e18640 Background: Malnutrition occurs in 40-80% of cancer patients and has great impact on quality of life and treatment outcomes. The essential elements of malnutrition for patients with cancer are early identification of patients at greatest risk, nutrition assessment to determine the level of deficit, and appropriate nutrition intervention. Currently we don’t have a standard tool to identify patients who are malnourished on chemotherapy and nutrition referrals were placed based on provider's subjective assessment. Methods: From March 2020 to August 2020, 41 patients on chemotherapy were reviewed, of which 29% were referred to nutrition. To assess the patients at risk early on, a validated Malnutrition Screening Tool(MST) was implemented from September 2020 to February 2021 in the Medical Oncology fellow's clinic notes. Although the original MST was implemented mostly for inpatient elderly patient population, the idea of this study was to apply this tool to assess acute nutrition issues for patients receiving cancer therapy in the outpatient setting. This tool used two simple questions, Have you lost weight recently without trying? (If lost 1-6lbs = 1points, 7-13lbs = 2points and > 13 = 3points), and have you been eating poorly because of decreased appetite? (Yes = 1 point; No = 0 points).A smart phrase which included these questions was used in the notes and if patients scored greater than or equal to 2, were considered malnourished and qualified for nutrition referrals. Other variables included were age, sex, and type of cancer. Results: Of the 41 charts that implemented MST, 21 patients(49%) screened positive and all 100% of them were referred to nutrition. After implementing this tool, there was a 20% increase in identifying and referring the malnourished patients who were receiving cancer therapy during the clinic visits. Median age for patients who screened positive was 60 years, more males screened positive than females(60% vs 40%). Gastro-intestinal malignancies and head and neck cancers were the highest who screened positive in the MST group(14% each out of the 49%). Conclusions: Malnutrition is a major cause of morbidity and mortality in patients with any stage cancer and especially worse in advanced stage cancer. By simply using this two-step questionnaire, we were able to identify 20% more patients who were at risk for malnutrition. Older age, Males and Gastro-intestinal and Head and Neck cancer patients are more at risk and needs to be more closely screened. The study concludes that using a simple tool in the outpatient clinics can assess patient's at risk and provide early qualitative support throughout course of therapy.

e18629 Background: The prevalence of anxiety and depression disorder in patients with cancer is about 10% and 22%, respectively. Cancer patients were seven times more likely to have a psychiatric disorder than the normal population. Prior studies have used multiple questionnaires like GAD7, HADS, PHQ2 and PHQ9 which have been approved by national guidelines to assess severity of anxiety and depression in the cancer population. Patient Health Questionnaire-4 (PHQ4) questionnaire is a validated screening tool for anxiety and depression disorders. This study aimed to implement a concise screening tool, PHQ4, to identify the mental health status of cancer patients early and intervene with counseling, medications, and referral to PCP/Palliative care for symptoms control. Methods: Patients completed the 4-item PHQ4 during their clinic visits at University of Texas Medical Branch between December 1, 2021, and February 1, 2022. The patient was provided with a PHQ4 questionnaire at the beginning of their visit. The PHQ4 implements two screening questions for anxiety and depression each, with the frequency of symptoms determining the score on a scale of 0 (not at all) to 3 (nearly every day) for each item. When the total score was > or = 3, a presumptive diagnosis of anxiety, depression, or both was made. These patients were given information regarding support groups, resources for interventions, and provided with medications/referrals to primary care/palliative care/psychiatry for further management. Demographic factors (i.e., age, sex, race/ethnicity), type of cancer, and stage of cancer were other variables that were collected and analyzed as well. Results: Out of 70 total patients, 12 (17.1%) screened positive for anxiety, 14 (20%) screened positive for depression, and 9 (12.9%) screened positive for both depression and anxiety. 10 (14.3%) patients were diagnosed with mild symptoms (score 3-5), 10 (14.3%) with moderate symptoms (6-8), and 4 (5.7%) with severe symptoms. Median age of study population was 60, median age for positive screening was 54.5 years. While there were 35 males and females included in the study, 10 males (14.3%) and 7 females (10%) screened positive. Caucasian ethnicity (76.5%) and Colorectal cancer (24.3%) had the highest prevalence of patients who screened positive. All patients who screened positive were either stage 3 or 4 cancer patients. All patients (100%) who screened positive, received intervention. Conclusions: Based on our results, PHQ4 almost met the national average for depression screening. It possibly over diagnosed patients with anxiety and depression which may have been also contributed by other social/financial/personal stressors, warranting further attention with social worker support. PHQ4, is a quick, validated, effective screening tool that can regularly monitor cancer patients’ psychological health and enable timely intervention.

Gastric cancer, a leading cause of cancer-related death in the world, may occur with an additional synchronous malignancy in rare cases. Of these rare cases many are colorectal cancer. Microsatellite instability is a phenomenon that may contribute to the pathogenesis of both cancers, as are field cancerization and genetic susceptibility, although none of these explain many concurrent cases. In this case, we described a patient with locally advanced microsatellite instability-high gastric cancer and synchronous microsatellite stable rectal cancer, who received a combination chemo-immunotherapy regimen and achieved complete response. This report reflects on current knowledge surrounding synchronous primary malignancies and achieving complete response.