Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding and highlight that an even greater number of patients with early stage I to III cancer have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.

Introduction: Studies have shown aggressive cancer care at the end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive systemic anticancer therapy at the end of life in a community cancer institute. Materials and Methods: We performed a retrospective cohort study of 201 patients who received systemic anticancer therapy in our institution and died between July 2016 and April 2017. Data collected included primary malignancy, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. We defined our outcome variable as the receipt of anticancer treatment in the last 14 days of a patient’s life. We evaluated 20 clinical exposure variables with respect to the outcome classes. Risk ratios along with their associated confidence intervals and P values were calculated. Significance was determined using the Benjamini-Hochberg procedure to account for multiple testing. Results: Of the 201 patients who died of cancer, 36 (17%) received anticancer therapy within the last 14 days of life. Several risk factors were significantly positively associated with receiving anticancer therapy at the end of life including hospitalization within 30 days of end of life, number of hospitalizations per patient (≥2), death in hospital, enrollment in OCM, and a diagnosis of hematologic malignancy. Conclusion: Our findings demonstrate those enrolled in the OCM and those with hematologic malignancies have a higher risk of receiving anticancer therapy in the last 14 days of life. These observations highlight the need for better identifying the needs of high-risk patients and providing good quality care throughout the disease trajectory to better align end-of-life care with patients’ wishes.

e21605 Background: Several studies have demonstrated patients have a poor understanding of prognosis, survival and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis as well as knowledge of remission status. Methods: 208 cancer patients previously treated at our large community based cancer institute participated in The Consumer-Based Cancer Care Value Index (CCCVI) Field Survey. Electronic medical record (EMR) documentation of stage at diagnosis and remission status were compared to patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: 51.0% of patients’ self-reported cancer stage matched the abstracted stage with the highest concordance in the advanced cancer patients (72%) versus stage I-III patients (36.4%-61.5%). Unexpectedly, discordance was lower among advanced cancer patients as compared to stage I-III patients (p = 0.0528) Those who were concordant for cancer stage at diagnosis were significantly more likely to be female (p = 0.001), under the age of 65 (p = 0.01), have an income greater than $60,000 (p = 0.03), and have more education (p = 0.02). 64.4% of patients’ self-reported remission status matched the abstracted status. Nearly 30% of patients were not sure about their status even when they were in remission. Conclusions: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding, as well as highlights that an even greater number of patients with early stage I-III cancers have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.

INTRODUCTION:COVID-19 caused a rapid integration of telehealth into prenatal care. This study aims to assess the effect of telehealth adaptation on timing and severity of the diagnosis of hypertensive disorders of pregnancy (HDP).METHODS:This is an IRB-approved retrospective cohort study of patients with HDP who delivered from April to October of 2019 (pre-pandemic) and 2020 (pandemic) at one urban tertiary care center. The primary outcome was mean gestational age at diagnosis of HDP. Secondary outcomes included initial and final severity of diagnosis before delivery. Results were adjusted for baseline characteristics different at P<.10, using multivariable logistic regression and ANCOVA as appropriate.RESULTS:Four hundred ninety-eight patients were included, with 231 from 2019 and 267 from 2020. 17.1% had preeclampsia with severe features initially, and 29.3% met these criteria by delivery. In 2020, 80.5% of patients used telehealth (versus 0.9% in 2019), doing so for a mean of 29% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, Black race was significantly associated with initial diagnosis severity (odds ratio [OR] 1.7 [1.0–2.8], P=.046); telehealth use as represented by cohort year was not (0.9 [0.5–1.3], P=.54). Black race (OR 2.6 [1.6–4.3], P<.001), non-Hispanic ethnicity (OR 0.4 [0.2–0.8], P=.04), and body mass index (OR 1.04 [1.0–1.1], P=.005) were significantly associated with final diagnosis severity; telehealth use was not (OR 1.0 [0.6–1.4], P=.87).CONCLUSION:The adaptation of telehealth is not associated with a change in timing or severity of diagnosis of HDP.