Background/Purpose: Rare cancers are a heterogeneous group of conditions that can be associated with unmet medical needs and poorer quality of life (QOL). Despite this, and because of their rarity, sufferers remain a poorly understood group from the vantage of psychosocial concerns and QOL. Our main goal was to explore psychosocial outcomes reported by patients diagnosed with a rare form of cancer. Methods: Data from 31 patients (64.5% female; M=51.32 of age) diagnosed with a rare cancer (74.2% at late disease stage) and treated at a Brazilian public hospital were evaluated for distress (DT), anxiety/depression (HADS) and QOL (FACT-G). All patients previous knew that their diagnostic was rare. Descriptive statistics and correlations between variables assessed were generated. Results: 48.4% patients reported high distress levels, with 32.3% endorsing anxiety and 25.8% depression. A low mean QOL score was found (at 25th percentile of the US norm), with emotional and functional well-being the most impaired subscales. Statistically significant correlations were identified between distress, anxiety/depression and QOL (p<.01). The most concerns were nervousness (71%), worry (71%), pain (64.5%), sadness (51.6%) and fatigue (51.6%). Conclusions: Patients reported poorer psychosocial outcomes and impaired QOL when compared to normative data, suggesting that this patient population may be at elevated risk. A rare cancer diagnosis can be traumatic and prompt anxiety and uncertainty. Given their rarity, limited disease specific support groups or counseling exists, thus potentially invoking feelings of isolation. Further research should be conducted to investigate psychosocial aspects and possible interventions targeting this poorly understood group.

Background/Purpose: Cancer during pregnancy can present complex and traumatic concerns. Little research has explored the impact of these two major life-changing events. We sought to explore the experience of gestational breast cancer patients (GBCP) and identify unique challenges GBCP are facing, compared to not pregnant breast cancer patients (BCP). Methods: A cohort study compared data from GBCP (n=6) and BCP (n=46), undergoing the same treatment at a Brazilian public hospital. Measures included the DT, HADS and FACT-G. GBCP also completed a semistructured interview. Results: GBCP reported lower levels of distress, anxiety/depression and better QoL than BCP. The content analyses revealed that GBCP discovered their pregnancy weeks after their diagnosis. Fears were related to risk of miscarriage or potential harm of treatment to the unborn baby. Ultrasonography helped to monitor baby’s health and to lessen anxiety. After the first chemotherapy infusion, 83.3% turned their focus to their baby. One patient reported increased distress associated with smoking cessation efforts. Other preferred to minimize social contact and avoided celebrations until their baby's healthy birth. Health care providers was essential and helped them to address issues regarding baby’s health and well-being. Conclusions: Unexpectedly, our preliminary findings suggest that GBCP experience less psychological turmoil than BC. It is possible that pregnancy provides a sense of meaning and a broader perspective for women diagnosed with cancer, possibly through the focus given to ensuring the health of their unborn child. Future studies should explore the long-term impact of GBCP.

As global cancer incidence is increasing with well documented poorer outcomes, cancer is receiving increasing attention in Latin America and the Caribbean. Due to the urgency of the cancer burden in developing countries (LMIC) where mortality ranges from 50‐90% compared to the 20‐40% range for developed countries (except for lung cancer), we are compelled to ask provocative questions and cultivate innovative best approaches in research and practice for more rapid translation of new knowledge and implementation of interventions to bring whole person cancer care and reduce the undue burden of cancer in this region. Further, mounting evidence directs our attention to the social determinants of cancer outcomes. Yet, there are several challenges in examining broad social contexts requiring the inclusion and guidance of survivor‐advocates. This symposium will discuss survivorship outcomes and survivorship care development within the Caribbean region focusing on two specific nations Brazil and Trinidad and Tobago. Our findings indicate high cancer related societal and survivor burden. The health care systems in LMIC countries are overwhelmed with the increasing cancer incidence. Multilevel factors including socioeconomic status, quality of care, distress screening and management seem to be associated with patient outcomes. Developing psychosocial and supportive care in developing countries involve the engagement of multisectorial stakeholders including civil society, government, healthcare system, clinicians, advocates and patients. The need to develop these cancer care components is urgent and compelling.

Background/Purpose: Studies have shown a clear difference among minority and economically disadvantaged patients. Less is known about marginalized populations in Brazil, a country that possesses a two-tiered healthcare system, based on socioeconomic status. We sought to explore differences in quality of life (QOL) and distress among patients receiving care within these systems. Methods: 270 patients were assessed for distress (DT), anxiety/depression (HADS) and QOL (FACT-G). Half of them was recruited at a private institution (PRI) and the other at a public institution (PUB) (each group: n=135; 68.9% breast and 31.1% gynecological cancers). We calculated descriptive statistics and examined QOL and distress using T-test and ANOVA. Results: We found ethnic differences between PUB (50.4% white, 32.6% mulato and 14.1% black) and PRI patients (82.9% white), and income disparities (PUB patients report almost a third less monthly income than PRI patients). PUB patients were mostly late-stage diagnosed 70.4% compared to PRI counterpart 42.2% (p<.001). In general PUB patients reported higher rates of distress and anxiety/depression (p<.03); and poorer QoL outcomes (p<.01). Conclusions: This preliminary study is one of the first to investigate inequities in cancer outcomes among patients in Brazilian healthcare settings. Analyses revealed notable differences between groups across demographic characteristics, while individuals of lower socioeconomic status reported significantly poorer psychosocial outcomes. These results suggest a complex interaction between ethnicity, access to care and cancer outcomes, and warrants further research to better understand and address these inequities. Further discussion of the role of psycho-oncology research and clinical practice in reducing disparate outcomes among Brazilian cancer patients is warranted.

Background/Purpose: Distress and anxiety/depression are common psychological issues associated with a cancer diagnosis and its treatment, and can impair quality of life (QoL). Less is known about the experience of older adults diagnosed with cancer in developing countries, such as Brazil. Methods: The participants included 315 cancer patients (65-89 years, M=72.5; 54% female), recruited at two Brazilian cancer centers. Patients were undergoing chemotherapy for gastrointestinal (27.9%), hematologic (22.2%) and breast (14.9%) cancer; 80% were at advanced disease stage. They were assessed using the DT, HADS and FACT-G. Results: Approximately 22% of patients reported moderate to severe distress, 11.7% symptoms of anxiety and 14% of depression. Patients also reported associated impairments in QoL. On the problem list, 59.9% reported an average of 1.6 Emotional Problems, and 93% an average of 4.6 Physical Problems. Linear regression analysis identified depression, sadness, worry, fatigue, nausea, pain and sleep as predictors of distress; and sadness, nervousness, worry, loss of interest in usual activities, eating, fatigue, nausea, pain and sleep predicting worse scores at FACT-G. Conclusions: A lower prevalence of distress among older patients was established in the current study, as well as higher rates of depression symptomatology compared to anxiety. The present findings also highlights a set of intersecting concerns among older patients, including sadness, worry, fatigue, pain and sleep; potential risk factors that should be considered as part of the psychosocial care routine. Further, it is possible that the screening program served as a tool to prompt discussion of psychological support services that may not have arisen organically due to stigma.

Inequalities exist between healthcare systems in Brazil. Understanding patient‐reported outcomes provide valuable information to guide health services and clinical practice. We aimed to characterize distress in cancer patients treated at private or public service. 1211 cancer patients (52.1% from public service) were assessed for distress during the chemotherapy. Descriptive statistics and logistic regression models adjusted for potential confounders were used. The most commonly endorsed sources of distress by patients treated at public and private services were finances (39.5% vs 19.5%), anxiety (40.4% vs 35%), sadness (41.2% vs 43.1%), worry (54.2% vs 49.1%), fatigue (55.9% vs 46.9%), pain (49% vs 24.1%), sleep (44% vs 49.3%), and nausea (26.8% vs 34.3%). The logistic regression model was statistically significant. Female patients were 1.23 times more likely to report distress. Decreasing age and being treated at a public service were associated with and increased likelihood of exhibiting distress. Marital status and race were not significantly associated with distress. Patients reported disparate levels and sources of distress. Patients from public hospital, and who are also lower socioeconomic status, were 20% more likely to be diagnosed with advanced disease and 50% more likely to reported pain. Importantly, early integration of palliative care seems urgent especially with the public health system. Further investigation on access to care leading to disparities are needed to address the unequal burden of cancer.

BACKGROUND/PURPOSE: National and international organizations have recommended that distress be assessed as part of routine cancer care. Considering the importance of these endorsements, an NCI R25-E training program was developed to teach healthcare professionals to implement biopsychosocial screening programs. The purpose of our presentation is to introduce this unique training program. A past trainee will share her experiences of implementing the program in Brazil. METHODS: The training program is offered nine times during the 5-year tenure of the award and trains 360 cancer healthcare professionals in how to implement biopsychosocial screening programs. The program includes eight pre-workshop webinars, a 2-day skills-based workshop incorporating faculty-led interactive clinical experiences, and supervised participation in the clinical implementation of a biopsychosocial screening program, including follow-up support of four post-workshop webinars, eight post-workshop faculty–trainee conference calls, and a web-based Discussion Board. RESULTS: The training program began in April 2013. Two of the nine planned workshops have been successfully conducted. The interest from healthcare professionals has been much higher than anticipated. To date, 87 healthcare professionals have been trained from institutions and community cancer settings across the United States as well as Brazil and China. 96% of the participants agreed or strongly agreed they were satisfied with the workshop. In addition, this training program allowed a Brazilian Cancer Center to improve their existing screening program. CONCLUSIONS: Dissemination of effective biopsychosocial screening implementation strategies has impacted institutions’ ability to meet the distress screening guidelines and standards. Overall, this training program has successfully impacted cancer care nationally and internationally. Research Implications: The research implications of this training program are to increase the number of biopsychosocial screening programs implemented in institutions and community settings, thus providing screening data to further understand the biopsychosocial needs of cancer patients globally. Practice Implications: This training directly impacts the quality of clinical care provided in the trainees’ institutions and community settings. Additionally, the great diversity in trainees, national and international, physician, nurses, social workers, chaplains, and psychologists creates unique and innovative opportunities to fine tune biopsychosocial screening to specific populations linked to tailored interventions. Acknowledgement of Funding: Funded by NCI Grant #1R25CA174444-01.