Background. The early integration of supportive care in oncology improves patient-centered outcomes. However, data is lacking regarding how to achieve this in resourcelimited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. Materials and Methods. This randomized controlled trial was conducted between 08/17 and 04/2018 at a public hospital in Mexico City. Patients aged ≥18 with metastatic tumors ≤six weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. Results. 134 patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm vs. 24% in usual care (difference 0.50, 95% CI 0.34-0.62; p<0.0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared to 0% in usual care (p<0.0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10 vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = 0.006), without differences in quality of life between arms. Conclusions and Relevance. Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. The Oncologist 2020;9999:• •

Background: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. Methods: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. Results: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). Conclusion: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

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contraindicated medications include: unadministered contraindicated medications (220 cases, 42.8%); drugs taken intermittently or pro re nata (PRN) (147, 28.6%); administered by a clinical decision (79, 15.4%); local administration (21, 4.1%); meaningless words(44, 8.6%); and emergency medication (three, 0.6%). The reasons for prescribing contraindicated medications with drug-drug interaction in cases of anti-diabetic agents with CT contrast medium were as follows: unadministered contraindicated medications(95 cases, 76.0%), meaningless words (22, 17.6%) and administered by a clinical decision (eight, 6.4%). Reasons for other genitourinary organ and rectal agents with vasodilator were PRN (54 cases, 38.3%), administered by a clinical decision (42, 29.8%), unadministered contraindicated medications (29, 20.6%) and meaningless words (16, 11.3%). Reasons for NSAID with other cardiovascular drugs were PRN (65 cases, 69.9%), unadministered contraindicated medications (16, 17.2%) and local administration (13, 28.9%). Conclusion We confirmed that certain medications were sometimes prescribed using an incorrect reason. Some clinicians input a reason that was something other than a PRN drug use, or entered a meaningless words. It is necessary to improve the system of entering the reasons why clinicians prescribe contraindicated drugs. REFERENCES AND/OR ACKNOWLEDGEMENTSWe acknowledge the assistance of Soojeong Yoon.No conflict of interest.

42 Background: Patient awareness regarding diagnosis and prognosis may lead to improved treatment shared decision making and improve satisfaction with treatment choices. We assessed the diagnostic and prognostic awareness among newly diagnosed patients with metastatic solid tumors in a public cancer center in Mexico City. Methods: Patients with metastatic cancer enrolled in a randomized clinical trial of patient navigation to improve access to supportive care in a public cancer center in Mexico City (NCT03293849) were included. At baseline, demographic, social, and clinical characteristics were collected. Patients answered open-ended questions regarding knowledge about their diagnosis and prognosis, as well as on patient-physician communication. We analyzed prognostic and diagnostic awareness using descriptive statistics, and explored if patients reporting worse patient-physician communication were less aware of their diagnosis and prognosis. Results: 125 patients were included between 08/17 and 04/18. Median age was 61 years (range 23-93; 52% male); 88.8% lived in urban areas; 41.6% had less than high school education; and 57.6% were married or partnered. 61% had gastrointestinal, 14% genitourinary, and 25% other tumors. Although all patients had had at least one consultation with an oncologist, 3% did not know what their diagnosis was. 77% of patients considered they had prognostic awareness; however, only 14% considered that their disease had a bad prognosis, and 2% considered they could be cured. 6.5% of the patients believed the information given by their oncologist was insufficient, and 8% felt they had trouble getting information about their disease. We found no statistically significant relationship between perceived barriers to patient-physician communication and diagnostic (p = 0.28) or prognostic (p = 0.18) awareness. Conclusions: Although most patients understood their oncologic diagnosis, a significant proportion were unaware of their prognosis. Communication strategies, tailored to the specific characteristics of each patient population and aimed at improving prognostic awareness, are fundamental for optimal shared decision making.