Despite the advances and spread of palliative care programs, communities of color remain significantly underserved. Although these disparities are widely known, there is a marked lack of empirical evidence. The authors conducted a systematic scoping review that synthesized the literature since 2000 about racial and ethnic disparities in palliative and end-of-life care. We searched PubMed, Medline, SocIndex, CINAHL, Social Work Abstracts, and PsycINFO, using search terms including palliative care or end-of-life care, disparities or barriers or utilization, and race or ethnicity or African American or Hispanic. Findings lend support to extant literature that social-environmental barriers and disparities distinctly affect access to care for these populations. The review expands upon understanding of how social determinants drive disparities in palliative and end-of-life care and suggests implications for practice, policy, and research in promoting health equity in serious illness.

The Mesothelioma Applied Research Foundation is the nonprofit collaboration of patients and families, physicians, advocates, and researchers dedicated to eradicating the life-ending and vicious effects of mesothelioma. The Meso Foundation's Advocacy Program objective is to obtain federal funding for mesothelioma research. An analysis was performed of the Meso Foundation's advocacy efforts and grant funding from years 2000- 2015. The Meso Foundation has funded 103 projects from 8 countries for a total awarded amount of 9.8 million dollars. From 2000- 2015, the Meso Foundation grant program has funded research that has produced over 240 publications in peer reviewed journals. As a direct result of Foundation advocacy, the Department of Defense has awarded a total of $12.4 million to mesothelioma research since 2008. The Meso Foundation's grant program has funded the basic science research that helped lay the groundwork for several mesothelioma clinical trials. A few of the more notable trials include the measles virus and the WTI Vaccine. Several of the proposals funded by Meso Foundation grants have extended to global levels through presentations at international conferences including but not limited to International Association for the Study of Lung Cancer (IASLC), American Society of Clinical Oncology (ASCO), and American Association for Cancer Research (AACR). Through actively engaging members of congress, the Meso Foundation has successfully advocated for increased funding for mesothelioma research. The Meso Foundation is committed to leveraging the knowledge we gain from our own research, as well as discoveries made by our collaborations with academic institutions and industry partners to work toward the development of innovative treatments and care platforms for mesothelioma patients and their families.

Mesothelioma, a rare cancer known to be caused by exposure to asbestos fibers, has not decreased in incidence over the past 15 years (CDC). As treatments and technologies continue to advance, there is a growing need for support networks. Mesothelioma community members were surveyed through our database to assess demographics and engagement with the foundation. An electronic survey platform was used to collect the data. Of those that participated in this survey, 69.66% are not in active treatment. The demographics of those that participated in the survey are as follows: Patients (44.68%), Caregiver (29.79%), Bereaved (24.47%), Other (1.06%); Male (30.43%), Female (69.57%). Of those surveyed, individuals were disseminated over 28 states. These data highlight the importance of an online platform as an interface of support communication. Because of the rare and remote nature of mesothelioma, accessible and consistent in-person support networks do not exist. We found that the primary mode of community member engagement was through private Facebook groups, and that participating through this online platform constructs a comprehensive community interface. Facebook groups, while remote, provide real-time access to others in similar situations, enhancing the feeling of community and decreasing the feeling of isolation globally. For rare cancers, it is imperative that remote care is comprehensively cultivated to accommodate the disseminated geographic nature of individuals and to permit continuous engagement of mesothelioma patients and community members.

While prognostic factors for pleural and peritoneal mesothelioma have been investigated over the last decade, the characterization of molecular alterations in pleural mesothelioma may lead to a better understanding of tumorigenesis and targeted chemotherapeutic treatments for these tumors. In a recent study examining mutation burden outcome of non-small cell lung cancer, Rizvi et al. found that smokers had more mutations, correlated higher mutation load, and better clinical outcome to immune-targeted therapies than non-smokers. This has yet to been fully elucidated for MPM. Method: A systematic review of literature published from October 2009 – July 2017 was done using PubMed. Various studies have shown patients with a history of smoking and asbestos exposure have a greater mutation burden than non-smokers. Despite non-small cell lung cancer studies suggesting that patients with greater mutational burden have better clinical outcomes to immune-targeted therapies, this population of MPM patients typically is excluded from these trials. To date there has not been a study showing that MPM patients with multiple malignancies should be precluded from participating in immunotherapy trials. Participatory groups in immunotherapy must be reshaped to include this subset of MPM patients to better grasp the role that multiple malignancies play with regards to appropriate treatment measures. It is notable that several large mesothelioma trials have not successfully made it pass Phase 2. This suggests that the correct population has not been identified. Perhaps early data showing promising results are merely a synergistic effect between study agents and tumor burden and should be reconsidered. Rather than potentiating study agents effects, increased tumor burden may be an independent factor in patient response. Elucidation of the role of tumor burden may improve the effectiveness and utility of novel MPM which retains its attractiveness despite the current sparse and narrow body of supporting data. Instead of observing treatment by individual case, there must be a shift in treatment observation to account for populations of similar characteristics (i.e. multiple malignancies). With no cure for mesothelioma on the horizon, evaluating the study populations will be imperative to understanding the effectiveness of these new treatments.

As medical developments advance and individuals with mesothelioma are increasingly surviving outside of the mean, the mental health impacts of their diagnosis and of treatment on the patient remain critical to examine. Malignant Mesothelioma, with a latency period of approximately 20-40 years, has not shown a downward trend in deaths for the past 15 years (CDC). As treatment for mesothelioma continues to advance, the overall survival of MPM patients has increased. With the growing number of surviving patients, it is essential to begin a conversation about mental health impacts, such as depression, anxiety, or PTSD, as they can be detrimental to a patient’s quality of life and survivorship.

Background: From the moment of diagnosis, malignant mesothelioma (MM) decreases health-related quality of life (QOL) in patients and their caregivers. In addition to symptoms of disease, aggressive treatments such as surgery, radiation, and chemotherapy can cause extreme side effects-chemotherapy specifically is associated with chronic fatigue, unremitting nausea, vomiting, and systemic pain. These side effects of treatments can be burdensome enough to lead to noncompliance or outright refusal of continuation of care.Methods: The platform for the support group was remote, consisting of online and telephone domains. Participants would utilize both online and phone systems during sessions held once a week for a total of six weeks. Sessions were guided and kept closed, available only to those affected by mesothelioma. Follow-up information and session summaries were provided online after support meetings.Results: Using a 0-5 Likert Scale, consistent attendees reported support groups as very helpful. Irregular attendees had mixed feelings ranging from extremely helpful to neutral. Eighty per cent of attendees participated in support groups prior to this project.Conclusions: Active participation in a guided and closed support group allowed participants to share their experiences and concerns about their diagnoses comfortably, supporting transition beyond active-treatment. Online space gave participants a place to provide more reflective responses outside the main dialogue of support sessions.

111 Background: The prognosis of malignant peritoneal mesothelioma (MPM) has improved over the past decade in patients undergoing operative extirpation and intraperitoneal chemotherapy (IC). This study investigates the time from diagnosis to treatment intervention in premenopausal women and its impact on fertility and childbearing options. Methods: A retrospective analysis of 195 patients diagnosed with peritoneal mesothelioma between 1995 and 2015. Patients with unresectable or bicavity disease were not excluded. Kaplan-Meier curves and univariate cox proportional hazards model were used to estimate survival and significant treatment and prognosis factors. Results: The median survival time of all peritoneal mesothelioma patients (n = 195) was 3.21 years with (95% CI: 2.38- 5.53), with median follow-up of 3.44 years (SD = 3.4, minimum = 0.014 and maximum = 16.752) years from first operation. Patient set included 111 men (57%) and 84 women (43.1%) with female sex having favorable survival [HR: 0.442 95% CI: 0.296-0.659), p < 0.001] of 110.1 months with (95% CI: lower bond: 48.3). Of these women, their mean age at diagnosis was 52 years, (SD = 14.5, minimum = 14.7 – maximum = 79.9), with a mean time of 8.20 months from diagnosis to the start of treatment (SD = 18.6, minimum = 0 and maximum = 128.6 months). Overall survival of premenopausal women (N = 23) during follow-up was 72.2% (SE = 27.8%). Mean age at time of diagnosis was 34.7 years, (SD = 9.26, minimum = 14.7, maximum = 48.1), with a mean time of 10.6 months from diagnosis to treatment (SD = 17.9, minimum = 0.63, maximum = 86.7). Of the 195 patients who received a full treatment course, 66 (33.8% CI: 95%) were still alive at the median follow-up, of those alive 37 are female: 7 are premenopausal and have presented with gynecological symptoms, and 17 are premenopausal and have presented with abdominal discomfort. Conclusions: This data suggests that women preparing for treatment of MPM should not be precluded from exploring fertility options. With a mean time of 10.6 months from diagnosis to treatment, it is possible for premenopausal women to take advantage of fertility preservation before starting treatment.

4111 Background: The prognosis of malignant peritoneal mesothelioma (MPM) has improved over the past decade in patients undergoing operative extirpation and intraperitoneal chemotherapy (IC). This study investigates the largest reported cohort of patients operated on for MPM. Methods: Kaplan-Meier curves and univariate cox proportional hazards model was used to estimate survival and significant treatment and prognosis factors, for 195 patients who underwent cytoreductive surgery and or HIPEC treatment between 1995-2014; patients were not excluded for bicavity disease or for unresectable disease. Results: The median survival time was 3.21 years with (95% CI: 2.38- 5.53), with median follow-up of 3.44 years (SD = 3.4, minimum = 0.014 and maximum = 16.752) years from first operation. The mean age at diagnosis was 54.8 years [HR: 1.027 (95% CI: 1.012-1.042)] with 111 men (57%) and 84 women (43.1), with female gender having favorable survival [HR: 0.442 95% CI: 0.296-0.659)]. Asbestos exposure was reported in 77 patients (39.5%) with n = 80 (41.0%) having no known asbestos exposure and in 38 patients (19.5%) asbestos exposure was not documented. The majority of patients had epithelioid histology (n = 161(82.6%), with the remainder biphasic/sarcomatoid (n = 34, 17.4%), with increased risk of death with non-epithelioid histology [HR: 2.46(95%CI 1.59-3.82)], (P = 0.001). Of the 195 patients who received cytoreductive surgery, 71(36.1%) received 1 HIPEC treatment, while 124 (63.9%) received 2 HIPEC treatments, with completion of protocol having an associated favorable prognosis [HR: 0.161 (95%CI 0.109-0.237)] (p = 0.001). Of those who received a full treatment course of cytoreductive surgery and 2 HIPEC treatments, 66 (33.8% CI: 95%) were still alive at the median follow-up. Conclusions: This large cohort illustrates that long-term survival is possible in MPM, although there is continued significant decline after 3 years from diagnosis. While the treatment of MPM continues to evolve, a comprehensive treatment approach may give the best chance for long-term survival.

e15204 Background: Malignant peritoneal mesothelioma (MPM) is best treated by cytoreduction and intraperitoneal chemotherapy (CIC). Although this approach dramatically improves overall survival, disease recurrence has not been studied. Methods: 125 patients underwent a two-stage CIC protocol from 1995-2014. Based on gross and histological data from the second operative cytoreduction, disease status was known at the conclusion of treatment. Recurrence-free survival was calculated using Kaplan Meier survival curves, and Cox regression identified significant prognosticators. Results: 51% of patients were male, mean age 53±14 years. 11 (9%) had sarcomatoid or biphasic histology and 24 (19%) also had thoracic mesothelioma. At completion of the second operation, 23% had no microscopic or gross disease, 19% had microscopic disease, and 47% underwent a complete cytoreduction; these subsets were considered disease-free. The remaining 11% could not be optimally debulked. 42% of the 111 disease-free patients recurred based on tri-monthly surveillance imaging. Median time to recurrence was 80 months (95%CI: 60-121). Median recurrence-free survival insignificantly varied by subgroup (p = 0.22): 131 months (95%CI: 61-NR) for those without microscopic or gross disease, 74 months (95%CI: 29-144) for microscopic disease, and 69 months (95%CI: 56-88) for complete cytoreduction. Absence of microscopic disease was not protective when compared to presence of microscopic disease or complete cytoreduction of gross disease [HR: 1.2 (95%CI: 0.5-2.9) and HR:1.4 (95%CI: 0.6-3.2), respectively]. Only male gender and omission of heated intraperitoneal chemotherapy were predictors of recurrence (HR: 2.61; 95%CI: 1.4-4.9 and HR:2.4; 95%CI: 1.3-4.6, respectively). 1- and 8-year recurrence-free survival rates were 95% (95%CI: 88-98) and 39% (95%CI: 26-51). Median survival for all patients was 69 months (95%CI: 52-122) Conclusions: After optimal CIC for MPM, recurrence occurs in 42% at a median of 80 postoperative months. Regardless of whether microscopic disease is present after CIC, recurrences appear slowly on imaging and are amenable to treatment, though the benefit of retreatment is not yet established.

e22191 Background: Malignant mesothelioma is a rare, aggressive, and seldom curable malignancy, arising from the mesothelial cells that line the serosal surfaces of the pleural and peritoneal cavities. At the time of diagnosis, almost 75% of these patients will present with pleural disease, while the remaining 25% will have peritoneal mesothelioma. In pleural mesothelioma, the tumor usually grows in the space between the visceral and parietal pleura forming a hardened rind encasing the lung. This is different than peritoneal mesothelioma, which arises from the peritoneal membranes and is characterized by rapid local invasion. Although commonly recognized as being linked to occupational asbestos exposure, MM can also develop in individuals without prior exposure to asbestos. Survival of untreated patients is dismal, with a median survival of less than 12 months. Malignant mesothelioma is refractory to most chemotherapy treatments. We studied the combination of bortezomib plus eloxatin in patients who have had one or more prior chemotherapy regimen to determine if this regimen could increase overall survival and slow tumor progression. Methods: Between 2007 and 2013, 21 patients with malignant mesothelioma were enrolled. The median age was 58 years (range: 31-80). Of the 21 patients, 7 were female (33.0%) and 14 were male (67.0%); 10 with primary pleural disease (47.6%) and 11 with primary peritoneal disease (52.4%); 19 with epithelioid subtype (90.0%), 1 with biphasic subtype (5.0%) and 1 with sarcomatoid (5.0%); 3 had no prior chemotherapy (14%) and 18 had one or more prior regimens (86%). A total of 206 doses of 1.3 mg of bortezomib were administered and total of 98 doses of 8.5mg of eloxatin were administered. Results: We report 18 of the 21 patients died from disease by the end of the study. Three patients (14%) were still alive, and therefore considered to be alive with stable disease. The median survival time was 10 months (with a 1-year survival rate of 29.0%). The median time to progression (TTP) was 4.5 months. Conclusions: This data shows that bortezomib combined with eloxatin may be effective in mitigating disease progression in patients with malignant pleural or peritoneal mesothelioma. Clinical trial information: NCT00996385.

10560 Background: Soft tissue sarcomas are rare tumors, for which complete surgical resection offers the best chance of survival. However, two thirds of diagnosed tumors are unresectable and/or metastatic, with a median survival of 12 months, and chemotherapy is the only treatment option. Temozolomide has been used in soft tissue sarcomas and has shown the most activity in leiomyosarcomas; response rates ranged from 5-15%. Azacitidine has not previously been used in the treatment of soft tissue sarcomas. Because of known effects of hypomethylating agents on caspase-8 genes, and the DNA repair gene MGMT involved in the action of temozolomide, we hypothesized that incorporating azacitidine into the treatment of soft tissue tumors with temozolomide could enhance its efficacy. Methods: Between June 2008 and July 2012, 28 patients with soft tissue sarcomas were enrolled. Among the 25 patients who completed the treatment, median age was 61 (range 41-83), 13 male and 12 female; 4 liposarcoma, 2 myxoid liposarcoma, 1 synovial sarcoma, 1 granular cell sarcoma, 1 epithelioid mesothelioma, 1 Ewing's sarcoma, 1 hemangioepithelioma, 7 leiomyosarcoma, 1 spindle cell sarcoma and 6 unspecified sarcoma. Treatment consisted of 10-11 cycles of azacitidine and temozolomide. Dosing: Azacitidine: dose level 1: 25mg/m2 SQ qd; dose level 2: 50mg/m2 SQ qd; dose level 3: 75 mg/m2 SQ qd; combined with temozolomide: 200 mg/m2PO qd x 5; both on days 1-5 of a 28-day cycle. Toxicity was graded by CTCAE IV. Results: Median number of cycles administered: 2 (range 1-6). There were nine drug-related adverse events experienced by 3 or more patients, none of which were dose-limiting. The maximum tolerated dose was 200mg/m2 temozolomide and 75 mg/m2 azacitidine. 15 patients died from their disease 2-59 months after enrollment; 10 patients are alive with stable disease. The median overall survival was 22 (95% CI:9-59) months, with a 1-year survival of 64% (95% CI:42-79%). Conclusions: We have not yet determined the antitumor effectiveness of this combination. These encouraging data show that temozolomide combined with azacitidine can be administered in their full doses with no dose-limiting toxicities. Clinical trial information: NCT00629343.