Objective predictors of financial toxicity in oncology.

This systematic review and meta-analysis aimed to assess the global prevalence and determinants of financial toxicity in colorectal cancer (CRC) patients. PubMed, Embase, Web of Science, Scopus, PsycINFO, Cochrane, CINAHL, CNKI were searched through January 2025. Studies reporting financial toxicity scores, prevalence, or determinants were selected. The Agency for Healthcare Research and Quality Methodological Checklist and the Newcastle-Ottawa Scale were used to assess the article quality. Meta analyses were performed in R 4.2.5, with heterogeneity assessed by I2 test and subgroup analyses. Publication bias evaluated using funnel plots, Egger’s test and Luis Furuya-Kanamori index. 65 studies met inclusion criteria. The pooled prevalence of objective financial toxicity (catastrophic health expenditure) was 0.69 (95% CI: 0.45–0.94). For COST-PROM scale studies, prevalence was 0.74 (95% CI: 0.58–0.90); for self-developed scales, prevalence was 0.31 (95% CI: 0.24–0.40). Female patients had a higher risk of financial toxicity (OR = 1.37) compared with male patients (OR = 0.73, 95% CI: 0.53–0.99 for males). Younger patients (< 60 years) had a higher risk (OR = 2.13) compared with those aged ≥ 60 (OR = 0.47, 95% CI: 0.32–0.69 for ≥ 60 years). Insured patients had a higher risk compared with uninsured patients (OR = 1.88, 95% CI: 1.05–3.37). Unmarried patients had a higher risk (OR = 1.49) compared with married patients (OR = 0.67, 95% CI: 0.48–0.93 for married). Patients with lower educational attainment had a higher risk (OR = 2.27) compared with those with high school education or above (OR = 0.44, 95% CI: 0.37–0.53 for high education). Patients with stage IV cancer had a higher risk compared with stages I–III (OR = 1.32, 95% CI: 1.11–1.57). Only employment status and education level showed publication bias, and correction by trimming and filling did not change the conclusions. Financial toxicity is common among CRC patients. Higher risk was observed in females, younger patients, those with lower education, insured individuals, and patients with stage IV CRC. Interventions should target these vulnerable groups, highlighting that insurance alone may not fully protect against financial toxicity, and should strengthen financial support and social resources. • Colorectal cancer (CRC) is the second most common cancer globally, and while advances in treatment have improved survival rates, patients often face significant financial burdens. • Financial toxicity in cancer care is a recognized concern, adversely affecting treatment adherence and overall quality of life. • Previous research has identified various factors linked to financial toxicity among cancer patients; however, variability in measurement methods has led to inconsistent estimates of its prevalence and risk factors across studies. • This study provides a comprehensive global meta-analysis that integrates data on financial toxicity in CRC patients using multiple measurement approaches, including objective indicators (catastrophic health expenditure) and subjective evaluations (COST-PROM and self-developed scales). • It offers pooled prevalence estimates of financial toxicity across different assessment methods, highlighting significant differences among them, which helps clarify the heterogeneity in previously reported findings. • The analysis identifies critical determinants of financial toxicity in CRC patients, showing that gender, age, insurance status, marital status, education, and cancer stage are significantly associated with the risk of developing financial toxicity.

518 Background: With the rising cost of chemotherapy, the financial toxicity (FT) of systemic therapy can substantially impair patient quality of life. FT is also associated with various socioeconomic factors, one being race. Patients of African American race often bear the worst burden of cancer treatment-related FT, with a 40% increased mortality from breast cancer. The degree to which chemotherapy prior to radiation therapy (RT) impacts FT has yet to be formally quantified. We report early FT findings among African American breast cancer patients prior to receipt of adjuvant RT on the ongoing Navigator-Assisted Hypofractionation (NAVAH) Phase I clinical trial (ClinicalTrials.gov ID: NCT05978232) to assess the impact of chemotherapy on FT. Methods: African-American breast cancer patients undergoing RT were eligible if age 18+ with pathologically confirmed breast cancer following resection. As part of the trial, patients were assisted by a patient navigator during and after treatment. FT was measured using the validated 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey instrument. COST-FACIT scoring was used to find FT in patients before receipt of RT. Values from 26-44 represent Grade 0 FT (none), values from 14-25 represent mild Grade 1 FT (mild), values from 1-13 represent Grade 2 FT (moderate), and values of 0 represent Grade 3 FT (severe). The chi-square test was used to identify statistically significant differences (p &lt;0.05) between patients who received chemotherapy versus no chemotherapy prior to receipt of RT. Results: The first 32 enrolled patients completing the pre-RT COST-FACIT survey were evaluated. 53% of patients underwent chemotherapy before RT. Mild to moderate FT was apparent in 56% of patients. The mean and median COST-FACIT score (range 4.4-39) was 25 (+/- 10.4). 78% of patients who experienced some level of FT underwent chemotherapy and 22% of patients experiencing FT did not receive chemotherapy (p = 0.0015). Of patients who did not experience FT, 21% received chemotherapy and 79% of patients did not. In total, 82% of patients who underwent chemotherapy before RT reported mild to moderate FT. Grade 3 FT was not observed. Conclusions: The NAVAH study is the first to objectively compare FT among patients receiving chemotherapy before RT for early-stage breast cancer. Our findings indicate that more than 80% of patients who underwent chemotherapy experienced FT. Approximately 1 in 5 patients not experiencing FT received chemotherapy. The findings indicate that chemotherapy plays a significant role in patient quality of life, highlighting a subsection of patients who may benefit from proactive financial assistance to reduce the detrimental effect of FT on their livelihood. Clinical trial information: NCT05978232 .

Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy—dimensions of “financial toxicity”—need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.

318 Background: Financial toxicity (FT), a patient-reported outcome measure (PROM) is defined as the detrimental impact of financial burden caused by a cancer diagnosis on a patient’s well-being. FT is common among cancer patients, yet little is known about FT following radical prostatectomy (RP) for prostate cancer in countries with universal health coverage. We aimed to assess de novo FT and its impact on health-related quality of life (HRQOL) in a large prospective cohort of patients undergoing RP with a systematic follow-up of up to 10 yrs. Methods: 2254 consecutive patients who underwent RP at a large tertiary care center were analyzed. PROMs were prospectively assessed preoperatively, postoperatively at 3mo, then annually until a maximum follow-up of 120mo, applying the validated EORTC QLQ-C30- and the prostate cancer-specific QLQ-PR25 questionnaires. FT was assessed by the “financial toxicity subscale” (FTS) of the EORTC QLQ-C30. Based on previous reports, meaningful FT was defined as FTS ≥ 17. Multivariable regression analysis was used to identify predictors for the development of de novo FT. Separate modeling of longitudinal HRQOL was performed for patients with de novo FT (FT-cohort) and without FT (no-FT-cohort). General HRQOL was assessed by the global health status domain (GHS) of the EORTC QLQ-C30. Results: 298 patients reporting FT prior RP were excluded from further analysis. 20.3% (n=397) of the included patients reported de novo FT within 12 months after RP with a mean FTS-score of 47.3 (SD 21.9). Baseline clinicopathological characteristics did not differ between the FT-cohort and the no-FT-cohort (p-range .060-.173). Multivariable logistic regression analysis revealed subsequent therapies following RP (OR 1.981, 95%CI 1.11-3.53, p=.020), low preoperative emotional functioning (OR 0.990, 95%CI 0.92-0.99, p=.031) and low preoperative social functioning (OR 0.990, 95%CI 0.98-0.99, p=.035) to independently predict development of de novo FT after RP. In longitudinal analysis, significantly worse general HRQOL was observed for patients with de novo FT postoperatively and up to 48mo after RP (p-value each &lt; .001). In the longer term, both cohorts reported no significant difference in general HRQOL up to 10yrs post RP (p-range: .90 - .91). Conclusions: The current study provides prospective data from a unique contemporary patient cohort, which reveals independent predictors for de novo FT in prostate cancer patients following RP. Furthermore, it displays the natural course of general HRQOL for patients who develop de novo FT.

119 Background: Patients with gynecologic cancer and high financial toxicity (FT) are significantly more likely to report delaying care than patients with low FT. We compared time of symptoms onset to diagnosis and treatment stratified by FT in patients with gynecologic cancer. Methods: Patients with gynecologic cancer completed a cross-sectional survey at follow-up visits with gynecology oncology providers from 2017-2021. The survey included the Comprehensive Score for Financial Toxicity (COST) tool. Data were abstracted from medical records, including dates of symptom onset, initial biopsy, surgery and/or start of relevant treatment. FT was categorized as high (COST score ≤23) and low (COST score &gt;23). Data are presented as n (%) and median (interquartile range). Results: There were 258 respondents, 54% with uterine cancer, 30% with ovarian and 16% with cervical. High FT was reported by 31% and low FT by 69%. Median age at diagnosis was 62 (53.8-69.9) years, 81% of respondents were Non-Latinx White, and 7% had a non-English primary language. Most cancers were stage I (59%), 10% stage II, and 31% stages III-IV. Most patients had surgery (91%), 50% had chemotherapy and 45% had radiation; 15% had recurrence. Median time of COST score since diagnosis was 13.6 months (5.7-41.1). Risk factors for high FT included age, race and ethnicity, education, employment, insurance status, income, and chemotherapy (all p&lt;0.05). Median time from symptom onset to diagnosis in all gynecologic cancers was longer in the high FT [3.1 (1.1-5.8) months] compared to the low FT [1.8 (0.9-3.8) months] group (p=0.01). Time from biopsy to gynecologic oncology consult and time from consult to surgery did not differ based on FT (both p&gt; 0.05). Among patients with cervical cancer, those with high FT had a longer median time from symptom onset to diagnosis [5.0 months (3.1–8.8)] compared to those with low FT [1.7 months (0.9–3.7); (p=0.04)]. Similarly, patients with uterine cancer and high FT had longer median time from symptoms onset to diagnosis [3.0 months (1.0–6.4)] than those with low FT [1.8 months (0.9–3.8); p=0.03]. In patients with ovarian cancer, time from symptom onset to diagnosis was not significantly different based on financial toxicity (p&gt;0.05). Conclusions: Patients with uterine and cervical cancer who reported high FT had a longer time to diagnosis compared to patients with low FT. Delays in accessing care, initial evaluation and treatment may contribute to worse cancer outcomes and survival for patients with FT as reported in other studies. More work is needed to understand what financial and social factors lead to the longer time to diagnosis in patients with uterine and cervical cancer.

ObjectiveUsing the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) among differentiated thyroid cancer (DTC) patients in China and investigate the association between FT and psychological distress.MethodsWe carried out a cross-sectional investigation of individuals who had survived DTC in two tertiary medical facilities. The assessment of FT was performed using the Chinese version of the COST tool. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) was used to measure psychological distress. A multivariate logistic regression model was constructed to identify factors related to FT, and the Pearson correlation was used to evaluate the association between COST and DT scores.ResultsOut of the 207 patients who participated in this study, the average COST score was 16.3. Notably, the prevalence of financial toxicity was 47.8% (95% CI: 41% ~ 54.7%) of the patients. Of these, 22.7% (47/207) were mild FT, 23.7% (49/207) were moderate FT, and 1.4% (3/207) were severe FT. Four variables were found to be associated with increased FT in the logistic regression model, younger age (odd ratio [OR], 4.52; p = 0.003), lower educational level [OR], 1.13; p = 0.040, uninsured (odd ratio [OR], 6.53; p = 0.028), had lower household income (odd ratio [OR], 6.34; p = 0.037), and advanced cancer (odd ratio [OR], 2.99; p = 0.034). Furthermore, the Pearson correlation revealed a mild correlation between financial toxicity and psychological distress (r = −0.53, p &amp;lt; 0.001).ConclusionIn this study, the prevalence of FT in DTC patients was 47.8%. FT was associated with younger age, lower educational level, uninsured, had lower household income, and advanced cancer. Clinicians should identify patients by predictors early and conduct psychological interventions.

ObjectiveTo evaluate the risk of financial toxicity (FT) among inpatients undergoing gynecologic cancer resections and the association of insurance status with clinical and financial outcomes. MethodsUsing the 2008–2019 National Inpatient Sample, we identified adult hospitalizations for hysterectomy or oophorectomy with a diagnosis of cancer. Hospitalization costs, length of stay (LOS), mortality, and complications were assessed by insurance status. Risk of FT was defined as health expenditure exceeding 40% of post-subsistence income. Multivariable regressions were used to analyze costs and factors associated with FT risk. ResultsOf 462,529 patients, 49.4% had government-funded insurance, 44.3% private, and 3.2% were uninsured. Compared to insured, uninsured patients were more commonly Black and Hispanic, admitted emergently, and underwent open operations. Uninsured patients experienced similar mortality but greater rates of complications, LOS, and costs. Overall, ovarian cancer resections had the highest median costs of $17,258 (interquartile range: 12,187–25,491) compared to cervical and uterine. Approximately 52.8% of uninsured and 15.4% of insured patients were at risk of FT. As costs increased across both cohorts over the 12-year study period, the disparity in FT risk by payer status broadened. After risk adjustment, perioperative complications were associated with nearly 2-fold increased risk of FT among uninsured (adjusted odds ratio 1.75, 95% confidence interval 1.46–2.09, p < 0.001). Among the insured, Black and Hispanic race, public insurance, and open operative approach exhibited greater odds of FT. ConclusionPatients undergoing gynecologic cancer operations are at substantial risk of FT, particularly those uninsured. Targeted cost-mitigation strategies are warranted to minimize financial burden.

The significant financial costs associated with solid-organ and bone marrow transplantation incurred by the United States' (U.S.) health systems are well documented. However, the out-of-pocket (OOP) costs and the risk of financial toxicity - defined as economic stress from OOP expenses relative to available resources - for transplant recipients remain poorly characterized. We assessed annual OOP medical expenses for transplant recipients using the Medical Expenditure Panel Survey (MEPS) from 2016 to 2020 (n = 201 patients representing N = 466,016) and calculated yearly medical care expenses and insurance premiums. Logistic regressions were performed to analyze risk factors for financial toxicity, using income category and insurance status as indicators of socioeconomic status. The mean annual OOP expense was $4034 (SE 508), with insurance premiums and medications being the most significant costs. Among transplant recipients, 12% (SE 3) experienced high financial toxicity. Low-income patients, compared to high-income patients, were nine times more likely to experience financial toxicity (OR 9.3, p = 0.001), with privately insured low-income patients at the highest risk (OR 7.4, p <0.001). Financial toxicity was associated with delayed medication refills due to costs (12% vs 3%, p < 0.05), poorer perceived health status (27% vs 9%, p = 0.05), and increased anxiety (47% vs 20%, p < 0.05). Low-income transplant recipients with private insurance are particularly vulnerable to financial toxicity. Future research should examine the health effects of financial toxicity to enable development of health system and policy interventions aimed at mitigating financial toxicity in this population.

29 Background: Financial toxicity (FT) refers to the financial strain and distress experienced by patients due to the costs associated with cancer care. Patients with pancreatic ductal adenocarcinoma (PDA) experience unique challenges including limited treatment options, aggressive disease progression, complex multidisciplinary care needs and an overall limited prognosis. The aim of this preliminary analysis was to measure FT in patients newly diagnosed with PDA and determine factors associated FT. Methods: In this prospective cohort study, patients with newly diagnosed PDA prior to treatment initiation were enrolled through a pancreatic multi-disciplinary clinic at a single institution. The Comprehensive Score for Financial Toxicity (COST), a validated instrument for measuring FT, was used to measure participant’s baseline FT upon initial clinic visit and at two-month intervals via online survey. Mean baseline COST scores were compared using a two-sided t test for binary variables and an ANOVA test for categorical variables with &gt;2 categories. Demographic information including age, race, educational experience, income and insurance status was also collected by questionnaire. Results: Between July 2021 and March 2023, 63 patients were enrolled of which 45 participants completed the baseline surveys (71% response rate). Patients with higher stage disease experienced higher baseline financial toxicity, with mean COST score 38.0 for resectable disease, 26.9 for borderline resectable disease, 22.1 for unresectable disease and 17.5 for metastatic disease (p = 0.03). Participants enrolled in Medicaid experienced the highest FT (mean COST 16.0), while those enrolled in Medicare reported the lowest FT (mean COST 31.8). Participants having private insurance fell in-between with a mean COST score 22.1. Baseline FT also varied inversely with household income with participants with annual household incomes &lt;$50,000 experiencing the most FT (mean COST = 12.7) and participants with annual household incomes &gt;$200,000 experiencing the least FT (mean COST = 34.6). Conclusions: Patients with more advanced pancreatic cancer not only face a worse prognosis but also experience heightened financial strain even before initiation of therapy, emphasizing the early vulnerability of these individuals both medically and financially. Future analyses will measure FT longitudinally after treatment initiation and measure the association between FT, response to therapy and mortality. [Table: see text]

To describe financial toxicity (FT) in patients with resected lung cancer and identify risk factors in this population. FT describes the financial burden associated with cancer care and its impact on the quality of survivorship. Few prior studies have examined FT in patients with lung cancer. Patients who underwent lung cancer resection at our institution between January 1, 2016 and December 31, 2021, were surveyed to gather demographic information and evaluate FT using a validated questionnaire. A multivariable model was built to identify risk factors for FT. Of the total, 1477 patients were contacted, of whom 463 responded (31.3%). Most patients were stage I (n = 349, 75.4%) and lobectomy was performed often (n = 290, 62.8%). There were 196 patients (42.3%) who experienced FT. Upon multivariable analyses, divorced marital status [odds ratio (OR) = 3.658, 95% CI: 1.180-11.337], household income <$40,000 (OR = 2.544, 95% CI: 1.003-6.455), credit score below 739 (OR = 2.744, 95% CI: 1.326-5.679), clinical stage >I (OR = 2.053, 95% CI: 1.088-3.877), and change in work hours or work cessation (all P < 0.05) were associated with FT. Coping mechanisms, such as decreased spending on food or clothing and increased use of savings or borrowing money, were more likely to be reported by patients experiencing FT than those who did not ( P < 0.001). Patients undergoing lung cancer resection often experienced significant financial stress with several identifiable risk factors. FT should be considered early in the care of these patients to alleviate detrimental coping mechanisms and enhance their quality of survivorship.

There has been mounting interest in understanding the impact of financial toxicity (FT) in various cancer types; however, it remains poorly understood and understudied within neuro-oncology-especially as it relates to neurosurgical components of patient care. Retrospective, single-center study of patients who underwent craniotomy for resection of glioblastoma from 2020 to 2022. OIBEE™ (Austin, Texas) software was queried to identify the subset of these patients who had a bad debt charged to their account. These patients were deemed to qualify as experiencing FT. Chi Square analysis was conducted between FT and non-FT patient groups. Additionally, survival analyses were performed to determine predictors of progression free and overall survival. 74 patients were included in this sample. 33/74 (44%) met criteria for FT. The average bad debt amount was $7,476.76 and the median debt amount was $2,015.96, with the average time to financial toxicity after surgery being approximately 127 days. FT patients were significantly younger at diagnosis than those who were not FT (64.6 years- non-FT vs. 59.0 years- FT, p = 0.0344). FT patients were more likely to have undergone subtotal resections rather than a gross total resection compared to non-FT patients (FT GTR 27.3%, non-FT GTR 52.4%, p = 0.028). Hospital length of stay was significantly longer for FT patients compared to non-FT patients (LOS FT 9.5 days, non-FT 6.5 days, p = 0.0312). Glioblastoma patients are at high risk of experiencing FT with our series showing no significant impact on overall survival. Larger studies are needed to understand the impact of FT on patient outcomes.

Financial toxicity in oncology, defined as the economic burden and psychosocial distress of cancer care, has been associated with poor clinical outcomes. Despite high projected treatment costs, data on financial toxicity in patients with sarcoma remain limited. This study aimed to characterize financial toxicity in survivors of sarcoma and to better inform screening practices for patients with rare cancers requiring complex, multidisciplinary treatment plans. This retrospective cohort study surveyed patients with a diagnosis of trunk or extremity sarcomas between 2016 and 2024 (i.e., survivors of sarcoma). Patients were administered the COmprehensive Score for Financial Toxicity (COST) instrument, which has been validated with cancer patients. Scores ranged from 0 to 44. Financial toxicity was categorized into moderate-to-severe (score <26) and low-to-none (score ≥26) groups. Demographic and clinical variables were obtained from electronic medical records. Univariate logistic regression analyses were used to explore variables associated with financial toxicity. Among 205 participants, 77 % reported moderate-to-severe financial toxicity. The odds of financial toxicity were similar across insurance types, race, ethnicity, employment status, income, and geography. Patients were less likely to report financial toxicity if they had soft tissue sarcomas (compared with bone sarcomas; odds ratio, 0.43; 95% confidence interval, 0.18-0.98). Financial toxicity is highly prevalent among survivors of sarcoma. The widespread nature of this financial distress across different patient groups suggests that no specific population is disproportionately affected, underscoring the universal risk of financial toxicity. These findings support exploring universal financial toxicity screening for patients with sarcoma to facilitate timely interventions.

e18362 Background: Financial toxicity (FT) is a major cause of distress for cancer patients. We have previously reported that FT was high among patients at a county hospital and a tertiary academic center. In this study, we sought to compare factors associated with FT at these institutions. Methods: Patients with clinic visits were asked to fill out an 11-item validated FT survey, the COST tool, and demographic questions from 10/2017 - 2/2018 at the county hospital and 7/2015 - 10/2018 at the academic center. We used a logistic regression model to analyze demographic factors associated with FT. Results: Mean COST score was significantly higher at the county hospital (28.7) compared to the academic center (20.4) (p &lt; 0.001). Distribution of cancer stage was similar between the institutions. Patients at the county hospital were more likely to have an annual household income (AHI) &lt; $25K (p &lt; 0.001), and be insured by Medi-cal (p &lt; 0.001). Patients at the academic center were more likely to be White (p &lt; 0.001). Monthly OOP spending was more likely to be &gt; $500 at the academic center (p &lt; 0.001). Conclusions: Overall, FT was higher at the county hospital as compared to the academic center. FT at both institutions was associated with higher OOP spending and lower AHI. However, variations in FT among other demographic factors may reflect differences in care delivery systems and patient populations. Our study demonstrates that demographic groups at risk for FT differs between institutions suggesting the factors that contribute financial toxicity are complex and variable. Thus local assessments of FT may be necessary for individual health systems to develop targeted interventions to improve FT among their patients.[Table: see text]

OBJECTIVES/GOALS: Financial toxicity describes the adverse effects of medical expenses on financial security and health related quality of life. Though dementia caregiving carries serious costs, financial toxicity has not been studied in this context. Here we assess the prevalence of financial toxicity in dementia caregiving and its sociodemographic correlates. METHODS/STUDY POPULATION: We utilized the COmprehensive Score for financial Toxicity (COST)— 12-item questionnaire validated to quantify financial toxicity in patients and their caregivers— to conduct a nationally representative survey of 317 US dementia caregivers, oversampling non-Hispanic Black (n = 75) and Hispanic (n = 61) caregivers. Participants were required to be currently providing unpaid care to someone 50 years or older with dementia. Financial toxicity was defined as COST 0 & RESULTS/ANTICIPATED RESULTS: COST scores ranged between 0 and 44, with a survey-weighted mean of 24.57 and standard deviation of 9.8. Weighted analysis revealed 52.7% of American dementia caregivers experience some degree of financial toxicity. Of those who experience financial toxicity, 73.1% are classified as mild, 25.7% as moderate, and 1.2% as severe. Financial toxicity was identified in 69.5% of non-Hispanic Black, 54.1% of Hispanic, and 42.3% of non-Hispanic White caregivers, with non-Hispanic Black caregivers significantly more likely to experience financial toxicity compared to their non-Hispanic White counterparts (p = 0.017). DISCUSSION/SIGNIFICANCE: Most US dementia caregivers experience financial toxicity, though prevalence varies significantly by caregiver race. Discerning the pervasiveness of financial toxicity in this population and significant correlates will inform the development and expedient delivery of resources for patients and families.

Financial Toxicity (FT) in Patients (pts) with Breast Cancer (BC) Receiving Radiation Therapy (RT): A Prospective Observational Study