Background: Lay health navigators are able to address various issues that cause distress in older cancer survivors by administering and responding to distress thermometers (DT). Methods: Lay navigators in the UAB Patient Care Connect Program assist cancer patients ≥ 65 years old with traditional Medicare insurance at 12 cancer centers in Alabama, Mississippi, Georgia, Florida, and Tennessee. Navigators documented distress levels, causes of distress, and requests for intervention.. Distress screening data from the final DT administered prior to death were used to describe care gaps for older adults with advanced cancer. Results: DTs were collected on a representative sample of 1060 patients who were evenly divided with respect to gender and 18% minority. Median number of days from date of last DT to date of death was 42(1-544). Distress score ≥ 4 were observed in 43% of patients;10% reported scores ≥ 8. Forty four percent of patients attributed distress to physical symptoms such as pain and fatigue. Twenty two percent indicated mobility issues contributed while 15% indicated informational needs related to their illness or treatment. Patients were more likely to ask for help from navigators with informational issues related to their illness (63%) or hospice (75%) than mobility (35%) or physical symptoms (33%). Conclusions: Through distress screening lay navigators are able to help older adults with advanced cancer with informational or logistical needs and advocate for proactive assistance with issues related to symptom burden. The project described was supported by Grant Number 1C1CMS331023 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.