8 Background: The financial cost of cancer is a large burden and continues to rise substantially. Expenditures can be divided into the initial phase after diagnosis, the continuing phase, and the last year of life. Typically costs are greatest in the initial phase and last year of life. The major determinant of cost during the initial phase is hospitalizations. We sought to examine cancer costs of patients with newly diagnosed malignancies at an academic institution during the initial phase and compare outcomes based on insurance status. Our institution serves a significant portion of South Texas, a population facing serious cancer health disparities. Methods: This was a prospective, non-randomized study evaluating patients with new cancer diagnoses from 2014-2016 at an academic hospital. Patients meeting eligibility criteria were screened and consented for participation. A total of 74 patients were included in analysis. Results: The average age was similar in both the self-pay group and the insurance group (including government-sponsored, private, and county funding); 51.1 vs 54.8 years respectively (p = 0.09). Ethnicity between the two groups was not significantly different, 46.2% were Hispanic in the self-pay group vs 45.8% in the insurance group (p = 0.94). The majority of patients in both groups presented with advanced disease, 61.5% in the self-pay group vs 70.8% in the insurance group (p = 0.44). The average number of days of hospitalization was significantly higher in the insurance group compared to the self-pay group, 15.4 days vs 10.6 (p = 0.04). Congruently, average total cost of hospitalization was higher in the insurance group, $96,200 vs $64,200 (p = 0.05). 26.9% of patients in the self-pay group enrolled in hospice within 6 months of their diagnosis vs 20.8% in the insurance group (p = 0.26). Conclusions: With the limitation of a small sample size, our study demonstrates a statistically significant difference in hospitalization days and cost in insured vs uninsured patients with new cancer diagnoses at an academic hospital.