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e24071 Background: SC includes the prevention and management of the adverse effects of cancer and its treatment. One of the main needs of patients is the mitigation of pain, which is often associated with other symptoms. We studied the presence of pain and its relationship with other symptoms among patients with metastatic cancer enrolled in a SC patient navigation program at a Mexican cancer center. Methods: This was a secondary analysis of a prospective study of adult patients with newly diagnosed metastatic solid tumors at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. Patients' SC needs were assessed using validated questionnaires to create a personalized SC plan by a multidisciplinary team. Interventions included pain management, physical therapy, geriatric assessment, psychological support, and nutritional interventions. Descriptive statistics, X2, and Student's T tests were used to compare patients with and without pain. A multivariate model was used to determine the effect of pain and other patient-related factors on the presence of additional SC needs. Results: We included 336 patients with newly diagnosed metastatic solid tumors enrolled in the patient navigation program between 04/2018 and 10/2020 (median age 64 years, range 19-94 years). 46% reported moderate/severe pain, 74% anxiety/depression, 71% fatigue, 37% caregiver collapse, 59% sleep disturbances, 43% required advance directives, 39% had abnormal geriatric evaluation, and 74% risk of malnutrition, with a mean of 4.3 recommended interventions per patient. Patients with pain were more likely to screen positive for anxiety/depression (88 vs. 61%, p < 0.01), to need physical therapy (87 vs. 57%, p < 0.01), to report sleep disturbances (72 vs. 48%, p < 0.01), to have an abnormal geriatric screening (43 vs. 63%, p < 0.1), to require nutritional interventions (84 vs. 65%, p < 0.01), and to have a life expectancy of < 6 months (65 vs. 25%, p < 0.01). The mean number of SC needs for patients reporting pain was 5.8 (95% CI 5.5-6.1) compared to 3.1 (95% CI 2.8-3.4) in those without pain. On multivariate analysis, the presence of moderate/severe pain was associated with increased odds of screening positive for anxiety or depression (OR 3.1, CI 95% 1.62-5.75), and fatigue (OR 2.8, CI 95% 1.49-5.10), while increasing age was found to be inversely associated with the odds of reporting psychological problems (OR 0.9, 95% CI 0.95-0.99). Conclusions: Patients with metastatic solid tumors who report pain require a significantly greater number of interventions and have more additional SC needs, particularly those related to psychological support. These results highlight the importance of multidisciplinary management in patients with advanced cancer, as well as the relevance of collaboration with psychology professionals when providing pain control.

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186 Background: Completion of advance directives can help to ensure consistency with people´s preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective: To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Methods: We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Results: From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Forty-three (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusions: In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.

181 Background: Caregivers of patients with advanced cancer often face significant physical, social, and emotional distress. In many Latin American cultures, family plays a particularly important role in the decision-making process of patients with cancer, and relatives often assume the role of unpaid caregivers. However, there is limited research about the burden associated with cancer unpaid caregiving among patients living in Latin America. We aimed to describe the profile of caregivers and to identify patient-related factors associated with caregiver burden in a third-level cancer center in Mexico City. Methods: We conducted a cross-sectional analysis of baseline data from patients with advanced cancer and their caregivers included in a multidisciplinary patient navigator-led supportive care program in Mexico City ( Te Acompañamos). At the time of enrollment in the program, caregivers completed a short version of the Zarit Burden scale and patients completed a series of screening questionnaires including assessments of quality of life (FACT-G), depression (PHQ-9), and anxiety (GAD-7). Life expectancy was calculated using the palliative performance scale (PPS). We used descriptive statistics, chi-square tests, and multivariate logistic regression analyses to understand which patient factors were associated with higher caregiver burden. Results: A total of 321 patients with advanced cancer (58% women; average age 63.3 +/- 14 years; 32.7 with hepatopancreatobiliary tumors) and 321 caregivers (67.1% women; 44% were the patient’s son/daughter; 29% were their spouses) were included. Sixty-four caregivers (20%) had a high caregiver burden (score > 16 in the Zarit scale). Caregiver burden was more common among the patients’ spouses (24.1 %) followed by brothers/sisters (23.6%). On univariate analysis, moderate/severe levels of depression (p = 0.001), moderate/severe levels of anxiety (p = 0.02), and lower PPS scores (p = 0.002) were associated with a high caregiver´s burden. Multivariate analysis showed that only PPS < 180 days was associated with increased odds of having caregiver burden (2.0; 95% CI 1.8-3.7); p = 0.02). Conclusions: A significant proportion of unpaid caregivers of Mexican patients with advanced cancer report high levels of caregiver burden, and the odds of having caregiver burden are increased when the patient has a calculated life expectancy of <6 months. These results suggest targets for future supportive care interventions to improve caregiver wellbeing in Latin American and Hispanic populations.