Many healthcare professionals, including nurses and midwives, have described their involvement in critical incidents as the 'darkest hour' of their professional careers (Scott et al., 2009, p. 328). Incidents have the potential to leave heathcare professionals in significant distress and hence have been described as the second victims of critical incidents. The notion of second victims has drawn attention to and inspired international exploration of this phenomenon (Wu, 2000).A critical incident is defined as 'a sudden unexpected event that has an emotional impact sufficient to overwhelm the usually effective

Health care is intrinsically risk laden giving rise to critical incidents that are often associated with devastating consequences for those involved (Joint Commission, 2018;Ozeke et al., 2019). Although patient safety is a serious global public health concern, the World Health Organization (WHO) estimates one in 10 patients are harmed whilst receiving hospital care (World Health Organisation, 2022). It is presumed that health care professionals are able to deal with the severity and seriousness of these events and return to emotional and cognitive function in readiness to continue with their professional responsibilities (Stone, 2020;Wands, 2021). The SARS-CoV-2 (COVID-19) pandemic further challenges, and in many cases stretched the capacity of health care professionals worldwide, yet still, they continue to provide care for patients, in overwhelming work conditions and being isolated from their families, friends and colleagues (Mehta et al., 2021). To effectively support health care professionals, their challenges and needs must be understood and addressed.

Purpose: Studies have shown that financial toxicity can reduce survival, decrease quality of life, and reduce compliance with treatments. The aim of this retrospective study was to investigate material markers of financial toxicity, including insurance coverage, financial assistance, and balances due among adolescent and young adult (AYA) (18–39), adult (40–64), and senior adult (>65) patients with a sarcoma diagnosis after the Affordable Care Act became effective. Methods: This study performed a retrospective analysis of possible indicators within the material domain of financial toxicity in sarcoma patients, a common diagnosis in young adult patients. Indicators of financial toxicity included: insurance status and number of insurances, charity care, accessing financing options, or having an unpaid balance referred to a collection's agency. Results: The cumulative charges per patient were similar between AYA, adult, and senior adult populations at an average of $194,329 (standard deviation [SD] = $321,425), $236,724 (SD = $368,345), and $188,030 (SD = $271,191), respectively. AYA patients were more likely than adult and senior adult patients to have Medicaid coverage (income-based government insurance) (22.1% vs. 8.4% vs. 1.2%), receive charity care (5.3% vs. 2.6% vs. 1.2%), or have a balance referred to a collection's agency (9.2% vs. 5.8% vs. 1.2%). Conclusions: This study suggests that younger cancer patients are more likely to suffer material financial strain and additional financial resources may need to be made available to ensure they can receive care without an increase of financial toxicity markers and undue financial stress.

541 Background: Black women have worse breast cancer outcomes compared to their White counterparts, even for hormone receptor positive (HR+) HER2 negative (HER2-) breast cancer (BC). This tumor type is usually treated with 5-10 years of adjuvant endocrine therapy (ET) to reduce risk of BC recurrence and improve survival. We investigated the impact of adherence to ET on racial differences in survival for HR+ HER2- BC survivors. Methods: We conducted a population-based, retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, which links demographic and clinical data with cause of death for persons with cancer and Medicare claims for covered health services. We examined 9,039 women with HR+ HER2- stage I-III BC diagnosed between 2007 and 2016, who received primary breast surgery and initiated ET. Adherence to ET was measured using the medication possession ratio (MPR), which assesses the proportion of time a patient has medication available via filled prescriptions. As in established literature, we defined ET adherence as MPR > = 80%. Causal mediation analysis was performed to measure to impact of adherence on survival disparities between Black and White BC survivors. Results: Mean age at diagnosis was 72 years, 6.5% were Black, and 20.9% were dual eligible for Medicaid (a surrogate for socioeconomic hardship). Most had stage I or II breast cancer (69.3%) and mastectomy as primary surgery (69.7%). Nineteen percent received chemotherapy and 62.5% received radiation. In univariate analyses, factors associated with ET adherence were Black race (OR 0.62, 95% CI 0.54-0.75), insured by Medicaid (OR 0.72, 95% CI 0.65-0.81), being married (OR 1.14, 95% CI 1.03-1.25), and increased comorbidities (Charlson score > = 2) (OR 0.88, 95% CI 0.78-0.99). Age, BC stage, type of surgery, and receipt of chemotherapy or radiation were not associated with ET adherence. In multivariable models adjusting for age, race, marital status, Medicaid eligibility, and Charlson score, Black race and Medicaid eligibility remained inversely associated with ET adherence (OR 0.70, 95% CI 0.59-0.83 and OR 0.77, 95% CI 0.69-0.87 respectively). Among those who were adherent to ET, Black women had 43% higher risk of mortality compared to White women (HR 1.43, 95% CI 1.17-1.76). In mediation analysis, 4.25% of the observed survival disparity between Black and White women can be explained by differences in ET adherence. Conclusions: We identified racial disparities in ET adherence and overall survival among women with BC. Adherence to ET accounted for a small percentage of racial disparities in survival. Further research is needed to delineate other factors contributing to ET non-adherence among Black women and to investigate additional factors contributing to known disparities in BC survival.

e15503 Background: Anal Squamous Cell Carcinoma (SCCA) accounts for 90% of cases of anal cancer. ~95% of SCCAs are driven by Human Papilloma Virus (HPV). We did a follow-up population-based analysis to assess incidence trends of SCCA over 20 years (2000-2019) in era of HPV vaccination (available since 2006). Methods: Data was extracted from Surveillance, Epidemiology, and End Results (SEER) database for years 2000-2019. Joinpoint regression models were fitted to identify a discrete joints (year) that represented a statistically significant change in direction of the trend of overall SCCA incidence. The average annual percentage change (AAPC) in age-adjusted incidence rate in all subgroups pre- and post-2009 (statistically significant joinpoint year) was measured. (Table 1). Results: 30,294 new cases of SCCA were identified from 2000-2019, with majority in females (61.6%), white population (86.5%), and ages 40-79 years (84.1%). A significant joinpoint for SCCA incidence was observed in 2009, wherein APC of 2.8% (95% CI 2.0-3.6) in 2000-2009 was reduced to 0.5% (95% CI -0.1-1.2) in 2009-2019 (82% relative reduction [RR]). In subgroup analysis, evaluating the trends after identifying a discrete joint (2009), we found that APC for White population reduced from 3.1% (P < 0.0001) to 1.1% (P = 0.022) (65% RR), and for Black population, APC of 3.2% (P = 0.0015) seem to flatten out at 0.3% (P = 0.768) in post-2009 years (91% RR). Ages 20-39 had a -4.2% (P = 0.028) APC pre-2009 that showed increase to 1.3% (P = 0.214) post-2009, however, small sample size noted. In ages 40-59, APC of 4.7% (P < 0.0001) seem to flatten out at -0.5% (P = 0.393) (111% RR). Ages 60-79 had a similar APC (2.4% [P = 0.0011] and 2.5% [P = 0.0001], respectively). In males, APC of 2.8% (P = 0.002) flattened out to 0.5% (P = 0.249) and females reduced from 3.2% (P < 0.001) to 1.2% (P = 0.009). Conclusions: In this study, we found a trend of decrease in the rate of growth of SCCA incidence pre- and post-2009, overall and among various subgroups. Furthermore, our results suggest that widespread education and scaling up access to HPV vaccination can decrease and potentially reverse the SCCA incidence. [Table: see text]