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22 Background: Caregivers (CGs) of advanced cancer patients (pts/ACPs) experience a higher incidence of medical and psychological conditions compared to general population. Methods: We conducted a prospective assessment of the caregiver burden (CGB) - a term describing the physical, psychological, emotional, social, and financial problems often experienced by CGs - to identify potential risk management strategies. We used the Caregiver Burden Inventory (CBI), a multi-dimensional questionnaire with 5 subscales: Time Dependent, Developmental, Physical, Social, Emotional CGB, as a quantitative tool to investigate the level of stress of our pts CGs. Also, we used a semi-structured interview with 5 questions as a qualitative tool. Results: From Dec 2016 to Feb 2017 we administered the CBI and the interview to 37 CGs (F/M 31/6) of ACPs in 3 different settings: inpatient (9 CGs), outpatient (15 CGs), home-based (13 CGs). The quantitative data analysis showed that CGs had a variable emotional load, mostly of moderate level. In particular, the level of stress of our pts CGs of outpatients and inpatients was higher in the physical dimension, while was higher in the time dimension for CGs of home-based pts. Semi-structured interviews showed that CGs of home-based pts did not feel adequate to provide assistance to their relatives, and had partial or poor knowledge of basic care, especially of in-bed mobilization and hygiene techniques. In the other 2 settings, CGs showed a higher level of stress due to the lack of a professional contact person throughout the care pathway, and experienced the need of psychological support. Overall, the qualitative assessment showed that CGs lives were strongly affected by caregiving. Conclusions: Our results confirm published data showing that assisting ACPs is a particularly difficult task for the CGs. Therefore, we implemented potential improvement strategies: in the home setting, specific attention to the educational aspects of basic care; in the inpatient setting, a weekly meeting for physicians, nurses, and psychologists, to discuss the most difficult cases; in the outpatient setting, a 25% increase in the number of visits for pain and supportive therapy to offer a better continuity of care.

225 Background: Advanced cancer patients (pts) often present with multiple concomitant symptoms and off-label use of drugs (indications doses formulations administration route) is a common practice. Drugs mixture (DM) solutions by continuous administration are frequently used. However, evidence-based data in this setting is scarce. Methods: We performed a retrospective analysis of 576 consecutive care pathways provided by our Home Palliative Care (HC) Service from Jul 2010 to Jun 2017. Infusions were administered subcutaneously (sc) or by a venous (iv) access, by elastomeric pumps (EP) (5 days - 2 mL/h) with drugs diluted in 0.9% NaCl with no light protection. We analyzed: treated symptoms, drugs, doses/concentrations, solution transparency, administration route, infusion duration, clinical response, adverse events (AEs), compliance/treatment acceptability, device proper functioning, and treatment interruptions. Results: We analyzed 266 pts out of 576 care pathways treated with DM infusions, M/F 143/123, median age 70 yrs (21-92); treated symptoms: pain (50%), nausea/vomiting (20%), dyspnea/agitation (20%), dysphagia/mucositis (18%); infused drugs: morphine, midazolam, dexamethasone, ranitidine, metoclopramide, scopolamine, alizapride, haloperidol, furosemide, and ketorolac. Median number of drugs in the DM was 3 (1-6). Administration route was sc in 214 pts/80%, iv in 52 pts/20%. Median infusion duration was 5 days (0-64). Symptoms control was achieved within 72 h in 69% of pts. No AEs related to the infusion devices were observed. Compliance was good in 92% of pts, poor/inadequate in 8%. 5 EP malfunctions were observed: 1 human error, 1 device obstruction due to furosemide flocculation, 3 unexplained. Also, 3 pts required sc infusion interruption due to fluid accumulation near the injection site. Conclusions: This retrospective analysis on a large number of pts shows efficacy and tolerability of DM administration by EP in the HC setting. Treatment compliance was high, no AEs were observed, EP malfunction and therapy discontinuation were rare. However, there are still many open questions about the off-label use of drugs in this setting, and prospective trials are strongly suggested.

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158 Background: Terminally ill cancer patients (pts) are often hospitalized in the last 3 months of life, and a large number of them die in hospital. They require specific care provided by a team of health professionals with expertise in palliative (PC) and end-of-life care (EoLC). The aim of this analysis is to investigate the attitudes of nurses (Ns) and health care assistants (HCAs) towards terminally ill patients in a Cancer Center (CC). Methods: From July to November 2017 we applied the Frommelt Attitudes Toward Care of the Dying FORM-B Scale (FATCOD) to Ns and HCAs working in a CC, situated in a metropolitan area in Italy. FATCOD is a validated tool in its Italian version, composed of 30 questions investigating 6 specific areas: Fear (Fe), Communication (Co), Relationship (Rs), Care of the family (CoF), Family as Caring (FaC), Active Care (Ac). Each question has 5 answer options: strongly disagree, disagree, don’t know, agree, strongly agree, with scores from 1, negative, to 5, positive attitude. The total score ranges from 30 to 150. Results: We administered 116 questionnaires, 102 (87.9%) were completed. 81 Ns were involved (79.4%, 31/50 males/females) and 21 HCAs (20.6%, 4/17 males/females). The median age of Ns was 39 years (range 20-50) and 43 for the HCAs (range 30-50). The median duration of employment was 10 years for both groups (range 0-20). The median score achieved by both groups was 110.3 (range 78-140). Ns obtained a score of 112.1 (range 98.7-125.5), HCAs of 103.4 (range 89.4-117.7). Our analysis shows a positive attitude in both groups across 3 areas ( FaC, CoF, AC) and a negative one in others (Fe, Co, Rs), with a statistically significant concordance between the 2 groups (p=0.0037). Conclusions: Data shows NS and HCAs negative attitude in 3 important areas, with scores below the average results reported in literature. Based on our results, we proposed some intervention strategies. We organized periodic meetings with our psychologists. Our Institution introduced the PERCS ( Program to Enhance Relational and Communication Skills) and specific programs in medical and nursing schools of our university, favoring the earliest approach to PC and EoLC. We also provided seminars in PC to Ns and HCAs working in the CC.