≤6 mo in accordance to Mexican law), changes in SC needs, and changes in quality of life (assessed using FACT-G). Results: 133 patients (median age 60, range 23-93; 52% male) were randomized (66 PN, 67 control). 61% of patients had gastrointestinal tumors. 94% of patients in the PN arm completed baseline assessments and received recommendations from the navigator. At 3 mo, 37 patients died or were lost to follow-up (16 PN, 21 control; p = 0.45), and 96 completed assessments. SC interventions were provided to 73% of patients in the PN arm and 24% of controls (p < 0.01). In the PN arm, 48% of 29 eligible patients completed AD, compared to 0% of eligible controls (p < 0.01). At 3 mo, patients in the PN arm were significantly less likely to report moderate/severe pain than controls (10 vs 33%, p = 0.006). There were no significant differences in other symptoms or in FACT-G scores (76 vs 76.3, p = 0.46) between PN and control arms at 3 mo. Conclusions: PN can lead to significant improvements in early access to SC, AD completion, and pain control among patients with metastatic cancer treated in a resource-limited setting. Clinical trial information: NCT03293849.

42 Background: Patient awareness regarding diagnosis and prognosis may lead to improved treatment shared decision making and improve satisfaction with treatment choices. We assessed the diagnostic and prognostic awareness among newly diagnosed patients with metastatic solid tumors in a public cancer center in Mexico City. Methods: Patients with metastatic cancer enrolled in a randomized clinical trial of patient navigation to improve access to supportive care in a public cancer center in Mexico City (NCT03293849) were included. At baseline, demographic, social, and clinical characteristics were collected. Patients answered open-ended questions regarding knowledge about their diagnosis and prognosis, as well as on patient-physician communication. We analyzed prognostic and diagnostic awareness using descriptive statistics, and explored if patients reporting worse patient-physician communication were less aware of their diagnosis and prognosis. Results: 125 patients were included between 08/17 and 04/18. Median age was 61 years (range 23-93; 52% male); 88.8% lived in urban areas; 41.6% had less than high school education; and 57.6% were married or partnered. 61% had gastrointestinal, 14% genitourinary, and 25% other tumors. Although all patients had had at least one consultation with an oncologist, 3% did not know what their diagnosis was. 77% of patients considered they had prognostic awareness; however, only 14% considered that their disease had a bad prognosis, and 2% considered they could be cured. 6.5% of the patients believed the information given by their oncologist was insufficient, and 8% felt they had trouble getting information about their disease. We found no statistically significant relationship between perceived barriers to patient-physician communication and diagnostic (p = 0.28) or prognostic (p = 0.18) awareness. Conclusions: Although most patients understood their oncologic diagnosis, a significant proportion were unaware of their prognosis. Communication strategies, tailored to the specific characteristics of each patient population and aimed at improving prognostic awareness, are fundamental for optimal shared decision making.

contraindicated medications include: unadministered contraindicated medications (220 cases, 42.8%); drugs taken intermittently or pro re nata (PRN) (147, 28.6%); administered by a clinical decision (79, 15.4%); local administration (21, 4.1%); meaningless words(44, 8.6%); and emergency medication (three, 0.6%). The reasons for prescribing contraindicated medications with drug-drug interaction in cases of anti-diabetic agents with CT contrast medium were as follows: unadministered contraindicated medications(95 cases, 76.0%), meaningless words (22, 17.6%) and administered by a clinical decision (eight, 6.4%). Reasons for other genitourinary organ and rectal agents with vasodilator were PRN (54 cases, 38.3%), administered by a clinical decision (42, 29.8%), unadministered contraindicated medications (29, 20.6%) and meaningless words (16, 11.3%). Reasons for NSAID with other cardiovascular drugs were PRN (65 cases, 69.9%), unadministered contraindicated medications (16, 17.2%) and local administration (13, 28.9%). Conclusion We confirmed that certain medications were sometimes prescribed using an incorrect reason. Some clinicians input a reason that was something other than a PRN drug use, or entered a meaningless words. It is necessary to improve the system of entering the reasons why clinicians prescribe contraindicated drugs. REFERENCES AND/OR ACKNOWLEDGEMENTSWe acknowledge the assistance of Soojeong Yoon.No conflict of interest.

BackgroundAccording to the American Society of Health System Pharmacists (ASHP) and the American Society of Parenteral and Enteral Nutrition (ASPEN), the pharmacist is responsible for proper preparation of parenteral nutrition (PN), for control during the process and for the final product.The European Medicines Agency (EMA) and the United States Pharmacopoeia (USP) postulate that 100% of PN must be prepared with a gravimetric error <5% for larger volumes of 100 mL.Quality control of the elaboration process includes components and gravimetric tests, which are used to identify areas with potential errors and therefore areas that could be improved.PurposeTo evaluate the quality control established in PN elaboration for 6 months, to determine the number and types of errors, and to identify opportunities for improvement.Material and methodsA data collection notebook was designed for prior checking, which describes the type of error and the number of times it occurs. The process begins with preparation of the components required for each PN by the nursing assistant. Then the pharmacist checks the occurrence of the components, and records any discrepancies found. Finally, the nurse makes a second check before compounding the PN.Regarding control of the finished product, PN solutions were weighed checking that the gravimetric error did not exceed 3%. In the case of this limit being exceeded, possible causes were investigated and the preparation was repeated.Results1238 PN were performed (1127 adults, 111 paediatric). 109 errors were found in 62 PN (5% of the total), with an average of 0.1 errors per PN, distributed as shown in table 1.Abstract PP-026 Table 1Adult PNPaediatric PNError typePharmacistNursePharmacistNurseTotalLack of product3779356 (51%)Extra product861823 (21%)Misrepresentation1401015 (14%)Wrong product623415 (14%)Total65 (60%)15 (14%)14 (13%)15 (14%)109Regarding the gravimetric test, 9 PN (0.7%) had to be prepared again because the gravimetric error exceed the 3% limit.ConclusionQuality control of the PN has proven effective in detecting errors, noting that the second check can correct errors unnoticed in the first checkup. It is highly important that the staff involved are trained in advance to avoid errors during the process.No conflict of interest.