20520 Background: A significant proportion of cancer deaths occur in the in ICU. Advanced cancer patients (pts) admitted to ICU and their family member experience severe distress. The impact of PCT in the ICU pts is not known. Purpose: To characterize symptom distress and outcomes in ICU pts referred to a PCT in a cancer center. Methods: A retrospective review of the PCT consults was done in pts admitted to ICU between 07/2006 and 10/2007. Demographic data, comorbidities, PCT findings, interventions, and outcomes were collected. Results: 88 ICU pts seen among 1637 PCT consults (5%). Median age (range) was 60 years (22–87), 46% female. Primary was hematological (22%), gastrointestinal (22%), lung (20%), breast (9%), and others (26%). 76% had metastatic disease and 44% had chemotherapy ≤4 weeks prior evaluation. 19 pts (21%) were on mechanical ventilation (MV) and 24 pts (27%) on BIPAP. Findings: delirium (81%), dyspnea (82%), pain (84%), fatigue (95%), anxiety (65%), sedation (78%), depression (45%), insomnia (69%), nausea (33%), cachexia (44%), and constipation (60%). Main interventions: participation in DNR conversion (70%), withdrawal of MV (17%), BIPAP (29%), dialysis (11%), and TPN (8%), start/rotate opioid (99%), steroids (70%), antiemetics (79%), bowel regimen (72%), antipsychotic (76%), and counseling (100%). Improvement was observed in: pain 67 (90%), nausea 34 (91%), dyspnea 60 (90%), anxiety 51 (80%), depression 19 (48%), delirium 31 (44%), constipation 44 (83%) and family distress 88(100%). 53 (60%) pts remained in ICU and 35 (40%) were transferred to palliative care unit (PCU). 51/88 ICU pts died during admission (58%), vs 130/1549 (8%) non ICU PTC consults pts (p<0.0001). 28/53 (53%) died in ICU vs total medical ICU deaths 318/1383 (23%) p< 0.0001). 23/35 pts transferred to PCU (66%) died in PCU vs 212/629 (34 %) admitted to PCU from other services (p<0.0001). 37 pts (42%) were discharged alive (14 pts to home with hospice, 11 pts to an inpatient hospice unit, and 10 pts to home with clinic follow up and 2 pts to a nursing facility. Conclusions: ICU referrals to the PCT have severe distress. PCT interventions resulted in symptom improvement. Mortality was high but 47% of pts followed in ICU and 34% of pts transferred to PCU were discharged alive. No significant financial relationships to disclose.