Background: M/P may be the most valued end point of life. How hope, faith, physical and psychological factors impact M/P is unknown. We evaluated factors affecting M/P in pts with OC. Methods: OC pts at a cancer center (CC), academic hospital (AH) and county hospital (CH for primarily uninsured) participated. Surveys completed at initiation of chemotherapy (CTX); completion of CTX; and 1 yr later. Surveys included FACT-O, -SP, Herth Hope Index, Hospital Anxiety and Depression Scale (HADS), ESAS, and Locus of Control (LOC). Results: N=115. Median age=55 yrs, married 64%, Christian 96%. CH had more AA/Hispanics pts (p=.001) and unmarried pts (p=.001). QOL and symptoms improved for all sites over time (p =.03); CH pts had the worst scores (p= <.001). CC pts expressed more hope, less anxiety and depression (A/D) compared to CH and AC pts for all time points (p=.03). CH pts had higher and increasing A/D over time while CC pts had the least (p=.02). LOC scores differed by site (p=.01). CH pts held strongest belief that life was controlled by chance and “others”; CC pts had the least. There was no association between site/time for belief of internal control over one’s life. CH pts consistently had the lowest M/P scores (p=004). Adjusting for site, disease status and time, higher M/P associated with higher hope, better QOL, symptoms and faith (p= <.0001). Lower M/P associated with increased A/D (p=.003) and symptoms (p<.0001). Poorer M/P over time correlated with belief that life was controlled by chance (p=.01) and "powerful others"(p=.02). Level of M/P did not correlate with belief of internal control over one’s life. Conclusions: M/P did not change over time. CC pts had highest M/P. Higher M/P associated with higher hope and faith, better QOL, less symptoms and A/D. Lower M/P associated with sense that life is controlled by chance and powerful others. Data show medically underserved pts have poorer QOL, more symptoms and A/D and may believe the future is determined by luck/chance and by “others”. Triaging for spiritual crisis may be important in these pts. Interventions to decrease A/D and symptoms may improve pts’ sense of M/P over the cancer journey.