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207 Background: Cancers of the gynecologic and gastrointestinal tracts (GYN/GI) often metastasize along the peritoneum (peritoneal carcinomatosis; PC), causing ascites and malignant obstructions of the bowel, urinary tract, and biliary tree. Patients with PC frequently require palliative surgical interventions; e.g., ostomies, gastric tubes, and catheters. To date, few researchers have described the unique needs of these patients and their caregivers. Methods: We recruited adult patients with advanced GYN/GI cancers, a recent hospitalization for PC, and a new complex care need. We invited adult caregivers of enrolled patients to participate. We abstracted patients’ clinical characteristics and outcomes from the medical record. At baseline, patients completed items related to perceived health status and advance care planning, while caregivers completed the Caregiver Reaction Assessment (CRA) and items related to their caregiving role. All participants completed the Hospital Anxiety and Depression Scale. Results: Sixty-five patients and 40 caregivers completed surveys. Fifty-six (86%) patients had GYN and nine (14%) had GI cancers. Most (56/65, 86%) were re-hospitalized within two months, and over a quarter (18/65, 27%) died within six months of enrollment. Twenty-four (37%) reported they were terminally ill, but only nine (14%) had spoken with a physician about the care they would want to receive if they were dying. Caregivers were primarily spouses (27/40, 70%) who provided most or all of the care for their loved one (25/40, 63%) and engaged in caregiving seven days per week (27/40, 68%). Of the four CRA subscales measuring negative caregiving experiences, mean scores were highest for impact on schedule (3.3, SD = 0.8; possible range 1-5, higher scores indicate greater burden), followed by impact on finances (2.3, SD = 1.1), impact on health (2.0, SD = 0.65), and lack of family support (1.8, SD = 0.67). Caregivers reported that they received training on a mean of 1.1 (SD = 1.3) clinical care tasks but performed a mean of 2.9 (SD = 1.7) clinical care tasks. Thirty-two (49%) patients and 9 (23%) caregivers met borderline case or case criteria for depressive symptoms, while 26 (40%) patients and 15 (38%) caregivers met borderline case or case criteria for anxiety symptoms. Conclusions: Patients with PC and their caregivers are highly burdened and distressed. Patients are at high-risk for re-hospitalization, but few have discussed their end-of-life wishes with their medical teams. Interventions that train these patients and their caregivers to perform clinical care tasks, facilitate serious illness conversations, and provide psychosocial support are needed. Clinical trial information: NCT03367247.

418 Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.

195 Background: Pain is among the most common reasons that cancer patients present to the emergency department (ED) and are ultimately hospitalized, yet little is known about the patient-level predictors and outcomes of pain-related ED visits and hospitalizations. This study sought to evaluate the predictive association of clinical pain and psychological variables on ED admission with average daily pain and opioid consumption in subsequently hospitalized patients with cancer. Methods: A prospective cohort study of patients with active cancer presenting to the ED with pain severity ≥4/10 on presentation completed baseline surveys that assessed demographic, socioeconomic, cancer diagnosis and treatment, medication use, and psychosocial profiles using validated questionnaires. Daily pain scores and opioids administrated were abstracted from the hospital record. Univariable and multivariable general estimating equation (GEE) analyses examined associations of baseline socioeconomic and clinical variables with the primary outcomes, average daily pain and total daily opioid administration. Results: Patients (N = 113) had various types of cancer, with 91% having a diagnosis of > 1 year, 80% with metastatic solid tumors, 73% reported pain as the primary reason for the ED visit, 43% were taking opioids, and 27% had chronic pain predating their cancer. Average daily pain scores ranged between (3.4 to 5.0 out of 10) and daily MMEs ranged between 0 to 1136 MMEs, yet the majority received lower than 60 MMEs per day. In multivariable models, higher pain catastrophizing (B = 0.1, p= 0.001), more recent surgery (B = -0.2 p= 0.016), outpatient opioid use (B = 1.4, p