PURPOSE To describe the characteristics of the members of the ASCO-sponsored Oncology Student Interest Groups (OSIGs) in Latin America. METHODS This was a multicenter cross-sectional study. We surveyed 97 OSIG members from three medical schools in Peru and Mexico. We administered a 60-question survey covering topics including personal background, oncology training experience, and professional practice expectations and preferences. RESULTS A little more than one half of the surveyed OSIG members were female. More than one half had a visa to visit the United States and had an advanced level of English. One half of the OSIG members were also ASCO members. Most participants agreed or strongly agreed that participation in their OSIG increased their interest in cancer-related specialties (94%) and provided professional networking opportunities (94%) and that it was accessible to all students (91%). Most participants believed that their OSIG had sufficient resources to carry out its activities. Students were asked to rate their interest when they entered medical school versus at the time of the survey. Most of the members were strongly interested in pursuing surgical oncology. The majority of members were somewhat interested or very interested in palliative care and medical oncology. CONCLUSION To our knowledge, this is the first study that provides data on medical student perceptions of the Latin American OSIGs sponsored by ASCO. Student perceptions of medical oncology and the impact of OSIGs were generally positive. Given the shortages of oncology specialists in Latin American and elsewhere, strategies to engage medical students in the pursuit of cancer-related careers are becoming increasingly essential.

PURPOSE The financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden. METHODS This mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives. RESULTS Ninety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care. CONCLUSION A high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.

e18827 Background: FT associated with cancer care damages patients’ quality of life and increases symptom burden. Developing countries lack public insurance programs to protect the growing population of older adults with cancer from catastrophic expenses. In this cross-sectional mixed methods study, we evaluated FT among a Mexican older adults with cancer and their relatives. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months (mo) of diagnosis at two public hospitals in Mexico City, and their relatives. For the quantitative component, patients and relatives answered the CFPB Financial Well-Being Scale (range 0-100 points, lower scores represent worse financial well-being), the COST-FACIT cancer-related financial burden scale (range 0-44 points, scores < 26 represent FT), and a 3 mo self-reported expense diary. For the qualitative component, focused interviews were used to describe the individual experience of selected patients and their relatives. Results: 96 patients (mean age 72.1 years, SD 6.1; 59.4% male) were included for the quantitative component. The most common tumor types were prostate (33%), colon (14%), breast (14%), and lung (10%); 45% had stage IV disease; and a third had no healthcare coverage. Mean COST-FACIT score was 16.4 (95% CI 14.8-17.9), with 9% reporting no FT (score ≥26), 52% mild FT (14-25), 39% moderate FT (1-13), and 0% severe FT (0). Mean CFPB Financial Well-Being Scale score was 45.2 (95% CI 43.3-47.1); with 78% reporting poor financial well-being (score ≤50). Median expenses in the previous 3 mo were $3225 USD ($23-$55,000), of which most were associated with purchasing medications, including chemotherapy (median $735, $0-$13425). Average monthly patient income was only $123/mo ($0-$2000). Focused interviews were done for 25 patient-relative dyads. While most had no debt before cancer, a significant proportion of patients and their relatives (mainly their sons, daughters, or siblings) acquired multiple debts from banks, retail stores offering high-interest sub-prime credits, and/or relatives to pay for cancer-related costs . A common theme related to FT was the long interval (up to 1 year) between first symptoms and diagnosis, during which they paid for several private consultations and diagnostic tests. In many cases patients had to travel up to 180 miles to find cancer care. Conclusions: 91% of older Mexican adults with cancer had FT, compared to 18% reported by older patients with advanced cancer in the USA. Likewise, 78% had scores ≤50 in CFPB, in contrast with 24% in the US. Our results show high out-of-pocket expenses, limited healthcare coverage, and a deleterious effect of FT on the economic stability, productivity, and income of entire families and generations. Financial protection schemes are needed to protect older adults with cancer living in developing countries.

139 Background: Early palliative care (PC) improves the outcomes of patients with advanced cancer, and ASCO has issued guidelines to encourage the integration of PC into standard oncology care. However, even in developed nations, many patients fail to obtain a timely PC evaluation. We reviewed current practices in the assessment of PC needs and use of PC services in a cancer center in a developing country. Methods: All patients with newly diagnosed advanced solid tumors seen at the National Institute of Medical Science & Nutrition in Mexico City from 10/2015 to 03/2016 were included. Demographic and clinical characteristics, data regarding assessment of PC needs, and referrals to PC services were retrospectively obtained from chart reviews for the first year after diagnosis. Frequencies and summary statistics were utilized. Results: 77 patients were included (median age 62 years; range 19-88; 55% male). 53% had gastrointestinal, 21% genitourinary, and 16% other tumors. The most commonly assessed symptom by oncologists (in at least one visit) was pain in 77% of patients, followed by anorexia (75%), fatigue (70%), nausea (57%), dyspnea (28%), and depression/anxiety (13%). 30% of patients were referred to PC in the first year after diagnosis. Median time from diagnosis to PC referral was 138 days (range 25-467). The most common causes for PC referral were pain (38%), delirium (23%), dyspnea (20%) and fatigue (20%). Only 1% of patients completed advance directives. 42% died during follow-up, of which 38% had previous PC visits. Median time from first PC visit to death was 15.5 days (range 1-70). Median time from last chemotherapy to death was 72.5 days (range 2-1201). Conclusions: Less than a third of the patients were referred to PC early in the course of their disease, and many PC needs were not routinely evaluated. Novel strategies are needed to improve access to early PC in developing countries.

Este ensayo examina la reproducción y circulación de  videos, imágenes y memes para la construcción de regímenes de verdad en la esfera pública mexicana durante  la pandemia de la covid-19. Desde marzo de 2020, fecha  en que comenzó la circulación de información sobre contagios, muertes y repuntes de casos, medios digitales y  sus plataformas de verificación de datos, familiares de  personas fallecidas y hospitalizadas de covid-19 se movilizaron en redes sociales videos e imágenes para evidenciar  y comprobar lo que acontecía. Este cúmulo de información, sumada a los memes, generó un estado de ánimo  de desconfianza en México ante las diferentes versiones  compartidas. A partir de metodologías visuales, este ensayo examina cómo la imagen a través de las diferentes plataformas es apropiada y recombinada con otros géneros  discursivos en la pandemia de la covid-19 para la obtención de legitimidad y legibilidad. Dentro de la abundante  información, la figura del subsecretario de salud, Hugo Ló pez-Gatell, especialista y encargado en dar a conocer a los  mexicanos los detalles de la pandemia figuró de manera.