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Performance status (PS) scales are used routinely in clinical oncology to evaluate functional status and help direct treatment decisions. PS is also used to determine research protocol eligibility, indicate treatment response, and evaluate toxicity in oncology clinical trials. Malnutrition (like poor PS) is associated with adverse outcomes such as lower tolerance to anti-tumor treatment, poor quality of life, and decreased survival. Nutritional status is therefore arguably as important as PS for cancer outcomes. Despite well-documented adverse consequences for patients, malnutrition also often goes undiagnosed until severe depletion is evident. If the predictive importance of nutritional status is comparable to PS, why is nutritional status not routinely used along with PS to guide treatment decisions? There is compelling evidence to support the predictive abilities of both PS and nutritional status in cancer outcomes and treatment decision-making. Perhaps, PS may be a proxy for nutritional status. Nutritional status might also serve as an effective tool for patient selection and stratification in oncology trials. Together with PS, it might provide important and distinct prognostic information; we propose both should be routinely included in outcome studies. The extent to which impaired PS may be a surrogate for malnutrition warrants investigation. Given its comparable importance to PS, it is inexcusable that nutritional status is not given the prominence it deserves as a key patient-reported outcome.

The Health Care Network proposes itself as a model of organization for health actions and services in an integral way, aiming to improve access, comprehensiveness of care, effectiveness of actions and economic efficiency. It is necessary to analyze the set of practices offered by our health institutions, discussing and problematizing the current policy based on the visibility and sayings of the daily lives of users, professionals, services and management. The implementation of a policy is not based only on its text, its intentions and publication, but is crossed by disputes and tensions of different natures. Thus, this study was concerned with mapping a Care Network for People with Disabilities in a Brazilian capital from the maps and flows of the services of the Care Network for People with Disabilities and from the analysis of the RCPD maps and flows followed by users/guide/citizens to access the network's services in search of health care, in order to contribute to the debate on how the production of care as PCD has materialized and problematize the policy itself. Having the meeting with users-citizens, professionals and managers as a method, we bring analyzers that emerged from the experiences and existential connections of the research participants. The maps, flows and analyzers that were produced and discussed gave visibility to multiple care networks: formal, invisible and existential. The formal network consists of several public and philanthropic rehabilitation institutions in specialized care. In addition, the paths of research evidenced the invisible network, which are spaces that constitute other forms of network construction and do not officially make up the RCPD of the municipality, but which are permanently materialized in the construction of existential networks that transit in the space of health and life of citizen users. It is noticed that the policy proposes the creation of a health care network, but that, paradoxically, it reinforces a fragmented care that places the centrality of PCD care in rehabilitation services in EA, either when we think of the formal network as well as the invisible network, and both are crossed by the existential networks of citizen-users. All issues highlighted and problematized in this research are important clues that the current policy does not account for the realities that present themselves in the daily care of PCD, both in relation to the modes of implementation and in relation to the power of the policy as a care device integral that considers the PWD in their differences. A Rede de Atenção à Saúde se propõe como um modelo de organizar as ações e serviços de saúde de forma integral, objetivando a melhoria do acesso, integralidade do cuidado, efetividade das ações e eficiência econômica. É preciso colocar em análise o conjunto de práticas ofertadas por nossas instituições de saúde, discutindo e problematizando a política vigente a partir das visibilidades e dizibilidades do cotidiano dos usuários, dos profissionais, dos serviços e da gestão. A efetivação de uma política não se baseia somente a partir de seu texto, suas intenções e publicação, mas é atravessada por disputas e tensões de diferentes naturezas. Assim, este estudo ocupou-se em cartografar a Rede de Cuidado às Pessoas com Deficiência de uma capital brasileira a partir dos mapas e fluxos dos serviços da Rede de Cuidados à Pessoa com Deficiência e da análise dos mapas da RCPD e fluxos percorridos pelos usuário-cidadãos-guia para acessar os serviços da rede em busca do cuidado em saúde, a fim de contribuir para o debate sobre como a produção do cuidado às PCD tem se materializado e problematizar a própria política. Tendo o encontro com usuários-cidadãos, profissionais e gestores como método, trazemos analisadores que emergiram a partir das vivências e conexões existenciais dos participantes da pesquisa. Os mapas, fluxos e os analisadores que foram produzidos e problematizados deram visibilidade a múltiplas redes de cuidado: a formal, a invisível e as existenciais. A rede formal é constituída por diversas instituições públicas e filantrópicas de reabilitação na atenção especializada. Além disso, os caminhos da pesquisa evidenciaram as redes invisíveis, que são espaços que constituem outras formas de construção de rede e não compõem oficialmente a RCPD do município, mas que se materializam permanentemente na construção das redes existenciais que transitam no espaço da saúde e da vida dos usuários-cidadãos. Percebe-se que a política propõe a criação de uma rede de cuidados em saúde, mas que, paradoxalmente, reforça um cuidado fragmentado que coloca a centralidade do cuidado das PCD em serviços de reabilitação na AE, tanto quando pensamos na rede formal quanto na rede invisível, e ambas são atravessadas pelas redes existenciais dos usuários-cidadãos. Todas as questões visibilizadas e problematizadas nessa pesquisa são pistas importantes de que a política vigente não dá conta das realidades que se apresentam no cotidiano do cuidado das PCD, tanto em relação aos modos de implantação quanto em relação à potência da política como dispositivo de cuidado integral que considere as PCD em suas diferenças.

12052 Background: Older cancer patients in developing countries face considerable challenges in obtaining access to specialized medical attention, often due to a lack of human resources and healthcare infrastructure. This study sought to explore the benefit of a remote, validated geriatric assessment (GA) program for older patients starting chemotherapy in Brazil. Methods: Older adults (65+ years) beginning a new chemotherapy treatment regimen in Brazil were recruited. Through telehealth, patients were assessed with GA before starting chemotherapy treatment for any type of solid cancer and at a follow-up visit (3 months after enrollment). GA results were discussed by a multidisciplinary team (e.g., geriatrician, psychologist, nutritionist) and recommendations were determined. Outcome measures included chemo toxicity scores (CARG, scale 0-19), physical symptoms (FACT-G, scale 0-108) and activities of daily living (IADL, scale 0-5 for men and 0-8 for women, or scale 0-1 for IADL ratio). Descriptive statistics were generated, and paired t-tests were used to evaluate the change in these measures over time. Results: A total of 51 older patients from 5 different Brazilian states (Amazonas, Distrito Federal, Espirito Santo, Pernambuco and Rio Grande do Sul) have been enrolled to date. The mean distance from a patients’ home to their place of cancer treatment was 21 miles (range: 3-101 miles). Participants had a mean age of 76.5 years (SD = 7.6) and were predominantly female (57%), white (57%), married (61%), and had a high school degree or more (65%). Patients were mostly diagnosed with gastrointestinal (39%) or gynecological (20%) cancers; 55% of patients were diagnosed with a stage IV disease. The majority of patients (80%) were referred to appropriate remote services based on the GA; including geriatricians (41%), nutritionists (39%) and/or psychologist (16%). At the time of abstract submission, data from 34 complete cases were available for longitudinal analysis, in which we observed a decrease in chemo toxicity scores (M1= 6.65, M2= 5.88, p = 0.035) and an improvement in FACTG (M1= 92.94, M2= 98.53, p < 0.001). The improvement in IADL ratio was not significant (M1= 0.79, M2= 0.85, p = 0.069). Conclusions: This novel, ongoing study is, to our knowledge, the first to implement a remote GA program in Brazil. Our preliminary findings suggest that a remote GA program, with appropriate referrals to specialists, may increase the reach of supportive services and improve cancer care in developing countries.