BACKGROUND AND OBJECTIVE:The 21st Century Cures Act mandates patient access to electronic health record (EHR) information, including test results, and prohibits practices that interfere with that access. Many health systems operationalized this through patient portals, enhancing transparency and patient engagement. This narrative review synthesizes emerging literature on patients' and clinicians' experiences with portal-based access to oncology test results. METHODS:We conducted a narrative review in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA), performing a non-systematic literature search of PubMed/MEDLINE and Google Scholar for studies published between January 2021 and December 2025. We included qualitative, quantitative, and mixed-methods studies, as well as policy analyses, using non-empirical sources for contextualization rather than as primary evidence, with emphasis on high-stakes results and context relevant to metastatic or advanced cancer populations. KEY CONTENT AND FINDINGS:Twenty articles were included. Patients consistently valued timely access to their health information and reported increased transparency and engagement, though preferences varied by test type. Evidence regarding potential harms was mixed: some patients reported distress or confusion when accessing complex results, while others reported no changes or felt better prepared for clinical encounters. Clinicians concerns regarding patient distress, portal messaging, and workflow disruption were reported in surveys and qualitative studies, although empirical findings were not uniform across studies. Direct evidence focused specifically on patients with metastatic cancer was limited, with only one study explicitly examining this group. CONCLUSIONS:The available literature describes both potential benefits and challenges associated with expanded electronic access to oncology test results. Evidence specific to patients with advanced cancer remains sparse, highlighting an important gap and the need for further research to inform patient-centered disclosure practices in oncology.

1582 Background: The ASCO Global Guideline recommends routine geriatric assessment (GA) for adults aged ≥65 years with cancer to identify vulnerabilities beyond standard oncology evaluation and guide tailored management. However, real-world implementation of GA-guided interventions in low-resource settings remains limited. Building on prior feasibility work in private (PRI) oncology settings, we evaluated the feasibility and implementation of a remote, multidisciplinary GA-guided intervention in public (PUB) oncology settings in Brazil. Methods: We conducted a prospective feasibility and implementation study in PUB settings, with contextual reference to prior PRI experience. Patients aged ≥65 years initiating chemotherapy underwent baseline GA assessing functional status, depressive symptoms (GDS), cognitive screening (Mini-Cog), chemotherapy toxicity risk (CARG), nutritional status, and quality of life (FACT-G), with repeat assessment at 12 weeks. Identified impairments prompted referral to telehealth interventions (geriatrics, nutrition, psychology/psychiatry, exercise). Feasibility outcomes included recruitment, GA completion, referral recommendations, and follow-up retention. Implementation barriers in PUB settings were prospectively documented. Results: A total of 109 patients were included (PRI n=61; PUB n=48). The PUB cohort was younger (mean age 72 vs 76), included a higher proportion of Black participants (58% vs 44%), had lower education (no/limited 19% and elementary school 50% vs college degree 47%), and more advanced disease (92% stage III-IV vs 54% stage IV). Baseline geriatric vulnerability was similar (median CARG 6 vs 7, GDS 2); weight loss was more frequent in PUB (54% vs 36%). Quality of life was lower in PUB (FACT-G -5 points). GA identified actionable vulnerabilities, with 21% referred to ≥1 specialist (vs 33% in PRI) and 44% to ≥2 specialists (vs 28% in PRI). Key challenges included delayed recruitment, limited digital literacy (63%), restricted videoconferencing (73%), delays in nutritional supplements (38%), and exercise adaptation (50%), prompting ongoing, context-specific adaptations. Conclusions: Remote GA delivery and identification of actionable vulnerabilities were feasible in PUB settings in Brazil. Similar geriatric vulnerability profiles and characterization of implementation barriers support the scalability of GA-guided care in low-resource settings. Clinical trial information: NCT07084454 .

1638 Background: Patients with advanced cancer receiving immunotherapy experience reduced physical function, increased symptom burden, and poorer health-related quality of life (HRQOL). Limited access to structured exercise programs makes technology-supported interventions a potentially scalable alternative. We assessed the feasibility and preliminary efficacy of a 12-week remote exercise program on HRQOL, symptom burden, and fear of cancer recurrence (FCR), with an exploratory economic evaluation. Methods: In this Phase II trial, adult receiving immunotherapy alone or in combination were randomized 1:1 to a remote exercise intervention or usual care (UC). The study was powered to detect a 10-point difference in Functional Assessment of Cancer Therapy-General (FACT-G) scores (80% power, α=0.05). The intervention included weekly virtual sessions with an exercise physiologist, individualized Borg-guided exercise prescriptions, video support, and telehealth monitoring 12 weeks (30-45 minutes/day). Outcomes assessed at baseline and 12 weeks included HRQOL (FACT-G), symptom burden (Edmonton Symptom Assessment Scale; ESAS), and FCR (FCR-7). Between-group differences were analyzed using ANCOVA adjusted for baseline values, with effect sizes estimated using Cohen’s d. A preliminary provider-perspective cost-consequence analysis estimated cost per one-point FACT-G improvement. Results: Seventy patients were randomized (35 per arm); five died before 12 weeks (3 control, 2 intervention). Baseline characteristics were balanced. At 12 weeks, the intervention group had significantly higher FACT-G scores compared than UC (mean difference = 11.1; p<0.001; Cohen’s d=1.30). Symptom burden was lower in the intervention arm (p<0.001; Cohen’s d=1.68), and FCR was reduced (p=0.014; Cohen’s d=0.85). Group assignment remained a significant predictor in adjusted ANCOVA models (all p<0.01). Estimated intervention cost was R$7,023 per participant, or R$634 per FACT-G point gained. Conclusions: A 12-week remote exercise intervention produced a clinically meaningful 11-point improvement in HRQOL at an estimated cost of R$ 634 per FACT-G point, supporting its economic feasibility and scalability. The program reduced symptom burden and FCR. These findings justify larger trials to confirm effectiveness and further evaluate cost-effectiveness. Changes in patient-reported outcomes at 12 weeks. Outcome (scale) Group BaselineMean ± SD 12-weekMean ± SD Mean Change P-value Cohen’s d FACT-G Control (n=32) 87.3 ± 9.7 85.9 ± 10.2 -1.4 0.001 1.30 Intervention (n=33) 85.2 ± 9.1 96.9 ± 6.7 +11.8 ESAS Control (n=32) 17.3 ± 12.1 19.0 ± 12.8 +1.7 0.001 1.68 Intervention (n=33) 20.6 ± 9.6 5.5 ± 3.7 -15.1 FCR-7 Control (n=32) 15.0 ± 6.0 15.4 ± 6.5 +0.4 0 .014 0.85 Intervention (n=33) 16.2 ± 6.3 11.3 ± 3.8 -4.9

BACKGROUND:Patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (ICIs), alone or in combination with tyrosine kinase inhibitors (TKIs), often experience significant treatment-related adverse events, including fatigue, that can impair health-related quality of life (HRQOL). Structured exercise interventions may mitigate these symptoms, but data in mRCC are limited. OBJECTIVE:To evaluate the feasibility and impact of a 12-week supervised remote exercise program on HRQOL, fatigue, and symptom burden in patients with mRCC receiving ICIs or ICI-TKI combinations. METHODS:Nineteen patients with mRCC (median age 67 years; 57.9% male) participated in a 12-week home-based exercise program, supervised via telehealth. The program included aerobic, resistance, and mobility exercises delivered through weekly virtual consultations and supported by the Vedius platform. Outcomes were assessed at baseline and post intervention using the Functional Assessment of Cancer Therapy-Immune Checkpoint Modulator (FACT-ICM), Brief Fatigue Inventory (BFI), and Edmonton Symptom Assessment System (ESAS). RESULTS:Participants demonstrated significant improvements in overall HRQOL (FACT-General mean increase, 9.8 points; P  = .001; Cohen d  = 0.8), treatment-related toxicity (ICM mean increase, 10.1 points; P  = .017), and fatigue (BFI mean decrease, 21.1 points; P  = .018; ESAS fatigue mean decrease, 5.0 points; P  = .001; Cohen d  = -1.5). Symptom burden (ESAS mean decrease, 12.3; P  = .001) and key patient-reported outcomes, including anxiety, depression, appetite loss, and sleep disturbances, also improved ( P  ≤ .02). CONCLUSIONS:A 12-week supervised remote exercise program was feasible and associated with meaningful improvements in HRQOL, fatigue, and symptom burden among patients with mRCC undergoing ICI-based therapies. These findings support the integration of structured exercise into supportive care for mRCC, highlighting the potential of remote interventions to enhance physical and emotional well-being. Future studies should confirm these results in larger randomized trials and identify the most effective program components.

PURPOSEExercise improves outcomes for patients with cancer, yet implementation of exercise counseling and referral in oncology care remains inconsistent in Latin America. This study evaluated current practices, barriers, promoters, and provider/practice factors influencing exercise counseling.METHODSWe conducted a cross-sectional survey in Spanish and Portuguese among oncology physicians in Latin America (December 2024-February 2025). Eligible participants included medical, surgical, radiation oncologists, and palliative care specialists providing direct patient care. A culturally adapted questionnaire assessed practices, barriers, promoters, and demographics. Analyses included descriptive statistics, Chi-square tests, and regression to examine predictors of counseling behaviors.RESULTSA total of 454 physicians completed the survey (response rate: 29.5%). Although 62.5% routinely assessed physical activity, only 26.4% did so at every visit. Half regularly recommended exercise (50.7%), and 27.1% never referred patients to exercise programs. Barriers included patient factors (eg, fatigue, side effects, low motivation), provider insecurity/lack of knowledge (65.9%), and cultural norms favoring rest (76.7%). Promoters included prior training, personal exercise experience, and institutional support. Medical oncologists and hospital-based providers were more likely to assess, recommend, and refer (all P < .01). Regression showed prior training strongly predicted counseling behaviors (P < .001), while years in practice was negatively associated.CONCLUSIONDespite awareness of exercise benefits, counseling and referral remain suboptimal in Latin America. Barriers include structural, knowledge, and cultural factors, while provider training and institutional support improve practices. These findings support the need for targeted educational, system investments, and culturally adapted guidelines to enhance exercise integration in cancer care.

BACKGROUND:Fear of cancer recurrence (FCR) is a prevalent and distressing concern among cancer survivors. Although psychological interventions have demonstrated efficacy in reducing FCR, they often require significant resources and specialized personnel, limiting their accessibility. Remotely delivered exercise programs offer a scalable and cost-effective alternative, yet their impact on FCR remains underexplored. AIMS:To evaluate the effectiveness of a 12-week remote exercise intervention in reducing FCR among patients with cancer. METHODS:This study combines data from pilot studies assessing the feasibility of a remote exercise intervention. Patients were recruited from June 2022 to January 2024 from five Brazilian states, representing diverse geographic regions. Eligible participants were adults undergoing active cancer treatment with moderate-severe FCR (FCR-7 score ≥ 17). The intervention included a 12-week remote exercise program with weekly virtual consultations with an exercise physiologist and tailored exercise prescriptions. Primary and secondary outcomes included changes in FCR-7 and Functional Assessment of Cancer Therapy-General (FACT-G) scores. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and mixed-effects modeling. RESULTS:A total of 149 patients with moderate-severe FCR were included; 86.5% adhered to the program. The mean FCR-7 score decreased significantly from 20.2 (SD = 4.6) at baseline to 12.8 (SD = 4.6) at 12 weeks (p = 0.001, Cohen's d = 1.6). FACT-G scores improved significantly from 84.4 (SD = 11.5) to 95.6 (SD = 9.2) (p = 0.001, Cohen's d = 1.0). Mixed-effects modeling confirmed a significant reduction in FCR-7 scores over time (F = 377.176, p < 0.001), with a significant overall effect across participants (F = 2210.733, p < 0.001). CONCLUSION:This study suggests that a 12-week remote exercise program may reduce FCR among patients with cancer. Given its accessibility and scalability, remote exercise programs should be further explored as a feasible strategy for addressing FCR in diverse populations. However, these findings are preliminary and should be confirmed in larger, controlled trials.

BACKGROUND:Older adults with metastatic cancer often experience declines in physical function, emotional well-being, and quality of life (QOL). Geriatric assessment and management (GAM) have shown promise in addressing these challenges, but underlying mechanisms remain unclear. This study explored coping strategies as potential mediators for improvements in physical function, depression, and QOL. METHODS:For this secondary analysis of a randomized controlled trial, older adults (≥ 65 years) with metastatic cancer across multiple cancer centers in Brazil were recruited (n = 77). Participants were randomized 1:1 to receive either usual care (UC; n = 38) or a tailored multidisciplinary telehealth GAM intervention (GAIN-S; n = 39). Outcomes were assessed at baseline and 3 months, including Instrumental Activities of Daily Living (IADL), geriatric depressive symptoms (GDS), and Functional Assessment Cancer Therapy-General (FACT-G). Coping was assessed using the Brief COPE. Mediation analyses examined whether coping strategies explained intervention effects. RESULTS:Among 77 patients (mean age = 74 years; 56% female), most were married (61%), and well educated (50% ≥ college degree). The most common cancer types were genitourinary (29%), breast (24%), and gastrointestinal (22%) cancers. Mediation analyses revealed that improvements in approach-oriented coping mediated the effects of the GAM intervention on depressive symptoms (31%) and QOL (18%). Avoidant coping did not significantly mediate any outcomes. CONCLUSIONS:In the GAIN-S trial, improvements in approach-oriented coping partially mediated improvements in QOL and depressive symptoms outcomes among older adults with metastatic cancer. Enhancing adaptive coping could plays a key role in the care of older adults with cancer, and our results offer a novel mechanistic insight for GAM gains.

Understanding how health-related quality of life (HRQOL) concerns vary by disease stage is essential for developing patient-reported outcome measures (PROMs) that reflect the lived experiences of individuals with renal cell carcinoma (RCC). This study aimed to explore differences in the perceived relevance of HRQOL domains between patients with localized and metastatic RCC using a provisionally grouped item set derived from validated instruments. This is a secondary analysis of a prospective international study conducted from August 2022 and October 2024, with participants from the United States, Europe, and Brazil (Bergerot et al., JCO 2025). In Phase 1, a 54-item was developed using the Functional Assessment of Cancer Therapy–Kidney Symptom Index (FKSI-19), the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), and the EuroQol (EQ-5D). Items were provisionally grouped into four conceptual domains: physical disease-related symptoms (DRS-P), emotional symptoms (DRS-E), treatment side effects (TSE), and function/well-being (FWB). Patients with localized or metastatic RCC rated item relevance. We calculated the mean number of relevant items per domain and conducted ANOVAs to compare groups, reporting partial eta squared (η²) for effect size. A total of 200 patients (localized n = 83; metastatic n = 117) were included. Patients with metastatic RCC reported greater relevance of physical symptoms (DRS-P: M = 39.2, SD = 6.0) compared to those with localized disease (M = 35.3, SD = 6.7; F(1,198)=17.53, P < .001, η²=0.081). Similarly, metastatic patients reported higher treatment side effect burden (TSE: M = 12.2, SD = 2.3 vs. 10.6, SD = 2.5; F(1,198)=19.47, P < .001, η²=0.089). No significant difference was observed in emotional symptoms (DRS-E; P = .260). Conversely, patients with localized RCC more often endorsed concerns related to function and well-being (FWB: M = 17.6, SD = 3.5) than those with metastatic disease (M = 15.5, SD = 2.9; F(1,198)=20.52, P < .001, η²=0.094). Given the differences in trajectory and treatment modalities across localized and metastatic RCC, our findings underscore the evolving nature of HRQOL concerns across the RCC continuum. While physical symptoms and treatment side effects were highly relevant across both groups, their prominence among metastatic patients suggests the burden of advanced disease and systemic therapies. In contrast, patients with localized disease prioritized functional limitations and emotional concerns, potentially linked to surveillance-related anxiety. These insights support the need for stage-specific PROMs and highlight the importance of integrating both physical and emotional dimensions of care in RCC. Validation of such a tool for both localized and metastatic RCC is underway in forthcoming studies.

130 Background: Patients with metastatic prostate cancer (mPCa) undergoing treatment often experience declines in health-related quality of life (HRQoL) and increased symptom burden. Exercise interventions are known to mitigate these effects, but adherence to such programs remains a challenge. This study aimed to assess the impact of adherence to a remote, home-based exercise program on HRQoL and symptom burden among patients with mPCa in a joint cancer practice in Brazil. Methods: This prospective study recruited patients with mPCa undergoing active treatment for both hormone sensitive and hormone resistant disease. Patients were assessed at baseline (T1) and after 12 weeks (T2) using the Functional Assessment of Cancer Therapy-General (FACT-G; scale: 0-108) and the Edmonton Symptom Assessment System (ESAS; scale: 0-90). Eligible participants received weekly exercise guidance through WhatsApp and performed prescribed exercise regimens (3 to 5 hours per week of combined resistance and aerobic training), with proper techniques demonstrated using the Vedius platform. Adherence was categorized as moderate to high (MH) ≥6 weeks of exercise, or low (L) ≤5 weeks. The primary outcomes included changes in HRQoL and symptom burden. Results: A total of 35 patients were recruited. The median age of participants was 74 years (range 58-91), with a majority being white (65.7%), married (82.9%), highly educated (88.6%), and retired (85.7%). All patients were receiving ADT plus abiraterone (34.3%), or docetaxel (25.7%), or enzalutamide (22.8%), or chemotherapy + abiraterone (14.3%). At 12 weeks, patients with moderate to high adherence demonstrated significant improvements in HRQoL (MH Mean T2 =94.9, L Mean T2 =88.7, P=0.01), particularly in physical (MH Mean T2 =25.1, Mean T2 =23.6, P=0.03), functional (MH Mean T2 =22.8, L Mean T2 =20.7, P=0.03), and emotional (MH Mean T2 =22.2, L Mean T2 =20.28, P=0.03) well-being domains, compared to those with low adherence. Additionally, those with higher adherence reported a lower symptom burden (MH Mean T2 =9.1 vs L Mean T2 =14.7, P=01). Conclusions: This study demonstrates that adherence to a remote exercise program significantly improves HRQoL and reduces symptom burden in patients with prostate cancer undergoing treatment. These findings underscore the importance of promoting exercise adherence through accessible platforms, such as WhatsApp, to enhance patient outcomes in mPCa.

INTRODUCTION:Exercise in oncology improves health outcomes in patients with cancer. Remote programs offer a promising alternative to in-person sessions, overcoming barriers such as mobility, geography, and treatment-related fatigue. This study assessed the impact of a 12-week supervised remote exercise program on health-related quality of life (HRQOL) as the primary endpoint, and feasibility and acceptability as secondary outcomes in older patients (65+ years) undergoing systemic treatment in Brazil. MATERIALS AND METHODS:This is a pilot, single-arm trial (June 2023 to January 2024) of a 12-week remote exercise program for older adults. Participants received individualized aerobic, resistance, and mobility exercises, completed at home. The program was facilitated through WhatsApp® and the Vedius platform for real-time monitoring and support. Patients were assessed using the Functional Assessment of Cancer Therapy - General and the Edmonton Symptom Assessment System. Linear mixed models were employed. Adherence was measured by the completion percentage of prescribed exercises, and acceptability was assessed via a satisfaction question. RESULTS:Of 48 patients approached, 41 enrolled (median age 70 years, 56.1 % female). Significant improvements were observed in HRQOL (baseline: 83.2; post-intervention: 94.4, P = 0.001). Symptom reductions included pain (1.6 to 0.7, P = 0.001), fatigue (3.8 to 1.3, P = 0.001), nausea (0.8 to 0.2, P = 0.01), depression (2.6 to 0.8, P = 0.001), anxiety (3.2 to 1.2, P = 0.001), and drowsiness (1.8 to 0.4, P = 0.001). Notably, 87.8 % of patients adhered to the prescribed exercise program, and reported high satisfaction, particularly with its convenience and flexibility. DISCUSSION:A 12-week remote exercise program is feasible and acceptable for older patients with cancer. High adherence and satisfaction suggest that remote exercise interventions can improve HRQOL and symptom management, offering a low-cost, accessible solution for cancer care in resource-limited settings. Future studies should explore long-term outcomes and integrate exercise with other supportive care services.

483 Background: Exercise is increasingly recognized as a critical component of cancer care, yet its integration into oncology practices varies across regions. In Latin America, data on physicians' perceptions, referral practices, barriers, and facilitators regarding exercise in the oncology setting remain scarce. This study evaluates these perspectives to identify challenges and opportunities for improving exercise implementation in oncology care. Methods: A prospective survey study was conducted from December 18, 2024, to January 18, 2025, across 21 Latin American countries. The survey included 25 closed-ended questions, predominantly Likert-scale-based, assessing perceptions, practices, and barriers related to exercise in oncology. Descriptive statistics summarized participant characteristics and adherence to exercise-related practices. Chi-square tests evaluated associations between referral and evaluation practices and key factors. Results: A total of 454 physicians (61% oncologists) participated, with most respondents from Brazil (32%), Argentina (12%), Mexico (11%), and Peru (7%). Among them, 37% worked in public institutions and 34% in private practices. Whereas only 15% reported institutional exercise programs, 62% routinely assessed patients’ exercise engagement. Notably, 87% had no formal education on exercise, which may contribute to the low referral rates – only 11% consistently referred patients to exercise programs, and 58% rarely or never made referrals. Moreover, 65% did not prescribe exercise effectively. Key barriers included patients' lack of motivation (78%), uncertainty about referral locations (75%), and misconceptions about exercise during treatment that included excessive fatigue (60%) and a belief in rest (60%). Facilitators included recognizing exercise as a treatment component (85%) and personal experience with exercise (85%). Significant differences in practices were noted by professional role (p=0.005), years of experience (p=0.001) and type of institution (public vs private) (p=0.001). Conclusions: This study highlights substantial gaps in exercise integration within oncology practices across Latin America. Barriers such as referral uncertainties and patient misconceptions highlight the need for targeted strategies to support exercise adoption. Future efforts should focus on formalizing exercise recommendations, improving referral pathways, leveraging technology for remote exercise support, and promoting greater accessibility in low- and middle-income countries (LMICs).

526 Background: Existing HRQOL measures may not fully capture the experiences of patients with localized and advanced RCC. This study aimed to develop a validated, patient-centered HRQOL metric by incorporating insights from patients, advocates, and clinical experts for both localized and advanced RCC. We previously developed a questionnaire for advanced RCC (Bergerot et al., JCO 2024). In this study, we integrate it into the FKSI-19 model and create a new questionnaire. Methods: A four-phase approach was used. Previous work in advanced RCC assessed item relevance from established HRQOL measures (FKSI-19, EORTC QLQ-C30, EQ-5D), refined through patient feedback and expert review. This phase expanded to include localized RCC in the adjuvant setting. In Phase 1, patients with localized RCC rated the the relevance of 54 items from the metastatic cohort. Phase 2 included a panel of 11 expert refining the adjuvant-specific items. Phase 3 gathered feedback from patient advocates, and Phase 4 further refined the items by harmonizing them with the FACT library for consistency across RCC stages. Results: In Phase 1, 6 of 54 items were rated as most relevant by patients with localized RCC. Phase 2 refined these further, excluding redundant items and adding 4 new questions focused on adjuvant therapy. Phase 3 led to minor revisions after advocate review, and Phase 4, the new items were harmonized with validated FACT library questions. The final adjuvant-specific questionnaire comprises 10 items, addressing concerns such as long-term side effects, surveillance anxiety, and post-surgery emotional distress. The advanced-specific version includes 13 items. Both versions deemed to be of utmost importance to patients with localized and advanced disease. These items can be used as standalone scoring options, resulting in the creation of a novel FKSI-23 metric, allowing for customized questionnaires tailored to specific clinical scenarios. Conclusions: Through collective input from patients, advocates and experts, novel items that aid in capturing the experience of RCC patients were identified and existing metrics were refined to generate separate “scoring options” for patients with localized and metastatic disease. Validation of the resulting FKSI-23 tool is underway in forthcoming studies in RCC.

BACKGROUND:Patients with metastatic renal cell carcinoma (mRCC) experience emotional distress and limited supportive care access. This study assesses a mindfulness app's feasibility, acceptability, and preliminary efficacy in improving emotional symptoms, trait mindfulness, and overall quality of life for patients with mRCC on immunotherapy. METHODS:This multinational study recruited patients with mRCC undergoing immunotherapy from Brazil and the United States. Participants were required to engage in mindfulness app-based activities for 20-30 min daily, at least 4 days per week, over a 4-week period. Assessments were conducted at weeks 0, 2, 4, and 12 to evaluate emotional symptoms (PROMIS-Anxiety and Depression, Fear of Cancer Recurrence-7), fatigue (Brief Fatigue Inventory), trait mindfulness (Mindfulness Attention Awareness Scale), and quality of life (Functional Assessment of Chronic Illness Therapy-General). Self-reported data were used to assess adherence. Linear mixed-effects models were used to evaluate changes over time for the measured outcomes. RESULTS:Among 50 patients with mRCC, the feasibility of this intervention was demonstrated; 96% of patients were assessed at week 4, with high adherence rates reported by 75% of patients. Participants expressed positive feedback on the smartphone-based approach. Significant improvements were observed in emotional symptoms, fatigue, and quality of life scores from baseline to post-intervention (P = .001 for each), suggesting the positive impact of this intervention. CONCLUSION:Our findings provide encouraging evidence for the feasibility and acceptability of a mindfulness app-based intervention among patients with mRCC. This intervention may offer a viable and accessible means of providing psychosocial support to patients with mRCC.

1624 Background: Prognostic awareness plays a key role in patient outcomes, particularly among older adults with metastatic cancer. This secondary analysis of a randomized controlled trial (RCT) evaluated the effect of a Geriatric Assessment-guided Intervention (GAIN-S) on patient responses to prognosis items over time between two arms. Methods: Eligible participants, aged 65+, diagnosed with metastatic solid cancers, and undergoing treatment across multiple Brazilian states, were randomized 1:1 into two arms. The GAIN-S included a geriatric assessment (GA), which devised tailored treatment based on identified impairments. Patients in the usual care (UC) arm received standard care. Both arms completed the Illness and Prognostic Awareness Impact Questionnaire (PAIS) at baseline (T1) and 12 weeks (T2), assessing Emotional (10 items; range 0-30) and Adaptive (12 items; range 0-36) domains; each rated on a 4-point Likert scale The change in PAIS (T2 - T1) was calculated for each participant in both the GAIN-S and UC arms, and then the mean changes in PAIS between the two arms were compared via independent t-test. Results: Eighty-six patients were approached; 80 provided consent (93% enrollment rate). At 12 weeks, the analytic sample included 77 patients. Demographic characteristics were well-balanced between arms, with a mean age of 74.5 years (SD=6.1), primarily female (55.8%), self-identified as White (71.4%), and 50.4% had at least a college education. The most common cancer types were genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). At T1, no significant differences were noted in PAIS between arms. However, there was significant improvement in PAIS Emotional (UC: mean change=-0.26, SD=1.6 vs GAIN-S: mean change=0.87, SD=1.4; P=0.002) and Adaptive (UC: mean change=-0.07, SD=0.6 vs GAIN-S: mean change=0.74, SD=1.7; P=0.008) domains between in the GAIN-S arm (Table). Conclusions: This secondary analysis highlights the impact of GA-guided care on improving prognostic awareness in older adults with metastatic cancer. GAIN-S resulted in significant improvements in Emotional and Adaptive domains compared to UC. Tailored interventions addressing the specific needs of older adults with metastatic cancer may enhance understanding of prognosis and improve adaptive responses. Studies are needed to determine whether these differences translate into meaningful improvements in outcomes. Impact of GAIN-S intervention on prognostic awareness. Change over time Arm 1 (T2-T1)Mean (SD) Arm 2 (T2-T1)Mean (SD) DifferenceArm 2 - Arm 1 (SE) p-value Emotional Domain10 items (range: 0-30) -0.263 (1.62) 0.872 (1.44) 1.135 (0.35) 0.002 Adaptive Domain12 items (range: 0-36) -0.079 (0.67) 0.744 (1.73) 0.823 (0.30) 0.008

BACKGROUND:Geriatric assessment (GA)-guided supportive care (GAIN-S) may improve decision-making in older adults with cancer, but its effects on prognostic awareness remain unclear. The authors evaluated whether GAIN-S enhances prognostic awareness among older adults with metastatic cancer in Brazil. METHODS:This randomized controlled trial was conducted in Brazil (June 2022-July 2023). Adults ≥65 years old with metastatic cancer were randomized 1:1 to GAIN-S (n = 39) or usual care (UC; n = 38). GAIN-S included multidisciplinary GA review, individualized care planning, and targeted referrals. UC consisted of standard care without GA-guided interventions. Prognostic awareness was assessed using the Prognostic Awareness Impact Questionnaire, covering emotional (10 items; range, 0-30), adaptive (12 items; range, 0-36), and cognitive (2 categorical items) domains. Group differences were analyzed using t-tests; item-level analyses used Mann-Whitney U, McNemar's, or χ2 tests. RESULTS:Seventy-seven participants were enrolled (mean age, 74.5; 56% female). Common cancers included genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). GAIN-S led to greater improvements in emotional (mean difference = 1.14, standard error [SE] = 0.35, p = .002) and adaptive (mean difference = 0.82, SE = 0.30, p = .008) domains compared to UC. No differences were observed in the cognitive domain. Most participants reported their oncologist had not clearly stated whether their cancer was curable (74% GAIN-S vs. 57% UC). GAIN-S participants more often reported improved coping with prognostic uncertainty, better emotional acceptance, and reduced distress (all p < .05). CONCLUSIONS:GAIN-S improved emotional and adaptive domains of prognostic awareness. These novel findings underscore the value of the GAIN-S intervention for older adults. Studies are needed to explore longer-term effects on decision-making, communication, and quality of life.

Background: Older patients with cancer face challenges in accessing high-quality cancer care, especially in resource-limited settings. We assessed the impact of a telehealth-adapted Geriatric Assessment–Guided Intervention (GAIN-S) among older Brazilians with metastatic cancer. Patient and Methods: This randomized clinical trial enrolled adults aged ≥65 years with metastatic cancer between June 2022 and July 2023. Patients were randomly assigned (1:1) to receive either usual care or GAIN-S. In the GAIN-S arm, a multidisciplinary team (MDT) developed an intervention plan based on impairments identified through geriatric assessment (GA). The plan included MDT discussions and targeted referrals to psychiatry, social services, nutrition, supportive care, and certified fitness training over a 3-month period. Assessments were conducted at baseline and at 3 months. The primary outcome was change in physical function, measured by instrumental activities of daily living (IADL) at 3 months. Secondary endpoints included changes in mood (assessed using the Geriatric Depression Scale [GDS]), quality of life (assessed using the Functional Assessment of Cancer Therapy-General [FACT-G]), and prognostic understanding. T tests and linear mixed models were used to compare groups at each timepoint and to assess longitudinal change. Results: A total of 80 patients were enrolled (40 per arm). Clinical characteristics were well balanced between arms. Most patients were female (55.8%), with a mean age of 74 years (range, 65–88). At 3 months, patients in the GAIN-S arm showed improvements in physical function (IADL, +1.8), mood (GDS, −2.7), quality of life (FACT-G, +13.2), and symptom burden (assessed using the Edmonton Symptom Assessment System [ESAS], −14.6), all with P values <.001. Patients in the intervention group also demonstrated more accurate prognostic understanding ( P <.01). Conclusions: This study demonstrates the efficacy of the telehealth-administered GAIN-S intervention in older adults with cancer in Brazil. These findings underscore the importance of tailoring GA-guided interventions for resource-limited settings.

1629 Background: Exercise offers significant benefit for patients with cancer, improving physical function, quality of life, and treatment-related outcomes. However, barriers such as limited referral practices and insufficient knowledge hinder its integration into care. This study compared referral practices, exercise assessment, and physicians’ perceptions in public (PUB) and private institutions (PRI). Methods: A cross-sectional survey of 454 physicians from 21 Latin American countries was conducted using a 25-item questionnaire on referral practices, patients’ exercise habits, and perceived barriers and facilitators to implementing exercise programs. Descriptive statistics summarized respondent characteristics and adherence to exercise-related practices. Chi-square tests were used to compare differences in referral practices and perceived barriers/facilitators between physicians working in PUB versus PRI institutions. Results: Out of 454 participants, most were from PUB (52%), mainly from Mexico (17%), Brazil (12%), and Colombia (10%). In the PRI (48%), Brazil led with 51%, followed by Argentina (18%), and Peru (8%). Female representation was higher in PUB compared to PRI (57% vs. 43%, P = 0.01). Physicians in PUB were less likely than those in PRI to assess exercise habits (53% vs. 18%, P = 0.001), refer patients (72% vs. 36%, P = 0.001), or provide guidance (56% vs. 12%, P = 0.001). Resource limitations were more common in PUB (e.g., no referral location: 86% vs. 70%, P = 0.04). Barriers included treatment side effects (PUB: 66% vs. PRI: 40%, P = 0.001) and lack of knowledge on prescribing exercise (PUB: 63% vs. PRI: 27%, P = 0.001). Physicians in PUB emphasized facilitators like access to qualified professionals (90% vs. 66%, P = 0.001) and personal experience (90% vs. 80%, P = 0.01). Conclusions: This study reveals significant disparities in cancer exercise practices between oncologists in public and private institutions across Latin America. Oncologists in public institutions were less likely to assess exercise, refer patients to exercise programs, and provide guidance. They also reported greater barriers, such as treatment side effects and lack of knowledge on exercise prescription and resources. Facilitators such as access to qualified professionals were less prominent in public institutions. These findings highlight the need for targeted interventions to improve exercise integration in cancer care, particularly in resource-limited settings.