Technology Unlocks Untapped Potential in a Financial Navigation Program

345 Background: Rural and non-English speaking populations experience a disproportionate burden of financial toxicity and access to services for their cancer care. Lessening the Impact of Financial Toxicity (LIFT) is an intervention designed to address financial toxicity (FT) through financial navigation (FN). FN identifies patients at risk for FT, assesses eligibility for financial support, clarifies costs, and develops strategies to cope with costs. LIFT was successful in reducing financial toxicity in preliminary studies among English-speaking patients with high levels of FT in a single large academic cancer center. To benefit diverse patients with FT in cancer programs across the US, there is a need to adapt LIFT. Adapting LIFT requires distinguishing between its core functions— the components of LIFT key to its effectiveness and implementation, and its forms— the activities that comprise LIFT, facilitate its implementation, and may be adapted to accommodate new populations and contexts. We completed the first stage of adaptation, identifying LIFT core functions. Methods: We conducted interviews with individuals responsible for LIFT’s design and implementation. Interview questions were based on Kirk’s methods for identifying core functions and were recorded and transcribed verbatim. Using a codebook based on the Model for Adaptation Design and Impact, we coded interview transcripts and identified themes related to how LIFT engaged cancer program staff in FN (implementation core functions) and decreased FT (intervention core functions). Results: Eight interview participants filled various roles in designing and implementing LIFT (e.g., P.I.s; FNs). LIFT intervention core functions include a systematic way of cataloging knowledge, resources, and tracking patient information; using patient-specific needs to guide access to resources; ongoing, dynamic assistance and strong one-on-one relationships between navigators and patients; and removing common barriers to accessing resources. Conclusions: We identified core functions key to LIFT’s effectiveness and implementation. Next steps include identifying systematic differences between LIFT’s original context and population and new ones. Successfully adapting LIFT has the potential to extend its benefits to diverse patients in cancer programs throughout the US, such as Spanish-speaking patients served by rural community cancer programs.

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.

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

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.

174 Background: Few studies have reported on interventions to alleviate financial toxicity (FT) in cancer patients (pts) and informal caregivers (cgs). We developed a financial navigation program in collaboration with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach Foundation (FRF), to offer financial coaching, insurance navigation, and assistance with unpaid non-medical bills. We conducted a pilot study to assess feasibility of enrolling cgs with pts and to describe the assistance provided. Methods: Pts with any stage solid tumor actively receiving treatment (tx) at the Seattle Cancer Care Alliance were asked to identify a cg who could participate. Pts or pt/cg dyads received an online financial education course and monthly contact for 6 months (mo) with CENTS and PAF. Subjects were referred to FRF for assistance in paying non-medical bills. We describe pt and cg characteristics, and assistance provided by the program. Results: Of 54 pts approached, 30 (median age 59.5, 61% white, 97% stage III/IV disease) were consented. Most pts (53%) had income ≤ $25,000, and all were insured (48% commercial, 28% Medicare, 21% Medicaid). 18 cgs (67% spouse/partner) were consented. At consent, 55% of pts reported debt in the prior 3 mo. Mean score using the COST PRO FT measure (range 0-44, lower score = higher FT) was 17.4 at baseline. After pts’ physical health, out-of-pocket costs were the most stressful aspects of tx for cgs. Cgs with high financial burden from caregiving more often reported taking on new debt, dipping into retirement accounts, or changing their jobs or hours. CENTS coaches assisted with budgeting, updating wills, and employment rights counsel. PAF case managers assisted with financial assistance for drugs, cost of living (e.g. transportation), disability applications, and secured $6,950 in debt relief. FRF dispersed $4,133, primarily for housing expenses. Conclusions: Implementing a financial navigation program that engages both pts and cgs is feasible. This lower income, financially stressed population received $11,000 in financial assistance. Future work will focus on evaluating the impact of this program on financial and psychosocial outcomes in pts and cgs.

TPS11187 Background: Financial toxicity is a critical issue in modern healthcare. The impact of financial toxicity is particularly pronounced in low- and middle-income countries (LMICs), where healthcare systems are underfunded, and out-of-pocket costs dominate medical payments. Financial navigation programs (FNPs) help patients manage costs through insurance, resources, and budget support. This study examines the challenges and opportunities of implementing FNPs in an LMIC, using data from the COST-FIN study, a randomized controlled trial investigating the impact of a structured FNP on cancer care in Nigeria. Methods: Adult patients (&gt;18 years) diagnosed with breast, prostate, or colon cancer within 6 weeks of presentation at Lakeshore Cancer Center or Obafemi Awolowo University in Nigeria were eligible for trial enrollment. Between July 15 and November 22, 2024, 52 patients were recruited, and 23 were randomized to the financial navigation arm of the study. Financial Navigators assessed each patient’s financial literacy and developed individualized financial plans. The extent of navigation required was categorized as high, moderate, low, or no assistance needed. Results: Among the 19 patients who completed financial literacy sessions, 17 received financial plans. Of these, 16 required financial navigation (extent of navigation: high, n = 8; moderate, n = 6; low, n = 2; no assistance needed, n = 1), and 15 were successfully directed to resources, including the National Health Insurance Scheme (100%), philanthropic organizations (26.7%), supports from other studies (53.3%), and drug discount programs-Nigerian Cancer Access Partnership, pharma companies and Medicaid PACE (100%). Low financial literacy was a significant barrier, with many patients lacking the knowledge to make informed decisions. Regulatory challenges, characterized by complex and inconsistent frameworks, and communication barriers also hindered FNP implementation. Navigators reported that addressing financial barriers reduced patients’ stress and improved their focus on treatment. Conclusion: Preliminary findings highlight the potential of structured FNPs to alleviate financial toxicity and improve treatment adherence among cancer patients in Nigeria. Implementing comprehensive FNPs is crucial to address low financial literacy and help patients navigate healthcare costs. Collaborating with government policymakers to improve healthcare affordability and accessibility is also essential.

165 Background: The National Cancer Institute (NCI) has identified rural cancer control as a research priority. Rural patients may have greater cancer-related financial burdens due to high travel costs, low insurance coverage, and less flexible work schedules. To better understand geographic differences in cancer-related financial toxicity from an organizational perspective, we interviewed staff from a range of cancer treatment settings in counties across the rural-urban continuum. The goal was to qualitatively assess the financial resources available to cancer patients, particularly those residing in rural areas. Methods: Seven research teams within the Cancer Prevention and Research Control Network interviewed personnel providing financial navigation services across four types of cancer care facilities and three urban/rural classifications. Interviews were audio-recorded and transcribed. We identified themes using inductive content analysis. A total of 28 interviews were collected across 7 states and preliminary results have been generated from 20 interviews. Results: Study participants identified transportation and housing costs as primary financial stressors for rural patients. A few personnel from centers in urban counties did not observe clear differences in experiences of financial toxicity between rural and urban patients. No personnel mentioned resources that are long-term or specifically for rural patients. Gas cards and temporary housing are often provided to help rural and urban patients access treatment. Insufficient staffing is a barrier to addressing patients’ financial concerns in rural and urban centers. Urban institutions, particularly NCI-designated facilities, employ more cancer-specific financial navigators than rural institutions. Conclusions: Patients across the rural-urban continuum experience financial hardship, but rural patients may be disproportionately affected by transportation and housing costs. Improving transportation and housing support may improve their ability to access treatment. Financial navigation practices within states vary; thus, patients and cancer centers may benefit from more streamlined approaches to address financial needs for all cancer patients.

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

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the preferred treatment for select patients with peritoneal malignancies. However, the procedure is resource intensive and costly. This study aimed to determine the risk of financial toxicity for patients undergoing CRS-HIPEC. We performed a retrospective cohort study of patients undergoing CRS-HIPEC at a single institution from 2016 to 2022. We utilized insurance status, out-of-pocket expenditures, and estimated post-subsistence income to determine risk of financial toxicity. A multivariable logistic regression was used to determine risk factors for financial toxicity. Our final study cohort consisted of 163 patients. Average age was 58 [standard deviation 10] years, and 52.8% (n = 86) were male. A total of 52 patients (31.9%) were at risk of financial toxicity. A total of 36 patients (22.1%) were from the lower income quartiles (first or second) and 127 patients (77.9%) were from the higher income quartiles (third or fourth). A total of 47 patients (29%) were insured by Medicare, and 116 patients (71%) had private insurance. The median out-of-pocket expenditure across the study cohort was $3500, with a median of $5000 ($3341-$7350) for the at-risk group and $3341 ($2500-$4022) for the not at-risk group (p < 0.001). Risk factors for financial toxicity included high out-of-pocket expenditures and a lower income quartile. An estimated one-third of patients undergoing CRS-HIPEC at our institution were at risk for financial toxicity. Several preoperative factors were associated with an increased risk and could be utilized to identify patients who might benefit from 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]

Current financial toxicity (FT) screening tools rely on patient-reported risk factors. Underrepresented populations may not be forthcoming about FT fears due to cultural concerns of treatment withholding or migratory repercussions, if applicable. Identifying objective risk factors, such as social determinants of health (SDOH) and disease-specific factors (DSF), could reduce FT in patients with cancer and throughout health care systems. This was a multicenter retrospective study evaluating SDOH and DSF associated with FT (defined as ≥ $15,000 owed) related to cancer treatment. Inferential statistics were used to evaluate differences between the FT cohort and those who owed less than $15,000. Continuous data were compared with a Student t test or Mann-Whitney test, depending on distribution. Categorical outcomes were compared with a χ² test. A logistic regression model was used to evaluate multivariate associations with FT, using a P value of less than .05 to define significant results. The sample comprised 162 records, 81 in each group. Univariate analyses demonstrated participants' differences in age, relationship with a primary care provider, country of origin, insurance status, education level, need for an English interpreter, whether their disease was stage IV at diagnosis, recurrent or metastatic disease, use of immune checkpoint inhibitors, and use of targeted molecular therapy. Employment status and marital status were not statistically different. The logistic regression model showed that lack of insurance and having stage IV disease at diagnosis were significantly associated with FT (P = .001 and P = .0495, respectively). Objective FT screening can minimize response bias and incidence in those at increased risk. In our study, we found that individuals who are first-generation Hispanic immigrants and lack English proficiency faced significant barriers to receiving help for the high financial costs of medical care. These findings identify specific subpopulations at risk for FT and will guide prospective interventions looking to minimize FT. Health care systems should analyze objective measures of FT while considering loco-regional and subcultural SDOH/DSF to overcome response bias.

290 Background: “Financial Toxicity” is the financial burden and stress imposed on a patient due to a disease and its associated treatment. About 50% of patients with gynecologic cancer experience financial toxicity. The aim of the study is to evaluate implementation of financial toxicity screening and a novel financial navigation program for patients with gynecologic oncology. Methods: Patients presenting for initial consultation with a gynecologic oncology provider from July 2022 to January 2023 were included. A new financial navigation program began in July 2022. On October 17, 2022, a financial toxicity screening question was added to new patient intake forms. We quantified patient referrals to the navigator before and after screening implementation, along with needs identified, action taken by the navigator and institutional support services utilized. Results: We included 458 new patients, 49% before and 51% after introduction of screening. The majority were white (61%) and had private insurance (59%) followed by Medicare (31%); median age was 59 (IQR 47-69). Following screening, a higher proportion of patients were referred to the financial navigator (15%) than before screening (4%, p&lt;0.001). Additionally, referrals to other hospital social support services decreased from 9% before screening to 3% after (p&lt;0.001). Uterine and cervical cancers were more prevalent in the 29 patients (12%) who screened positive (31% and 14% respectively) compared to those who screened negative (17% and 1%) or did not respond (24% and 4%). Referrals to the navigator included 59% of those who screened positive, 8% who screened negative and 10% who did not respond. Over six months, 62 patients (new and follow-up) were referred to the navigator. The most common need was transportation (21%) followed by financial assistance (16%) and emotional support (16%). The navigator assisted 11% of patients with transportation and referred 13% to financial counseling/billing and 27% to other resources. Conclusions: Implementing a financial toxicity screening question on intake forms was feasible, and increased identification of patients with financial toxicity and referrals to our financial navigator. Further investigation is needed to understand screening barriers and evaluate the program.

ObjectivesWe aimed to investigate the association between financial toxicity (FT) and the health-related quality of life profile of long-term survivors of acute promyelocytic leukaemia (APL) treated within a universal healthcare...

11099 Background: Financial Toxicity (FT), negative economic impacts resulting from cancer or cancer treatment, can adversely affect quality of life, treatment adherence, and clinical outcomes. Patient experience of care (EoC) captures information from patient’s perspectives on interactions with healthcare providers and systems and receipt of medical care services. While EoC is used to evaluate health care system and provider quality, the impacts of EoC on FT are unknown. Methods: To examine associations of EoC and FT, we used data from the from the 2016-2017 Experience of Cancer Survivorship Supplement of the Medical Expenditure Panel Survey (MEPS), the most recent years available of this national U.S. household survey. EoC was assessed using patient-reported frequencies (rated “never/sometimes”, “usually”, or “always”) of their health professionals explaining things in a way that was easy to understand; listening carefully; showing respect; and spending enough time with the patient in the past 12 months. FT was based on 9 MEPS items and classified as material FT (borrowing money, making financial sacrifices due to cancer), psychologic FT (worry about paying medical bills or financial stability), and behavioral FT (delaying/forgoing cancer care due to costs). Analyses were performed using multivariable logistic regressions controlling for patient sociodemographic and clinical characteristics and weighted to produce nationally representative estimates and address survey non-response. Results: Data included 1068 individuals diagnosed with cancer at age 18 or older; 30% reported material FT, 35% psychologic FT, and 27% behavioral FT. Examining EoC, 64% of respondents indicated their health professionals always explained things; 60% that they always listened; 66% that they always showed respect; and 57% that they always spent enough time with the patient. In multivariable regressions, the odds of psychologic FT were significantly (p&lt;0.05) lower among patients reporting their health professionals always (vs. never/sometimes) listened (odds ratio [OR] 0.37, 95% CI 0.19-0.70), showed respect (OR 0.36, 95% CI 0.16-0.81), and spent enough time with the patient (OR 0.47, 95% CI 0.26-0.86). Significant associations with EoC were also found with individual psychologic FT questions from the MEPS on worry about paying bills, financial stability, and keeping job/income. Conclusions: Worry/anxiety regarding costs can be a major factor affecting individuals with cancer. Improving patient-provider interactions to enhance patient EoC may help reduce this aspect of FT.

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.