The improvement in survival by the introduction of a standard protocol is an important achievement. This is of particular importance for smaller institutions with previous limited experience in the treatment of childhood germ cell tumors. In addition, the results of a two-agent regimen with PE were favorable (5-year overall survival rate is 83.3% for patients in the high-risk group [n = 36] who received PE v 58.8% for patients in the high-risk patients group who received PE plus ifosfamide, vinblastine, and bleomycin [n = 17; P = .017]). Thus for selected patients, complex three-agent regimens may not be necessary to achieve long-term survival, even for some patients with advanced disease.

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6530 Background: Cancer is the second leading cause of death in Sao Jose dos Campos (SJC, a mid-sized city with 720,000 hab. in Sao Paulo state, Brazil) and the most relevant budget in tertiary care. The City Healthcare Authority created in October 2018 a team to manage and provide more effective and efficient cancer care and access to the public healthcare system by using process redesign and daily management tools (Previna Project). The aim was to guarantee access to cancer specialist and care up to 60 days form diagnosis, understanding that this can impact in cancer morbidity, mortality, and cost. Methods: The Previna was grounded in 4 major actions: (1) process redesign (2) escalated daily management system, (3) improve communication channels to all providers connecting primary care to specialized care, (4) and emergency access. (1) Process Redesign involved connecting and linking access to several providers and eliminating unnecessary steps or repeated orders in the system, it also involved alerts into the system for specific conditions like elevated PSA or CEA; positive fecal occult blood test; BIRADS 4-5 mammogram; abnormal PAP smears; and new screening protocols for prostate and colorectal cancer. (2) Daily Management involved internal daily discussions about capacity and review of system alerts or demands. Weekly discussions on specialized procedures including imaging, biopsies, chemo, radiation or surgery flows; and biweekly meetings with all providers (3 hospitals and 4 specialized practices). (3) Communication channels improvements involved a hotline to access flow managers for primary and secondary care units, specialist’s consultancy by phone, and (4) emergency access provided for units with special needs or urgent care requirements. All actions were connected by flow managers using alert systems, visual boards, kanban and similar tools to manage daily progress. Results: The access to cancer care and treatment up to 60 days improved from 2017 to 2020 almost two-fold with the Previna (Table). Cancer diagnosis also increased substantially, and it is expected to be related to previous periods underdiagnosed patients. Flow redesign also reduced median time to process Her2, ER and PR for breast cancer from 38 days in 2018 to 9 days in 2019 and 4 days in 2020, positively impacting treatment decisions. The hotline access reviewed and answered 2,389 demands from care providers between 2018 and 2020. Access to Cancer Care for ICD C00 – C97 (excl. C44 and C73) in SJC. Conclusions: The combined use of daily management, lean tools and flow redesign in the Previna was able to improve access and anticipate cancer diagnosis in a public healthcare system using simple and low-cost initiatives.[Table: see text]