Financial toxicity screening: Who do we miss?

64 Background: Financial toxicity (FT) is associated with delayed care, reduced quality of life, and poor outcomes. FT screening is recommended to mitigate risk and facilitate resource referral; however, evaluation metrics are limited, and non-response may limit ability to identify and help those at high risk. This analysis examined clinical and demographic associations with completion of FT screening. Methods: Screening occurred at an urban comprehensive cancer center as standard of care. A survey was sent via patient portal before a treatment visit in breast, gynecologic, gastrointestinal (GI), and thoracic clinics. An iPad was offered at check-in for those who did not screen in advance or did not have portal access; interpreter services were available upon request. The screening included a 12-item FT assessment and an essential needs checklist, and it was intended to be repeated every 4 months. Multivariable logistic regression (MVA) assessed demographic and clinical associations with completing ≥1 screen. Data were collected from 3/2023-12/2024. Results: Of 83,978 unique patients, 50,949 completed ≥1 survey (61% response rate). Screening completion was lower at the extremes of age (emerging adults, those 80+); patients with breast cancer or earlier stage disease; and those who identified as Black or had a non-English primary language. See Table for results. Conclusions: FT screening was operationally feasible, but groups known to be at higher risk for FT —including Black and non-English speaking patients— were less likely to complete screening than their counterparts. Screening optimization, including targeted follow up, may be necessary to avoid unintentionally widening gaps in support; workflows have since been adapted to increase screening uptake. MVA Completed ≥1 screenn=50,949 (%) Did not respond n=33,029 (%) Odds Ratio 95% Confidence Interval p-value Age <0.001 18-25 298 (0.6) 284 (0.9) 26-39 3,328 (7) 2,164 (7) 1.47 1.10, 1.95 40-64 25,010 (49) 15,335 (46) 1.48 1.12, 1.94 65-79 18,871 (37) 11,671 (35) 1.38 1.05, 1.82 80+ 3,442 (7) 3,575 (11) 0.79 0.60, 1.04 Gender 0.6 Female 37,591 (74) 26,090 (79) Male 13,358 (26) 6,939 (21) 1.01 0.96, 1.07 Primary Language <0.001 Non-English 2,067 (4) 3,334 (10) English 48,882 (96) 29,695 (90) 2.53 2.33, 2.74 Race <0.001 White 38,856 (82) 23,503 (80) Black 3,561 (8) 2,888 (10) 0.78 0.73, 0.83 Asian 4,801 (10) 3,053 (10) 1.06 1.00, 1.13 Other 87 (0.2) 76 (0.3) 1.06 0.69, 1.65 Ethnicity 0.3 Hispanic 3,791 (8) 3,553 (12) Not Hispanic 44,055 (92) 27,229 (88) 1.04 0.97, 1.13 Service <0.001 Breast 17,275 (34) 13,958 (42) GI 18,487 (36) 9,673 (29) 1.37 1.30, 1.44 Gynecology 7,304 (14) 4,898 (15) 1.18 1.11, 1.24 Thoracic 7,147 (14) 4,071 (12) 1.30 1.22, 1.38 Other 736 (1) 429 (1) 1.09 0.95, 1.26 Stage <0.001 0-1 18,152 (46) 12,314 (52) 2 7,093 (18) 4,145 (18) 1.14 1.08, 1.19 3 6,938 (17) 3,342 (14) 1.26 1.20, 1.33 4 7,498 (19) 3,745 (16) 1.18 1.12, 1.24 Any Chemo, Radiation, or Surgery in past 4 months 16,539 (32) 9,270 (28) 1.18 1.13, 1.22 <0.001