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Background: Patient navigation (PN) is an essential component of cancer care that reduces barriers and enhances the provision of comprehensive, patient-centered care. PN programs and evidence regarding their effectiveness in low- and middle-income countries are limited. This study aimed to assess whether a PN program for the systematic identification of breast cancer (BC) patients’ medical and support needs facilitated referral and timely access to the specialty and supportive care services they required. Methods: This prospective cohort included women ≥18 years with a recent BC diagnosis (≤3 months [m]), treated at Hospital Zambrano Hellion TecSalud in Mexico, and who provided signed informed consent to participate in the PN program from Apr-21 to Jul-22. Participants completed a series of target questions and validated questionnaires to systematically identify their health needs at baseline, 3 m and 6 m since diagnosis. Subsequently, the navigator had a face-to-face or remote meeting with each patient to inform them about the needs detected at each timepoint. According to these needs, the navigator provided referral to the required services. However, it was each patient’s decision whether she attended to the recommended services. Patients’ attendance to referrals provided at baseline and 3 m were assessed at 3 m and 6 m, respectively. Descriptive statistics were employed. Results: During the analyzed period, 263 patients were invited to participate in the study. Of these, 161 (61%) agreed to participate, 57 (22%) agreed but did not complete any survey, and 45 (17%) denied participation. At the time of the analysis, 148, 119 and 86 patients had completed baseline, 3 m and 6 m navigation, respectively. Median time from BC diagnosis to the baseline navigation meeting post survey-completion was 46 days (12-90). Patients’ median age at baseline was 48 years (24-88). Most had ≥high school education (93%), were unemployed (51%) and were married/in domestic partnership (73%). As for medical insurance, most had public (32%) or both public and private coverage (32%), while the rest had private (26%) or no insurance (9%). Patients’ referrals according to their needs and the rate of attendance to those services are detailed in the Table. The main barriers that were qualitatively identified for non-attendance to referral services were time restrictions, patient-provider miscommunication, medical coverage limitations, and financial constraints. Feedback regarding the PN program was provided in 72 cases. All respondents were very satisfied (97%) or satisfied (3%) with the program; affirmed the navigator had facilitated their referral to all (97%) or some (3%) of the services they believed they needed; and stated that the program aided to better cope with their illness (100%). Conclusion: Patients experienced diverse health needs during their trajectory through BC, mainly in terms of psychological support, genetic counseling, maintenance of an adequate weight and access to support groups. However, a suboptimal proportion of patients received attention by the required services. This PN program effectively detected patients’ needs and provided referrals to specific services. Moreover, patients were highly satisfied with the program and believed it aided their coping process. Yet, several barriers that hinder attendance to the referral services might exist and should be identified to enhance the provision of timely, comprehensive care. Table. Patients’ referral and attendance to specialty and supportive care services. Citation Format: Fernanda Mesa-Chavez, Emmeline Rochelle-Palacios, Mauricio Canavati-Marcos, Cynthia Villarreal-Garza. Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-06.

Background: Genetic cancer risk assessment is a multidisciplinary approach that enables the invaluable opportunity to recommend measures aimed at decreasing the risk of recurrence and new cancer diagnoses in individuals with inherited cancer predisposition. However, different challenges may limit the uptake of risk-reducing (RR) strategies among patients in underserved settings. This study describes the implementation of RR surgeries or surveillance studies and related barriers among carriers of breast cancer-associated germline pathogenic variants (PV). Methods: PV carriers were identified at two referral cancer centers in Mexico ≥6 months after receiving test results and genetic counseling. From October 2020 to June 2021, participants were invited to answer a multiple-choice survey assessing their uptake rate of RR measures according to NCCN guidelines by type of PV, as well as the challenges that had hindered this uptake. Descriptive statistics and Chi-squared or Fisher’s exact tests were used for data analysis. Results: In total, 162 carriers (median age: 42.5 years [range 21-73]) answered the survey. Most were women (89%), lived in an urban setting (91%), were married/in domestic partnership (72%), had at least high school education (69%), and were employed (51%). Monthly household income was lower than the minimum wage in 25% of cases and most patients had public (53%) or no (32%) healthcare coverage. Overall, 105 (65%) had a personal history of cancer, most commonly unilateral (77%) or bilateral (13%) breast cancer. PV were found in BRCA1/BRCA2 (75%), CHEK2 (11%), PALB2 (6%), ATM (4%), RAD51C (3%), and less frequently (3%) in TP53, NF1 or PTEN. Carriers underwent at least one of the recommended RR surgeries and surveillance studies in 61% and 69% of cases, respectively. Specifically, 52/124 (42%) of female BRCA1/BRCA2, PALB2, PTEN or TP53 PV carriers had undergone RR mastectomy, while 45/77 (58%) of eligible BRCA1/BRCA2 or RAD51C PV carriers had RR salpingo-oophorectomy. As for surveillance studies, carriers performed all, some and none of the recommended examinations according to their PV in 34%, 35% and 31% of cases, respectively. When an annual mammogram was recommended, 69/109 (63%) underwent the study in the previous year; in the case of breast MRI, only 23/103 (22%) had performed it in the last year. Notably, 132 (81%) carriers reported ≥1 challenge that hindered the uptake of RR strategies (median: 2 [range 0-10]). The main barriers were lack of insurance coverage of the recommended interventions (60%), financial limitations (50%), belief that their physician had not requested the studies or procedures (36%), and fear (25%). Uptake of RR strategies was not associated with carriers’ age, education level, employment status, income, place of residence, or type of mutation (high-risk vs moderate- or low-risk PV). Significant associations are reported in the Table. Conclusion: An important proportion of PV carriers in this resource-constrained setting underwent all or some of the recommended RR strategies, with the most cited uptake challenges being financial barriers and lack of endorsement by their physician. Targeted interventions to reduce out-of-pocket expenses and improve patient-physician communication and patients’ understanding of the implications of carrying a genetic mutation are warranted to enhance the uptake of RR surgeries and surveillance strategies among PV carriers. Variables associated with the uptake of RR strategiesVariableUnderwent ≥1 RR surgeryDid not undergo any RR surgeryp-valueVariableUnderwent all or some surveillance studiesDid not undergo any surveillance studiesp-valueMarital status.012Gender Citation Format: Cynthia Villarreal-Garza, Fernanda Mesa-Chavez, Yanin Chavarri-Guerra, Dione Aguilar y Mendez, Andrea Becerril-Gaitan, Bryan F Vaca-Cartagena, Salvador G Santiesteban, Alejandro Aranda-Gutierrez, Daniela Obregon-Leal, Melina Miaja-Avila, Maria F Ochoa Chavez, Andres Rodriguez-Faure, Hermes J Franco Jimenez, Jeffrey N Weitzel. Uptake of risk-reducing strategies and related challenges among carriers of breast cancer-associated germline pathogenic variants in Mexico [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-09-11.

Background: Breast cancer (BC) is the most common malignancy and the leading cause of cancer-related deaths among young women worldwide. This population usually presents with more advanced stages at diagnosis compared to their older counterparts, exposing them to more intensive treatments which compromise their quality of life (QOL). This study aims to determine the change in QOL in young women with locally-advanced BC over time. Methods: Women aged ≤40, newly diagnosed with locally-advanced BC from 2016 to 2020 at three cancer referral centers in Mexico and accrued in the Joven & Fuerte cohort were included and asked to complete the EORTC QLQ-C30 and QLQ-BR23 questionnaires at diagnosis, six months, and one year follow-up. Differences in mean values were analyzed using repeated measures ANOVA tests. The Mauchly's test was employed to assess the assumption of sphericity and if violated the Huynh-Feldt correction was used. Adjustment of multiple comparisons was performed with the Bonferroni correction. Results: A total of 195 patients with a median age at diagnosis of 35 years (IQR: 32-38) were analyzed. Most patients (59%) were married or in a domestic partnership and the majority (60%) were housewives or unemployed. The distribution of clinical stages at diagnosis was: IIB (41%), IIIA (39%), IIIB (11%), and IIIC (10%). Regarding treatment modalities, most patients underwent mastectomy (n=111, 57%), neoadjuvant (n=103, 53%) or adjuvant chemotherapy (n=79, 41%), and adjuvant endocrine therapy (n=106, 54%). QLQ changes over time are shown in the Table. Most functional scales worsened significantly at six months. Although most of them improved at one year of follow-up, they did not reach baseline levels. Certain symptoms such as fatigue, insomnia, financial difficulties, and arm symptoms worsened from baseline. When analyzing QLQ changes according to the different treatment modalities (mastectomy vs lumpectomy), (neoadjuvant vs neoadjuvant/adjuvant vs adjuvant chemotherapy) and (receiving hormone therapy vs not) no significant differences were found in functional scales or BC symptoms over time. Conclusion: Young women with BC experience physical and psychological distress that negatively impacts their QOL. Several BC specific domains worsened from baseline, such as body imaging, sexual satisfaction, and arm symptoms. Thus, strategies aimed at addressing these specific areas are warranted. QLQ-C30 and QLQ-BR23 at baseline, six months and one yearMean (SEM)NumberBaselineSix monthsOne yearp valueQLQ-C30Global health status14277.76 (1.65)73.53 (1.81)78.46 (1.59)0.047Physical Functioning14290.09 (0.93)86.62 (1.16)89.20 (1.02)0.026Role Functioning14286.97 (1.53)80.16 (1.86)87.68 (1.37) Citation Format: Cynthia Villarreal-Garza, Bryan F Vaca-Cartagena, Andrea Becerril-Gaitan, Alejandra Platas, Melina Miaja, Fernanda Mesa-Chavez, Ana S Ferrigno, Alan Fonseca, Marlid Cruz-Ramos, Lucero Labra, Enrique Bargallo-Rocha, Alejandro Mohar. Quality of life in Mexican young women with locally-advanced breast cancer: A cohort study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-20.

Scalp cooling (SC) is the most reliable method for the prevention of chemotherapy-induced alopecia. However, it remains unclear if its effectiveness is related to the chemotherapy regimen, sequence, and frequency. This study aims to evaluate SC performance among breast cancer patients who received different chemotherapy regimens. The medical records of all consecutive patients undergoing curative-intent chemotherapy and receiving at least one SC session using the DigniCap® System from 2016–2020 in a private Mexican hospital were retrospectively reviewed. SC effectiveness according to chemotherapy regimen was analyzed using descriptive statistics. Successful alopecia prevention was defined as grade 0–1 alopecia (

Background: Mexican young women with breast cancer (YWBC) are a distinct population with particular characteristics and special needs that are not entirely known and are therefore not systematically addressed. J&F is the first program of its kind in Latin America and intends to meet the needs of YWBC in terms of information delivery and support on issues such as fertility, genetics and psychology, as well as to characterize this group by establishing a prospective cohort. The aim of this study was to evaluate patients’ outlook and satisfaction with the services provided by J&F to determine its strengths and areas of opportunity in order to implement strategies to better fulfill patients’ needs. Methods: This cross-sectional study analyzed patients’ satisfaction with J&F at Instituto Nacional de Cancerologia at Mexico City and TecSalud at Monterrey. For this matter, an online survey, kindly provided by the PYNK program, was adapted and piloted to fit the assessment of the J&F provided services. An invitation to anonymously complete it was offered via a messaging application to patients who had been enrolled in J&F for ≥6 months. The questionnaire included multiple choice, Likert scale and open-ended questions exploring patients’ demographics and evaluation of the program’s information delivery and support services, as well as their perspectives of the program’s research component. Likert scale answers were dichotomized to ease analysis, establishing a cut-off point according to their distribution; and free text answers were codified after selecting the most frequently addressed topics. Descriptive statistics, t-student and ANOVA were used for analysis. Results: Of 484 eligible patients, 134 (28%) agreed to answer the survey. Median age at diagnosis was 35 years. A considerable proportion had higher education (78%), were unpartnered (37%) and childless (26%). The timing, clarity and usefulness of the information provided by J&F were each described as good/very good by >80% for the written format and ≥98% for the verbal one. More than 82% of patients reported being very satisfied (≥9/10) with the psychological support, genetic assessment and support groups; and 74%, with the educational workshops and the Whatsapp patients’ group. The program overall was useful/very useful according to 97% of patients and aided 82% to better cope with their illness. Patients found that the most useful services were psychological support, information resources and support groups, for 36%, 19% and 11%, respectively. The number of support services used by patients was significantly associated with their perception of the program’s usefulness (p=0.008) and its aid in easing their illness process (p=0.009). Regarding fertility issues, 81% of patients recalled being informed about the potential effects of cancer treatment on fertility and 45% about preservation strategies. Notably, 33% of patients wished to have more children at diagnosis and 29% wanted to preserve fertility, with J&F supporting 20% of them to undergo a preservation procedure. Patients reported that J&F could improve by offering more educational workshops (31%) and by giving more dissemination to its support services (21%). Finally, 58% of patients were unaware of the J&F ongoing research component. Conclusions: Patient satisfaction with J&F is very high, reflecting that the program is achieving its main goals by meeting Mexican YWBC’s needs by providing clear and useful means of information and support services in a low-resource setting. Also, it is relevant to promote J&F services and highlight its research component to enhance the program’s supportive reach. It is imperative to keep efforts to guarantee the program’s continuity and advocate for the extension of its benefits to other oncologic centers. Citation Format: Cynthia Villarreal-Garza, Alejandra Platas, Melina Miaja, Marisol Garcia-Garcia, Fernanda Mesa-Chavez, Alan Fonseca, Claudia Pineda, Sylvia de la Rosa-Pacheco, Enrique Bargallo-Rocha, David Rodriguez-Gomez, Alejandro Mohar. Joven & Fuerte (J&F): Program for young women with breast cancer in Mexico strongly aids in supporting young patients’ needs and easing their illness process [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-10.

The aim of this study was to evaluate patients’ outlook and satisfaction with “Joven & Fuerte: Program for Young Women with Breast Cancer (YWBC) in Mexico” (J&F) and to determine its strengths and areas of improvement to better fulfill patients’ information and supportive care needs. Patients enrolled in J&F for ≥ 6 months at three cancer referral centers were invited via a messaging application to anonymously complete an online survey exploring their perspectives of the program’s information delivery, support services, and research component. Descriptive statistics, chi2 test, Student t, and ANOVA were used for analysis. Of 484 eligible patients, 28% completed the survey. The program overall was useful/very useful according to 97% and aided 82% to better cope with their illness. The timing, clarity, and usefulness of the information provided were each described as good/very good by ≥ 83% for the written format and ≥ 98% for the verbal one. Eighty-four percent of patients were very satisfied (≥ 9/10) with psychological support and genetic assessment. The number of support services used was significantly associated with patients’ perception of J&F’s usefulness. Regarding fertility issues, 45% recalled being informed about preservation strategies and J&F financially supported 27/39 of interested patients. Fifty-eight percent were unaware of J&F’s ongoing research component. Patients’ satisfaction with J&F is very high, reflecting that the program is meeting Mexican YWBC’s needs by providing useful information means and support services in a limited-resource setting. Efforts must keep up to guarantee the program’s continuity and advocate for its extension to other oncologic centers.

Background: Breast cancer diagnosis and treatment generates disruption in multiple aspects in the life of patients, including work-related outcomes. The disruption in employment may exacerbate the economic burden on patients and their families, contributing to financial toxicity and ultimately impacting quality of life, especially in young women. However, the evidence of employment status at diagnosis for this group and its trajectory thereafter is limited. This study aims to document the first change in employment experienced by Mexican young women with a recent diagnosis of breast cancer and determine which factors are associated with a decrease in work activities. Methods: Mexican women from the Joven & Fuerte prospective multicenter cohort, aged ≤40, diagnosed with stage I-III breast cancer between 2015-2021 with at least 6 months of follow-up were included. Participants with a documented disease recurrence, missing employment status information, diagnosis of a new primary breast cancer or a second type of cancer were excluded from the analysis. Patients completed surveys at baseline, 6 months, and yearly for up to 5 years to assess sociodemographic characteristics, employment status, medical and treatment data. Employment status was categorized on a scale as follows: full-time > part-time > student > medical leave > unemployed. Only the first employment status change was included in this analysis. The Kaplan-Meier failure estimate was employed to calculate the increase or decrease in employment status at 1 year and 2 years post-diagnosis. Competing risk regression models were undertaken to explore variables associated with a decrease in employment status. Results: A total of 142 women with a median age at diagnosis of 36.5 years (IQR 33-39) and median follow-up of 17 months were included in the analysis. Baseline employment status for these patients was: employed - full time (27%), employed - part time (14%), student (1%), medical leave (4%) and unemployed (54%). At 12 months, 18.5% of participants had a reduction in their work activity (95% CI 12.8 - 26.4%) and this proportion further increased to 25.8% at 24 months (95% CI 18.7 - 34.8%). In contrast, 11.8% (95% CI 7.3 - 19.0%) and 23.2% (95% CI 15.9 - 33.2%) of participants exhibited an increase in their work activity at 12 and 24 months, respectively. The most common patterns in first employment status change were from unemployed to employed - full time (19%), employed - full time to employed - part time (13%) and employed - full time to unemployed (13%). In univariable analysis, having a partner at diagnosis demonstrated a lower hazard for experiencing a decrease in work activities; in contrast, postmenopausal status at 1 year was associated with a higher hazard of experiencing a decrease in employment status. However, in a competing-risks model including both partner and menopausal status, only the latter was associated with a higher hazard for experiencing a reduction in work activity (SHR=3.05, 95% CI 1.38 - 6.72, p=0.006). Age, education, monthly income, number of people who contribute to the household, having a partner at diagnosis, number of children, being financially responsible for another person, mastectomy, chemotherapy, radiotherapy and endocrine treatment were not associated with a higher probability of reduction in work activity. Conclusion: This cohort is one of the few initiatives assessing the impact of diagnosis and treatment of BC in young patients, specifically Latin American women. Our results show that there are relevant employment status changes after BC, possibly as a consequence of their treatment. Physical and psychological elements of menopause might influence the decrease in work status. Further studies are needed to deepen our understanding of employment changes in Latin American young women and guide interventions that address unintended limitations of work activities. Citation Format: Cynthia Villarreal-Garza, Ana Ferrigno, Misael Salazar, Luis F. Enriquez, Alan Fonseca, Alejandra Platas, Lucero Labra, Marlid Cruz-Ramos, Melina Miaja, Bryan Vaca-Cartagena, Andrea Becerril-Gaitan, Fernanda Mesa-Chavez, Enrique Bargallo-Rocha, Alejandro Mohar. Employment status change in a cohort of young women with breast cancer in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-08.

Background: Breast cancer diagnosis and treatment carries a disruption in multiple aspects in the life of women. For young women affected by this condition, the evidence of employment status and its change is limited. This study aims to document the first change in employment that may be experienced by young women with breast cancer and determine which factors could influence such patterns. Methods: Mexican women from the Joven & Fuerte prospective multicenter cohort, aged ≤40, diagnosed with stage I-III breast cancer between 2015-2021 with at least 6 months of follow-up were included. Participants with a documented recurrence, missing employment status information, diagnosis of a new primary breast cancer or a second type of cancer were excluded from the analysis. Patients completed surveys at baseline, 6 months, and yearly for up to 5 years to assess sociodemographic characteristics, employment status, medical and treatment data. Women were categorized on a scale of employment status as follows: full-time > part-time > student > medical leave > unemployed. Subsequently, an increase or reduction in employment status was considered whenever a participant moved up or down a category, respectively. Only the first employment status change was analyzed. The Kaplan-Meier failure estimate was employed to calculate the increase or decrease in employment status at 1 year and 2 years post-diagnosis. Competing risk regression models were undertaken to explore variables associated with a decrease in employment status. Results: A total of 142 women with a median age at diagnosis of 36.5 years (IQR 33-39) and median follow-up of 17 months were included in the analysis. Baseline employment status for these patients was: employed - full time (27%), employed - part time (14%), student (1%), medical leave (4%) and unemployed (54%). At 12 months, 18.5% of participants had a reduction in their work activities (95% CI 12.8 - 26.4%) and this proportion further increased to 25.8% at 24 months (95% CI 18.7 - 34.8%). In contrast, 11.8% (95% CI 7.3 - 19.0%) and 23.2% (95% CI 15.9 - 33.2%) of participants exhibited an increase in their work activity at 12 and 24 months, respectively. The most common patterns in first employment status change were from unemployed to employed - full time (19%), employed - full time to employed - part time (13%) and employed - full time to unemployed (13%). Age, education, monthly income, number of people who contribute to the household, number of children, being financially responsible for another person, mastectomy, chemotherapy, radiotherapy and endocrine treatment were not associated with an increase or reduction in work activity. Postmenopausal status at 1 year postdiagnosis was associated with a higher hazard for experiencing a reduction in work activity (SHR=3.05, 95% CI 1.38 - 6.72, p=0.006). Conclusion: The results from the present study appear to be in line with those of a European cohort. Further studies are needed to identify other potential factors that influence employment status trajectories. The development of interventions that tackle actionable characteristics of young patients with breast cancer at risk of employment disruption is imperative. Citation Format: Cynthia Villarreal-Garza, Ana Ferrigno, Luis F. Enriquez, Alan Fonseca, Alejandra Platas, Marlid Cruz-Ramos, Melina Miaja, Bryan Vaca-Cartagena, Andrea Becerril-Gaitan, Fernanda Mesa-Chavez, Enrique Bargallo-Rocha, Alejandro Mohar. Employment status patterns in a cohort of young women with breast cancer in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-01.

Background Identifying and addressing breast cancer (BC) patients' unmet needs (UN) are crucial due to their possible contribution to higher levels of morbidity, particularly in vulnerable underserved populations, such as Latinas with BC. Objective This study aimed to (1) identify and describe the most frequently reported items of moderate-high UN among Mexican women with BC covered by public healthcare insurance; (2) analyze the differences in UN domains according to participants' sociodemographic and clinical characteristics; and (3) validate the Supportive Care Needs Survey-Short Form-34 (SCNS-SF34). Methods A cross-sectional study was conducted with 396 consecutive BC patients. A linguistically translated and culturally adapted version of the SCNS-SF34 for Mexican women with BC was completed by the participants. Results The validation yielded a 32-item version of the SCNS with adequate psychometric properties. The Health System and Providers Information was the highest UN domain, followed by the psychological domain. "Fears about cancer spreading" (37.4%) and "Concerns about the worries of those close to you" (37.3%) were the most prevalent moderate-high UN. Sexuality was the only domain associated with clinical and sociodemographic characteristics. Conclusion By defining the most urgent needs of this group of patients, our results will enable the development of targeted support services and patient-centered care.

This cross-sectional survey study evaluates the specific concerns of and high hesitancy rate toward COVID-19 vaccination among women with breast cancer in Mexico.

Background In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians’ prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice. Methods Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1–5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians’ adherence to standard-of-care prescription. Results In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying (p = 0.042), worrying about long-term ET use (p = 0.031), and experiencing >7 ET-related symptoms (p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy. Conclusions Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians’ knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes., Highlights • 72% of premenopausal patients had complete (100%) endocrine therapy adherence. • 27% of premenopausal patients had acceptable (80-99%) endocrine therapy adherence. • Incomplete adherence to endocrine therapy was mostly due to forgetfulness. • Physicians prescribed guideline-endorsed endocrine therapy in 64% of cases.

Young women with cancer comprise a special population of patients who experience cancer and oncologic care in a unique way. Recent progress in diagnostic and therapeutic approaches has transformed the landscape of clinical oncology practice. This perspective addresses novel therapies, and some of the main challenges that oncologists face when providing care for young patients in the era of next-generation sequencing and tissue-agnostic approaches through the use of targeted therapies for diverse malignancies.

Background: Despite the risk of treatment-related infertility, implementation of fertility-preservation (FP) strategies among young patients with breast cancer is often suboptimal in resource-constrained settings such as Mexico. The “Joven & Fuerte: Program for Young Women With Breast Cancer” strives to enhance patient access to supportive care services, including FP measures through alliances with assisted-reproduction units and procurement of coverage of some of these strategies. This study describes patients from Joven & Fuerte who have preserved fertility, and assesses which characteristics were associated with the likelihood of undergoing FP. Methods: Women aged ≤40 years with recently diagnosed breast cancer were prospectively accrued. Sociodemographic and clinicopathologic data were collected from patient-reported and provider-recorded information at diagnosis and 1-year follow-up. Descriptive statistics, chi-square test, and simple logistic regression were used to compare patients who preserved fertility with those who did not. Results: In total, 447 patients were included, among which 53 (12%) preserved fertility, representing 38% of the 140 women who desired future biologic children. Oocyte/embryo cryopreservation was the most frequently used method for FP (59%), followed by temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy (26%), and use of both GnRHa and oocyte/embryo cryopreservation (15%). Younger age, higher educational level, being employed, having private healthcare insurance, and having one or no children were associated with a significantly higher likelihood of preserving fertility. Conclusions: By facilitating referral and seeking funds and special discounts for underserved patients, supportive care programs for young women with breast cancer can play a crucial role on enhancing access to oncofertility services that would otherwise be prohibitive because of their high costs, particularly in resource-constrained settings. For these efforts to be successful and widely applied in the long term, sustained and extended governmental coverage of FP options for this young group is warranted.

There is paucity of data regarding the knowledge and understanding of patients with metastatic breast cancer (MBC) about their disease stage and treatment goals. This study assessed these patients’ awareness of MBC incurability, topics reviewed with their oncologist, perceptions of having enough knowledge to participate in treatment decision-making, most helpful information source, and satisfaction with the information they received. For this purpose, 185 patients with MBC who attended follow-up medical appointments at a Mexican referral cancer center completed a survey designed by the Metastatic Breast Cancer Alliance. Clinical data were obtained from medical records. Descriptive statistics were applied, and associations between qualitative and quantitative variables were assessed with χ2 and Mann-Whitney U tests, respectively. Half (52%) of the patients were aware that their disease was incurable, while 31% were not sure, and 17% thought it was curable. Forty percent found it difficult to talk about treatments because they did not understand the options that were available to them. The medical staff was the most helpful information source for 74% of participants, and 64% scored their satisfaction with information ≥9 of 10. A significant association was found between higher satisfaction and knowing that MBC is incurable, as well as being older than 40 years. These results illustrate the significant lack of understanding patients with MBC have regarding their cancer, even when reporting high satisfaction with the provided information, and identify a critical need for improved patient education to enhance their comprehension and promote their participation in decision-making processes, treatment adherence, and, ultimately, outcomes.

The relationship between pregnancy and breast cancer risk is not fully understood. Most of the literature has described this interaction in terms of the age at first pregnancy and the number of full-term pregnancies. During the prospective accrual of the "Joven & Fuerte: Program for young women with breast cancer in Mexico" cohort, a series of cases with pregnancy-associated breast cancer and a history of a short inter-pregnancy interval was identified. To date, there is a very limited number of descriptions about the interaction between a short inter-pregnancy interval and breast cancer, but none specifically regarding the association of a short inter-pregnancy interval and pregnancy-associated breast cancer. Based on findings from a prospective cohort of young Mexican breast cancer patients, we hypothesize that a short inter-pregnancy interval may increase the incidence of pregnancy-associated breast cancer, possibly by amplifying the effects of the pregnancy-associated factors involved in the development of breast cancer.

Communication challenges related to the delivery of bad news are present in oncologists’ daily practice. Hence, communication skills are essential for clinicians to handle these situations as appropriately and compassionately as possible. The aim of this study was to identify Mexican oncologists’ perceptions on the most important and hardest issues to discuss with patients and their families, as well as the challenges they most commonly encounter when communicating bad news. Physicians from various oncology centers were invited to anonymously complete an electronical survey designed by our multidisciplinary oncology team. Statistical analysis was performed with the SPSS software v25; descriptive statistics were used for the analysis of the survey’s answers. In total, 115 physicians were included; most were medical oncologists. Treatment objectives and prognosis were the topics most of them considered relevant to address; while end-of-life care and treatment objectives were the hardest ones to discuss. The most difficult challenges they faced when breaking bad news were being honest without taking away hope and dealing with patients’ emotions. Remarkably, we detected a lack of training in delivering bad news to patients among our participants, as a minority of them had formal training in the matter. However, most desired to receive communication skills training and believed a session of 2–5 h would be sufficient. Mexican oncologists face diverse communication challenges when disclosing bad news to patients. Our findings reveal an opportunity to develop formal training programs tailored for Mexican oncologists and to ultimately improve outcomes and patient-centered care.

e13536 Background: The COVID-19 Pandemic represents unprecedented new challenges for healthcare systems, care programs and especially for vulnerable populations like oncologic patients. The J&F Program, developed at the National Cancer Institute (INCan) in Mexico City, provides multidisciplinary care and navigation support for YWBC patients. During the first months of 2020, the whole mexican healthcare system, including the INCan and programs like J&F had to undergo structural adjustments to offer distance care attention (DCA) and face the Pandemic challenges. Methods: From March to September 2020, 196 patients received DCA (phone and video calls, text messages and virtual workshops), which addressed navigation, unmet psychological needs, psychoeducation, oncology and sexual support provided by different healthcare professionals (oncologists, psychologists, sexual specialists). Seventy agreed to participate in this study (intervention group, IG). Forty-three recently diagnosed breast cancer patients could not be contacted by the Program (control group, CG). The patients from the IG completed the emotional distress thermometer and were interviewed about stressors, coping strategies during the Pandemic, and satisfaction with the multidisciplinary support given by the J&F Program. We compared thestandard care given within the institutional facilities and the multidisciplinary support provided virtually by J&F Program for YWBC during the COVID-19 Pandemic regarding their perceived stressors and emotional distress. Results: The CG had more concerns about oncology treatments and their side effects (nausea p = 0.031, fever p = 0.007, anorexia p = 0.006) than the IG. Emotional distress was present in 77% and 86% in the IG and the CG respectively. The IG received significant navigation guidance and multidisciplinary support with the J&F Program’s DCA strategy during the Pandemic than the CG (p < 0.01 and p = 0.019). The J&F Program's psychological care significantly helped YWBC manage their distress (p = 0.001); 70% of the IG patients considered that the support given by the J&F Program dealt with the COVID-19 Pandemic challenges successfully (p < 0.01). Conclusions: DCA by theJ&F Program showed feasibility and benefit in the COVID-19 Pandemic context for YWBC. These findings suggest that multidisciplinary care could be preserved by combining care provision physically and virtually depending on patients' resources or unmet needs.

e12560 Background: Young women with breast cancer (YWBC) have worse survival outcomes compared to their older counterparts. Even though a higher recurrence rate has been previously documented in this population, there is still limited information regarding the timing, prevalence and type of disease recurrence. This study aims to describe the patterns of early recurrence in Mexican YWBC. Methods: Women aged ≤40 years at diagnosis, accrued in the Joven & Fuerte prospective cohort, with stage I-III BC and having at least a 2-year follow-up were analyzed. Recurrence-free survival (RFS) and overall survival (OS) at 2 years were evaluated using the Kaplan-Meier estimate. Log-rank and Fisher’s exact tests were employed for group comparisons; the Cox regression method was used to identify factors associated with RFS and OS. Results: A total of 210 patients with a median age at diagnosis of 36 years (range: 21-40) were analyzed. Most patients were diagnosed with stage II (50%) and III (39%). Distribution according to molecular subtype was: 50% HR+/HER2-, 26% TNBC, 17% HR+/HER2+, and 7% HR-/HER2+. In total, 31 (15%) patients experienced early disease recurrence. The two BC subtypes with the highest recurrence rate were TNBC (12/54; 22%) and HR+/HER2+ (6/35; 17%), followed by HR+/HER2- (12/106; 11%) and HR-/HER2+ (1/15; 7%). Stage at diagnosis was associated with a higher risk of recurrence (stage III: 21/82 (68%); stage II: 10/94 (32%); p= 0.003). Of the total recurrences, 23% were locorregional and the remaining 77% were distant metastases. The most common sites of distant metastases were lung (46%), bone (38%) and central nervous system (33%). Notably, 50% of distant recurrences affected multiple organs. Overall, RFS at 2 years was 85.2% (95%CI 79.7-89.4). In the univariate analysis, age ( < 35 v ≥35), type of surgery (conservative v mastectomy) and BMI ( < 25 v ≥25 kg/m²) were not significantly associated with RFS. In a multivariate model, node involvement (HR = 2.76; p= 0.044), not receiving chemotherapy (HR = 3.86; p= 0.024) and TNBC (HR = 2.47; p= 0.035) were independently associated with worse RFS. The OS found in this cohort was 92.9% (95%CI 88.4-95.6). In a multivariate model, TNBC (HR = 3.71; p= 0.029) and stage III at diagnosis (HR = 5.55; p= 0.008) were associated with worse OS. Conclusions: This cohort of YWBC experienced a low RFS at 2 years. As previously reported, patients with node involvement and TNBC faced a greater risk of early recurrence. Noteworthy, a high prevalence of distant metastases was observed, with half of them involving > 1 site. Future studies are warranted to elucidate the factors associated with early recurrence in YWBC. In addition, the incorporation of new treatment strategies is urgently needed to improve disease outcomes in this group.

10562 Background: Breast cancer (BC) is the most common cause of cancer-related death and morbidity among young women in Latin America. This group has a higher prevalence of advanced disease stages at diagnosis compared to their older counterparts. Thus, strategies aimed at detecting BC at early stages are imperative. Breast self-examination (BSE) remains a useful strategy for BC detection, especially in women who do not routinely undergo screening with imaging studies. This study aims to evaluate factors related with BSE practice in Mexican young women with BC and assess its association with earlier disease stages. Methods: Women aged ≤40 newly diagnosed with BC from 2014 to 2020 at three cancer referral centers in Mexico accrued in the Joven & Fuerte cohort were included and asked to complete a socio-demographic survey. Fisher’s exact and Mann-Whitney U tests were used to evaluate associations between BSE and socio-demographic characteristics, as well as disease stages. Results: A total of 554 patients with a median age at diagnosis of 36 years (range: 19-40) were analyzed. Most patients (65%) were married or in a domestic partnership, and the majority were housewives (63%). Regarding educational background, 64% had completed at least high school, and up to 84% had a monthly income < 11,600 Mexican pesos (US$ 581). Overall, 85% of patients had public insurance, 6% had private insurance, and 9% were uninsured. The distribution of clinical stages at diagnosis was: 0 (2%), I (11%), II (45%), III (32%), and IV (10%). BC detection methods were: 85% by self/partner exam, 11% by an imaging study, and 4% by a healthcare professional. A total of 443 (80%) patients practiced BSE, of which 50% did it on a monthly basis, 18% every 2-3 months, and the remaining 12% every 4-12 months. Notably, a higher educational level (≥ high school v ≤ middle school) was positively associated with BSE practice (RR: 1.28; 95%CI 1.06-1.54; p= 0.005). No significant association was found between BSE and age (≤35 v > 35), marital status (in a relationship v no), occupation (housewive v other), monthly income ( < 11,600 v ≥11,600) or medical coverage (public/uninsured v private). Patients that performed BSE were more likely to be diagnosed with early BC (stages 0-II) compared to those that did not (61% v 45%; p= 0.003). No association was found between BSE frequency and stage at diagnosis. Noteworthy, patients with private insurance were more likely to be diagnosed with stages 0-II compared to those with public or no insurance (80% v 56%; p= 0.007). Conclusions: The significant association between BSE and earlier stages at diagnosis found in this study highlights the need to raise awareness and promote this practice among young women with the objective of downstaging BC diagnoses. Public health interventions such as educational and social media campaigns that aim to improve the correct practice of BSE might be particularly useful in settings with inadequate screening programs.

e12510 Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.

1090 Background: Among patients with metastatic breast cancer (MBC), there is paucity of data regarding knowledge and understanding about disease stage and goals of treatment. The limited evidence shows that up to 40% of MBC patients ignore their stage and reports inadequate educational resources and support. Aim: To assess MBC patients’ knowledge of their disease and satisfaction with the medical information received. Methods: 185 patients diagnosed with MBC who attended follow-up medical appointments at INCan from June to December 2018 were asked to complete a survey to assess their knowledge on MBC curability, subtype, topics reviewed with the oncologist, need of additional information regarding MBC and satisfaction with the quality of the information they received. Clinical data was obtained from the medical records. Descriptive statistics were applied, and the association between qualitative and quantitative variables was assessed with the Chi square test and the Mann Whitney U test, respectively. This study was supported by the SPARC mBC Challenge. Results: Only 52% of patients knew that their disease is not curable, while 31% were not sure and 17% thought it was curable. 82% ignored their MBC subtype and 81% reported to want more information about their cancer. 64% scored their satisfaction with the provided information ≥9 (out of 10), and 74% stated that their most helpful source of information was the medical staff. A statistically significant association was found between the perception of the impossibility of curing MBC and better patient satisfaction (p = 0.038). Likewise, better patients’ satisfaction was associated with older age (p = 0.002), longer time since initial diagnosis (p = 0.018) and since diagnosis of MBC (p = 0.014). Conclusions: Our results dramatically illustrate the lack of understanding patients have regarding their cancer, even when reporting high satisfaction with the received information, and identify a critical need for improvement of healthcare providers’ communication skills. Directed efforts should be implemented to enhance patients’ comprehension to promote their participation in decision-making processes, adherence and, ultimately, outcomes.

e18387 Background: The subcutaneous presentation of trastuzumab has been recently incorporated into the treatment regimen of HER2-positive breast cancer (BC). Its use has been associated with cost savings and reduced chair time, being especially suitable for public health systems. Aim: To estimate the cost savings of the use of SC-T compared to intravenous trastuzumab (IV-T) according to patient weight, and calculate the infusion time of SC-T in a tertiary healthcare facility at TecSalud from Feb 2018 - Jan 2019. Methods: From a total of 2068 oncological treatments, 756 corresponded to SC-T, either alone or concomitantly with chemotherapy (CT). For cost estimation, we considered $1,103 USD per SC-T vial, $1,162 USD per IV-T vial and $2.6 USD per mg of IV-T, as per governmental rates. We compared the actual treatment cost of 600 mg fixed SC-T dose with the hypothetical cost of administering IV-T at a dose of 6 mg/kg, considering its price per vial and per mg. The total time of SC-T infusion was reported. Results: Median patient weight for the 756 reported SC-T treatments was 72 kg (45 - 127 kg). Of these, 561 consisted of SC-T alone; and 56% had adjuvant, 34% neoadjuvant and 10% palliative intent. The estimated cost of the 756 doses of SC-T was $833,500 USD. Considering patients’ weight, 46% of the infusion treatments would have required 2 IV-T vials, with a total of 1105 vials and an absolute cost of $1,282,374 USD. Likewise, if cost per mg of IV-T is examined, we would have used 338,744 mg of IV-T, with an estimated cost of $894,284 USD. Approximate savings of SC-T use would reach $448,874 USD per vial payment and $60,784 USD per mg payment. The median time of SC-T only infusion was of 3 minutes (1 - 20 minutes); and no adverse effects were documented during its administration. Conclusions: The SC-T fixed dose (irrespectively of patients’ weight) results in significant practical and financial advantages as weight-adjusted dosing is not required. This is specially relevant in countries like Mexico, where > 70% of BC patients are overweight/obese, requiring higher doses of IV-T and resulting in greater expenses. Thus, the use of SC-T not only offers greater convenience to patients, but also reduces overall healthcare costs compared to standard IV infusion.

e23190 Background: Communication in oncology practice presents numerous challenges. Patients may react to the diagnosis and treatment information with unpredictable and difficult to manage emotions, which may distress clinicians and affect patient-physician relationships. An effective communication has shown a beneficial effect on satisfaction from both patients and providers, as well as on quality of health care provision and patients’ adherence, decision-making processes and outcomes. Aim: To identify the most important and hardest topics to discuss during consultation that pose a challenge for Mexican medical oncologists during their clinical practice. Methods: Physicians were reached out by a messaging platform to complete a survey that addressed the most relevant and difficult issues for discussion and the frequent challenges they face during information exchange. Results: A total of 115 oncologists completed the survey. Most of them identified treatment objectives, prognosis and treatment selection as important issues to discuss with patients. They coincided that the hardest matters to disclose were palliative care referral, treatment objectives, prognosis and recurrence. Also, oncologists reported that the most important challenges they face when communicating with patients are being honest without being hopeless (43%) and responding to patients’ emotions (21%). 92% expressed that they would like to receive formal training in communication skills. Conclusions: The issues regarded as highly important to discuss with patients were also the most difficult ones to address, possibly due to barriers related to patients’ emotional reactions when receiving bad news. The incorporation of a psychologist could promote calmness and trust, aid in information assimilation, and provide support to partners and relatives, as needed. Also, results showed the interest of oncologists in receiving formal training in communication skills, which reinforces the need to include this training as part of the medical oncology curriculum to ease transmission and comprehension of information. [Table: see text]

e13150 Background: In limited-resource countries like Mexico, GCRA is not routinely provided due to elevated costs, lack of public coverage for testing and prophylactic surgeries, and limited GCRA expertise or awareness among providers and patients. Thus, GCRA services in Mexico are 20 years behind higher income countries, resulting in suboptimal care and limited opportunity for prevention. The Breast Cancer Center TecSalud established formal GCRA services for underserved patients by recruiting a cancer geneticist who provides care at no added expense to patients, building academic collaborations for training and research with City of Hope, and enabling free genetic testing through the Clinical Cancer Genomics Community Research Network, supported in part by the Breast Cancer Research Foundation. Aim: To report the uptake of the GCRA program by patients and relatives at TecSalud from January 2016 - December 2018. Methods: Eligibility includes Mexican women who meet hereditary breast cancer testing criteria and family members of mutation carriers. Risk reduction procedures are covered by Seguro Popular and/or the NGO Fundación Santos y de la Garza Evia. Results: GCRA was offered to 255 patients and 74 at risk relatives, with an increasing reach (proportion of those eligible who access the program). A significant growth of cascade testing and access to risk reduction surgery over time are noted. Conclusions: A growing number of referrals and GCRA visits shows improving reach, possibly due to engagement of the multidisciplinary team and increased patient awareness. The expansion of cascade testing and performance of risk-appropriate surgeries reflects a maturing prevention program. Key determinants of our progress are collaborations that provided us with crucial mentorship, access to genetic assays, as well as the increasing involvement of local leaders, administrators and benefactors for the establishment of vital clinical and research capacity. Multilevel efforts should continue to enhance the delivery of standard of medical care for the most vulnerable and underserved high-risk patients and families. [Table: see text]

e18677Background: In Mexico, inadequate infrastructure and use of analogue mammography equipment over digital for breast cancer (BC) screening and diagnosis contribute to prolonged total time inter...