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Background In cancer, malnutrition is common and negatively impacts tolerance and outcomes of anti-tumor therapies. The aim of this study was to evaluate the prevalence of malnutrition risk and compare the clinicodemographic features between those with high malnutrition screening tool (MST) scores (i.e., ≥ 2 of 5 = high risk for malnutrition, H-MST) to low scores (L-MST). Methods A cohort of 3585 patients (May 2017 through December 2018), who completed the MST at least once at the time of diagnosis of any stage solid tumor, were analyzed. Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence. Results The median age was 64 years (25–75 IQR, 55–72), with 62% females and 81% White. Most common tumor primary sites were breast (28%), gastrointestinal (GI) (21%), and thoracic (13%). Most had non-metastatic disease (80%). H-MST was found in 28%—most commonly in upper (58%) and lower GI (42%), and thoracic (42%) tumors. L-MST was most common in breast (90%). Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5–2.4, p =

We estimated the prevalence of potentially actionable pharmacogenetic (PGx) variants related to symptom control medications (SCMs) based on institutional prescribing patterns and correlated presenting symptoms with SCM prescribing. This was a retrospective study of adult ambulatory cancer patients undergoing electronic distress screening (EDS) within 90 days of intake to the cancer hospital. We estimated the proportion prescribed SCM(s) with PGx evidence within 90 days of intake. Those with potentially actionable variants were estimated using population frequency data from 1000 genomes. The expected number at risk of altered drug response was estimated. The associations between symptom scores and SCM(s) were estimated with logistic regression and threshold analyses performed with receiver operating characteristic (ROC) curves. Of 6985 patients, 3222 (46%) received ≥ one SCM. Of these, 2760 (86%) received SCM(s) with PGx evidence for CYP2B6, CYP2C19, CYP2D6, or SLC6A4; 2719 (84%) received a drug metabolized by CYP2D6, most commonly hydrocodone (40.4%), ondansetron (35.6%), oxycodone (24.2%), and/or tramadol (7.1%). Based on this, about one quarter were expected to have altered metabolism and/or drug response. One third were prescribed two or more SCMs with PGx evidence. About half reported at least one severe symptom, which significantly correlated with SCM prescribing (p < 0.001). Threshold scores were identified that highly correlated with SCM prescribing for anxiety, depression, nausea, neuropathy, pain, and sleep. About half presented with significant symptom burden, which highly correlated with SCM prescribing. Most received SCMs with PGx evidence. Preemptive PGx testing for these variants should be evaluated in prospective trials to evaluate the impact on symptom control.

Purpose Telechaplaincy (the use of telecommunications and virtual technology to deliver spiritual and religious care by healthcare chaplains or other religious/spiritual leaders) is a relatively novel intervention that has increasingly been used in recent years, and especially during COVID-19. Telephone-based chaplaincy is one mode of telechaplaincy. The purpose of this study was to (1) describe telephone-based chaplaincy interventions delivered as the first point of contact to patients who screen positive for religious/spiritual concern(s) using an electronic data system, and (2) assess the feasibility and acceptability of delivering interventions in an outpatient cancer institute using this methodology. Methods Patients were screened for religious and spiritual (R/S) concern(s) using an electronic data system. Patients indicating R/S concern(s) were offered a telephone-based chaplaincy intervention and asked to complete a survey assessing acceptability of the intervention. Feasibility and acceptability data were collected. Results Thirty percent of screened patients indicated R/S concern(s). Telephone-based chaplaincy interventions were offered to 100% of eligible patients, establishing contact with 61% of eligible patients, and offering chaplaincy interventions to 48% of those patients. Survey participants report high acceptability of the offered intervention. Conclusion This is the first study examining feasibility and acceptability of telephone-based chaplaincy with oncology patients. Telephone-based chaplaincy is feasible and acceptable within an outpatient oncology setting, supporting the promise of this interventional strategy. Further research is needed to refine practices.

12128 Background: Sexual health is an important component of overall well-being and can be adversely impacted by chemotherapy, surgery, radiation, in addition to the psychological effects of cancer treatments. Sexual health is challenging to discuss and may be overlooked or avoided during cancer care. Methods: Patients presenting for consultation in an outpatient multisite cancer center completed electronic distress screening (EDS) between January 2017 and December 2020. The EDS contains 42 questions; demographic information, cancer symptoms and side effects, and psychosocial factors. The EDS is completed by patients before a clinical encounter for early symptom identification and intervention. We conducted a retrospective data analysis of sexual health concerns (>5; scale 0-10) and evaluated patient characteristics and clinically relevant distress (>4; NCCN Distress Tool), depression risk (>3; PhQ2), and anxiety risk (>3; GAD2). Our primary aim was to identify the prevalence of sexual health concerns. The secondary aim was to examine the relationship between sexual health and emotional well-being. Results: 57,375 EDS screens were completed. 13,950 patients (24%) reported sexual concerns or lack of interest in sex (>5) within the last 2 weeks. The frequency of these concerns at specific clinics ranged from 12% to 48%, with the highest rates at Palliative care (39%) and Psycho-Oncology (48%) clinics. Genitourinary (30%), Gynecologic (27%) and Gastroenterology (26%) reported the highest frequency of sexual concerns from cancer site specific clinics. Males reported a higher rate of sexual problems compared to females (30% vs 21%, p < 0.001), but a lower rate of relationship concern distress (12% vs 13%, p < 0.05). Patients with a risk for depression (n = 9,126) or anxiety (n = 10,809) had higher rates of self-reported sexual concerns than those with a negative screen (44% vs 21% depression, p < 0.001; 40% vs 21% anxiety, p < 0.001). Conclusions: Sexual health is a concern for approximately one-quarter of patients presenting for cancer care. Sexual health concerns were prevalent across cancer sites. Patients with positive screens for anxiety and/or depression have nearly double the rates of reported sexual health concerns. Sexual health is a current unmet need that impacts cancer patients and warrants attention.

76 Background: Pain is one of the most common cancer symptoms. Individuals in pain often experience psychological distress in the form of anxiety and depression. Social support is an important resource utilized by patients to cope with cancer. Aims: (1) Identify clinicodemographic factors influencing cancer pain; (2) examine social support as a moderator of the relation between anxiety, depression and cancer pain. Methods: Participants included stage I-IV cancer patients (N = 11,815) who completed a routine tablet-based psychosocial distress screening at a large academic hybrid, multi-site, community-based cancer institute (Jan 2017- Jan 2019). Participants were matched to the Cancer Registry (N = 7,333); clinicodemographic factors were incorporated into lasso regression models. Models identified pain predictors from self-reported anxiety, depression and social support. Analyses examined if the effect of anxiety and depression on pain differed by levels of social support. Results: Median age was 59 (RNG, 18-101), 61% female and 77% white. Tumor site (GI, Gyn, head/neck), advanced disease, black race, and lower income were independently associated with severe pain. Anxiety (β = 0.48, p < .001) and depression (β = 0.69, p < 0.001) were related to pain intensity after accounting for clinicodemographic factors. The effect of depression on pain differed by level of social support (p = 0.009). The effect of anxiety on pain differed in patients reporting transportation issues (p = 0.035). Conclusions: This is the largest study to date examining cancer pain intensity, psychological factors of anxiety and depression, and social support. Our data suggests that patient characteristics of race, income, tumor site, and disease staging independently predict pain intensity. Anxiety and depression are significant factors of pain intensity; these associations remain after accounting for patient characteristics. Social support buffers the negative impact of anxiety/depression on pain. Clinicians who treat cancer pain should be attuned to modifiable psychological factors which can greatly influence a patient’s pain experience. Findings emphasize the need for interdisciplinary multimodal approaches for cancer pain.

6559 Background: ASCO/NCCN guidelines recommend screening for multifactorial distress in cancer patients. Understanding predictors of cancer related distress can lead to early intervention and improve clinical outcomes, symptom management, and operational efficiency. Through electronic distress screening (EDS), patient reported outcomes (PRO) were collected across 42 practice locations. Methods: EDS has 39 questions related to cancer related distress including: distress, cancer symptoms/side effects, malnutrition, depression, anxiety, social/family support, financial, and spiritual concerns. 27,106 patients completed screens between 2017-2018. Multivariate analysis and logistic regressions determined predictors of distress for completed screens overall, registry matched, and within 60 days of diagnosis. Results: Median age was 59 (IQR 18-101) and 65% were female. Five symptoms consistently predicted clinically significant distress ≥ 4: anxiety, fatigue, pain, poor emotional coping, and sleep. Diagnosis (dx), staging at time of dx, and timing of screen did not independently predict distress. Factors predicting clinically significant distress varied across geographic regions. Conclusions: In large patient population, five key PROs are predictive of clinically significant distress and could potentially impact clinical outcomes. Early PROs predictive of distress were consistent along the continuum, thus the importance of early symptom identification. EDS can help custom tailor supportive oncology programs to mitigate symptoms related to cancer distress. [Table: see text]

e15567 Background: Esophagectomy is accompanied by significant morbidity, mortality and altered quality of life. Understanding the factors responsible for adverse post-operative outcomes is essential for risk stratification in the selection of patients for surgery. Patient-reported measures are important not only as treatment outcome metrics, but also in predicting tolerance to therapy. Postoperative length of stay is a convenient measurement of patient tolerance of surgery. Our study aim was to determine whether preoperative patient-reported measures could add additional predictive power to clinical variables in predicting postoperative length of stay. Methods: A tablet-based symptom screening tool measured Distress, Anxiety (GAD-2), and cancer-related symptoms preoperatively. A generalized linear model predicting postoperative length of stay was constructed using age, gender, insurance status, income, T stage, and sarcopenia (hand-grip strength < 25kg). Patient-reported variables were then evaluated for their ability to predict length of stay in addition to these clinical factors. Factors found not significant (p > 0.05) are indicated N.S. Results: Esophagectomy (n = 58): Median age 62 (IQR 54-70) and 46 men (79%). Adenocarcinoma in 52 (90%). Neoadjuvant chemoradiation administered in 37 (64%). Major complications occurred in 13 (22%). Median postoperative length of stay was 8 days (IQR 6-10). Distress, Pain, Nausea/Vomiting, Trouble Swallowing, and Insurance or Financial Concerns independently predicted postoperative longer length of stay on multivariable analysis, while accounting for preoperative clinical factors. Conclusions: Preoperative cancer patient symptom reporting adds additional information to traditional clinical factors in predicting length of stay post-esophagectomy. Patient-reported measures may identify patients who benefit from interventions for preoperative optimization.[Table: see text]

11592 Background: SCMs are prescribed based on symptom burden, but response is variable, possibly due to PGx. We investigated the association between symptom burden, SCM prescribing, and frequency of SCMs with PGx evidence. Methods: Cancer pts ≥ 18 years old and completing electronic distress screening within 90 days of intake between 1/1/2017-12/31/2017 were included. Anxiety was measured using Generalized Anxiety Disorder 2-item (0-6) and depression using Patient Health Questionnaire-2 (0-6). Fatigue, nausea, neuropathy, pain and sleep were measured on a 0-10 scale. SCM prescribing within 90 days of intake was documented. Logistic regression compared symptom scores and SCM prescribing. Receiver Operating Characteristics analysis estimated sensitivity/specificity. Optimal symptom thresholds were selected according to Youden’s J statistic. SCMs with PGx evidence level A or B (according to Clinical Pharmacogenetics Implementation Consortium) were summarized. Results: Of 6985 pts, 65% were female, 75% Caucasian, 20% African American and median age was 60. 49% reported ≥ 1 severe symptom, which correlated with SCM prescribing (p < 0.001). 3208 (46%) were prescribed SCM(s), mainly for pain (69%) or nausea (46%). Of these, 2759 (86%) received ≥ 1 SCM with PGx evidence and 2695 (84%) received a SCM metabolized by CYP2D6 - hydrocodone (47%), ondansetron (41%), and oxycodone (28%). Based on reported CYP2D6 allele frequencies conferring altered metabolism (~20%), 539 of the 2695 pts may have altered drug response. Threshold scores for each symptom are summarized in the table. Fatigue and nausea were not associated with SCM prescribing. Conclusions: Symptom burden is high in cancer pts and correlates with SCM prescribing. Many SCMs have PGx evidence, suggesting preemptive testing, particularly for CYP2D6, may have broad applicability in this population.[Table: see text]

170 Background: Sustainable comprehensive screenings for cancer-related symptoms and distress is a challenge for large multisite cancer centers. Technological solutions are necessary to compile patient-reported outcomes at institutions with high volumes across broad geographic regions. Interdisciplinary collaboration and leadership engagement is required to effectively screen for and manage symptoms. Once integrated, electronic distress screening (EDS) produces large symptom databases for management of cancer related symptoms, strategic programmatic growth, and research. Methods: System-wide (n=44 clinic locations) implementation of EDS at consultation visits and simulations occurred in phases between November 2016-Dec 2016. EDS content, clinical sensitivity thresholds, and referral processes were developed with input from Supportive Oncology Department. Automatic alerts via email based on clinical thresholds developed and various symptoms profiles used to aid referrals to supportive oncology resources. Information and Analytic services ensured clinical integration into the EMR, delineation by clinic site, and troubleshooting. Ongoing completion rate tracked and sent to all practice managers. Results: The network-wide EDS completion rate for January 2017-June 2018 is 69% (26,564 completed out of 38,435 eligible patient encounters). Mean completion time per patient was 8 minutes. 84% of clinic sites (n=37) screened >50% of eligible patients and 46% of clinics (n=20) screened >75%. Triggered referral rates were established for all supportive oncology sections (e.g. 60% of patients reported clinically significant distress and 18% indicated being at risk for malnutrition). All screening data available for ongoing analysis. Conclusions: EDS can be integrated as a solution for distress and cancer related symptoms in multisite cancer centers. Interdisciplinary collaboration is needed to ensure clinical relevance. Phased rollouts, structured education, and completion rate dashboards help establish leader buy-in and consistent symptom screening. Such symptom databases allow large cancer hospital networks to strategically allocate limited resources based on highest volume/acuity/symptom profiles.

Caring for families who have experienced trauma, loss, or chronic conditions can have lasting effects on providers, especially when faced with complex situations for extended periods of time. Training programs often do not prepare providers to avoid common challenges such as burnout (BRN) and compassion fatigue (CF). In this chapter, the authors provide operational definitions for these conditions in healthcare based on research conducted with diverse medical and behavioral health providers. The authors include personal and professional recommendations that promote self-care in medical family therapists (MedFTs), that can be taught to other healthcare staff and providers within workplace contexts that are emotionally charged, psychologically draining, and oftentimes physically demanding.

e21592Background: Acupuncture is increasingly being used to treat cancer-related symptoms. Evidence for efficacy of symptom mitigation is lacking, as is volume of evidence for safety in this popula...

Intervention research for couples and families managing chronic health problems is in an early developmental stage. We reviewed randomized clinical trials of family interventions for common neurological diseases, cardiovascular diseases, cancer, and diabetes, which is similar to the content of previous reviews discussed later. One overriding theme of these studies is that patients with chronic illnesses and their families face a variety of challenges to which researchers have responded with an array of treatment modalities. Very few of the interventions reviewed, with the exception of treatment for adolescents with diabetes, tested family psychotherapy models. Most interventions were time-limited therapeutic interventions that trained families to improve their communication and problem-solving skills, individual and family coping skills, and medical management. Researchers more clearly described mechanisms of change in intervention studies with cancer and diabetes than with other diseases, and not surprisingly, they found greater empirical support for their interventions. Family interventions show promise to help patients and family members manage chronic illnesses. To develop an empirical base for family approaches to managing chronic illnesses, interventions must be based on theories that delineate mechanisms of change in family processes and skills in medical management necessary to maintain patients' and family members' health.

Intensive care providers who care for traumatized populations often face multiple traumas for extended periods and are vulnerable to developing lasting symptoms of compassion fatigue and secondary traumatization. Symptoms are often not recognizable until compassion fatigue or secondary traumatization negatively affects the providers' ability to care for their patients. More attention needs to be given to the care of the provider to ensure high-quality patient care, decrease turnover in the profession, and increase productivity. This article provides a framework for the development of an educational module for healthcare providers' self-care. This educational module created the opportunity to share with providers (a) how to explore their own professional experience; (b) how to recognize the different symptoms of compassion fatigue, primary traumatization, and secondary traumatization; (c) factors related to grief reactions; and (d) personal and professional strategies to decrease compassion fatigue and secondary traumatization.

The primary aim for this research was to explore the overlap and differences between the concepts related to secondary traumatization: posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), compassion fatigue (CF), and burnout (BRN). A secondary aim for this research was to examine the impact of secondary traumatization and some of the personal and professional elements that affect how pediatric healthcare providers experience PTSD, STS, CF, and BRN. An online survey was sent via e-mail to numerous list serves for healthcare providers who had worked on PICU, NICU, or PEDS units within the last year. The analyses revealed that a significant overlap existed between the terms of STS, PTSD, BRN, CS, and CF for PICU, NICU, and PEDS providers. However, a hierarchical linear regression revealed a significant amount of unique contributions to the variance in CF based on each of the measured concepts. Despite previous literature that indicates that the terms STS and CF can be used interchangeably, the two most prominent measures utilized in the assessment of CF and STS are actually capturing at least some unique elements. Given these results, future researchers should examine and conceptualize the difference in etiology, prevalence, symptoms, and treatment efficacy for CF and STS as separate but related entities and then return their focus to understanding secondary traumatization in healthcare providers.