Baseline practice-level financial screening processes and resources among Children’s Oncology Group National Cancer Institute Community Oncology Research Programs (NCORP).

34 Background: Financial toxicity is an increasingly recognized and prevalent adverse effect during cancer treatment. Systematic financial screening is recommended for families of children with cancer, and emerging data support the importance of system-level support and interventions to mitigate financial toxicity. Financial distress is a key, measurable domain of financial toxicity. Methods: To inform interventions for pediatric oncology settings, we are conducting ACCL20N1CD, a Children’s Oncology Group (COG) prospective, multilevel observational study among NCORP practices in the US, to determine the risk and trajectory for financial distress in guardians of children with newly diagnosed acute lymphoblastic leukemia. We analyzed baseline survey data from COG NCORP practices that enrolled at least one parent. Data were collected via REDCap following the practice’s first parent enrollment. We describe practice participation patterns, current approaches to financial screening, and available resources to address identified needs including navigation. Results: Of 50 eligible COG NCORP practices, 40 (80%) activated the study, and 28 (56%) enrolled at least 1 participant and thus, completed the survey. Most (61%) of these practices treated 50-99 new pediatric oncology patients annually; 10 (36%) enrolled at least 5 participants in ACCL20N1CD. Twenty (71%) reported that their practice routinely conducted financial screening in addition to insurance assessment; 15 (75%) of these 20 practices conducted financial screening at more than one timepoint. Social workers were primarily responsible for screening (16/20; 80%). Only three practices (3/28; 11%) used a standardized financial screening tool. Most practices had access to a private foundation/organization (25/28, 89%), institutional support (23/28, 82%), or local referrals to organizations (22/28, 78%) that provided financial support for patients/families. Fewer practices had patient navigators (9/28, 32%), financial navigators (8/28, 28%), or legal advocates (3/28, 11%) available to assist families. Conclusions: Though most COG practices treating children of parents enrolled in 20N1CD conduct financial screening, processes are not standardized, and resources available to address identified needs and potentially mitigate financial toxicity vary. Further, these data represent enrolling sites which may overestimate screening practices within COG NCORP practices. Variations in financial screening procedures and lack of individual-level resources to facilitate screening may impact delivery of equitable high-quality cancer care across NCORP COG practices. Clinical trial information: NCT04928599 .