Patient-reported benefit from proposed interventions to reduce financial hardship during cancer treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7080-7080
Author(s):  
Emeline Aviki ◽  
Fumiko Chino ◽  
Julia Ramirez ◽  
Victoria Susana Blinder ◽  
Jennifer Jean Mueller ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Financial Burden ◽  
Gynecologic Cancer ◽  
Financial Hardship ◽  
Care Providers ◽  
Financial Toxicity ◽  
The Past ◽  
Patient Reported ◽  
The Impact

7080 Background: Awareness of cancer patients’ financial toxicity (FT) has increased substantially over the past decade; however, interventions to minimize financial burden remain underdeveloped and understudied. This survey-based study explores patient beliefs on which potential mitigating strategies could improve their financial hardship during cancer treatment. Methods: Interviewer-administered surveys were conducted with consecutive patients in an outpatient, urban, private academic Gynecologic Cancer clinic waiting room for 2 weeks in August 2019. The survey items included patient demographics, disease characteristics, the Comprehensive Score for Financial Toxicity (COST) tool (validated measure of FT with score 0-44; lower scores indicate worse FT), assessment of cost-coping strategies, and patient-reported anticipated benefit from described potential interventions (items that were feasible and relevant to implement in clinic). Results: Of 101 patients who initiated the survey, 87 (86%) completed it and were included in this analysis. The median age was 66 (range, 32-87). Thirty-eight patients (44%) had ovarian, 29 (33%) uterine, 5 (6%) cervical, and 15 (17%) an “other” gynecologic cancer. The median COST score was 32 (range, 6-44). Twenty-nine patients (33%) had COST scores ≤25 and 16 (18%) had COST scores ≤18. The most frequent cost-coping strategy reported was reducing leisure activities (n = 36, 41%) and using savings to pay for medical bills (n = 34, 39%). Six patients (7%) reported not taking a prescribed medication in the past 12 months due to the inability to pay and 0 reported skipping a recommended imaging study. When it came to interventions patients anticipated would improve their current financial hardships, 34 (39%) indicated access to transportation assistance to and from appointments, 31 (36%) said “knowing up front how much I’m going to have to pay for my healthcare”, 29 (33%) indicated “minimizing wait time associated with appointments, which keeps me away from work”, and 22 (25%) indicated “access to free food during/around appointments and treatments”. Only 26 (30%) noted they were not experiencing financial hardship. Conclusions: For an outpatient population of gynecologic cancer patients, several focused, feasible interventions could be implemented to potentially decrease patient FT. Our study can help health care providers in the design of interventions to create meaningful improvements in patient financial burden. Next steps should assess the impact of targeted interventions on patient outcomes.

The impact of race, education, and employment status on cost-coping strategies and patient reported benefit from interventions to mitigate financial toxicity.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 91-91
Author(s):  
Kenya Braxton ◽  
Bridgette Thom ◽  
Carol L. Brown ◽  
Francesca Gany ◽  
Fumiko Chino ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Gynecologic Cancer ◽  
Bachelor's Degree ◽  
Financial Toxicity ◽  
Waiting Room ◽  
Targeted Interventions ◽  
Patient Reported ◽  
The Cost ◽  
The Impact ◽  
Hispanic White

91 Background: As patient financial toxicity increases with the cost of cancer healthcare, patient outcomes and quality of life may be impaired. We sought to evaluate sociodemographic factors associated with use of cost-coping strategies, as well as strategies to mitigate financial toxicity. Methods: We conducted a survey of consecutive patients in an urban outpatient gynecologic cancer clinic waiting room over 2 weeks in August 2019. The survey included patient demographics, disease characteristics, the Comprehensive Score for Financial Toxicity (COST; scored 0-44, lower scores indicate worse outcomes), assessment of cost-coping strategies, and patient-reported anticipated benefit from possible interventions. Patients were categorized by race/ethnicity (non-Hispanic white, Hispanic white, black, Asian, other) and employment and education status. Kruskal-Wallis and Fisher’s exact tests were used to assess differences between groups. Results: Of 101 patients, 75 completed the survey. Most patients were non-Hispanic white (60%), retired (45%), and had at minimum a bachelor’s degree (65%). The median COST score was 32 (range 6-44). For cost-coping strategies, among renters (n=48), black and other race patients compared to white patients more often indicated skipping a rent payment (25% and 50% vs 0%; p<.01). Employed patients compared to retired patients more often indicated reducing leisure spending (58% vs 27%; p=.02). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated borrowing money to pay for medical bills (24% vs 6%; p=.04). For proposed interventions to lessen financial toxicity, non-Hispanic white and Asian patients compared to black patients more often indicated they wanted to know the cost of their healthcare upfront (38% and 33% vs 0%; p =.26). Employed patients compared to unemployed and retired patients more often indicated that minimizing copays would be beneficial (36% vs 13% and 12%, p=.05). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated that transportation assistance would be helpful (76% vs 24%; p<.01). Conclusions: As the needs of different sociodemographic groups vary, so do their cost-coping strategies and preferred interventions to ameliorate financial toxicity. Varying patient needs should be considered when developing interventions to mitigate financial toxicity. Next steps should assess the benefit of targeted interventions on coping strategies in specific sociodemographic groups.

scholarly journals Identifying missing links in the conceptualization of financial toxicity: a qualitative study

2021 ◽  
Author(s):  
Sara L. Lueckmann ◽  
Nadine Schumann ◽  
Christoph Kowalski ◽  
Matthias Richter
Keyword(s):  
Financial Distress ◽  
Financial Burden ◽  
Subjective Evaluation ◽  
Subjective Assessment ◽  
Patient Reported Outcome ◽  
Financial Toxicity ◽  
Perceived Burden ◽  
Conceptual Clarity ◽  
Patient Reported ◽  
The Impact

Abstract Purpose Financial toxicity can have a major impact on the quality of life of cancer survivors but lacks conceptual clarity and understanding of the interrelationships of the various aspects that constitute financial toxicity. This study aims to extract major drivers and mediators along the pathway from cancer-related costs to subjective financial distress from the patients’ experiences to establish a better understanding of financial toxicity as a patient-reported outcome. Methods Qualitative semistructured interviews with 39 cancer patients were conducted in Germany and addressed patient experiences with cancer-related financial burden and distress in a country with a statutory health care system. Transcripts were analyzed using content analysis. Results Several aspects of financial burden need to be considered to understand financial toxicity. The assessment of the ability to make ends meet now or in the future and the subjective evaluation of financial adjustments—namely, the burden of applied financial adjustments and the availability of financial adjustment options—mediate the connection between higher costs and subjective financial distress. Moreover, bureaucracy can influence financial distress through a feeling of helplessness during interactions with authorities because of high effort, non-traceable decisions, or one’s own lack of knowledge. Conclusion We identified four factors that mediate the impact of higher costs on financial distress that should be addressed in further studies and targeted by changes in policies and support measures. Financial toxicity is more complex than previously thought and should be conceptualized and understood more comprehensively in measurements, including the subjective assessment of available adjustment options and perceived burden of financial adjustments.

scholarly journals Development of Machine Learning Algorithms for the Prediction of Financial Toxicity in Localized Breast Cancer Following Surgical Treatment

2021 ◽  
pp. 338-347
Author(s):  
Chris Sidey-Gibbons ◽  
André Pfob ◽  
Malke Asaad ◽  
Stefanos Boukovalas ◽  
Yu-Li Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Cancer Treatment ◽  
Linear Model ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Support Vector ◽  
Financial Toxicity ◽  
Operating Characteristics ◽  
Patient Reported

PURPOSE Financial burden caused by cancer treatment is associated with material loss, distress, and poorer outcomes. Financial resources exist to support patients but identification of need is difficult. We sought to develop and test a tool to accurately predict an individual's risk of financial toxicity based on clinical, demographic, and patient-reported data prior to initiation of breast cancer treatment. PATIENTS AND METHODS We surveyed 611 patients undergoing breast cancer therapy at MD Anderson Cancer Center. We collected data using the validated COmprehensive Score for financial Toxicity (COST) patient-reported outcome measure alongside other financial indicators (credit score, income, and insurance status). We also collected clinical and perioperative data. We trained and tested an ensemble of machine learning (ML) algorithms (neural network, regularized linear model, support vector machines, and a classification tree) to predict financial toxicity. Data were randomly partitioned into training and test samples (2:1 ratio). Predictive performance was assessed using area-under-the-receiver-operating-characteristics-curve (AUROC), accuracy, sensitivity, and specificity. RESULTS In our test sample (N = 203), 48 of 203 women (23.6%) reported significant financial burden. The algorithm ensemble performed well to predict financial burden with an AUROC of 0.85, accuracy of 0.82, sensitivity of 0.85, and specificity of 0.81. Key clinical predictors of financial burden from the linear model were neoadjuvant therapy (βregularized, .11) and autologous, rather than implant-based, reconstruction (βregularized, .06). Notably, radiation and clinical tumor stage had no effect on financial burden. CONCLUSION ML models accurately predicted financial toxicity related to breast cancer treatment. These predictions may inform decision making and care planning to avoid financial distress during cancer treatment or enable targeted financial support. Further research is warranted to validate this tool and assess applicability for other types of cancer.

Machine learning algorithms to predict financial toxicity associated with breast cancer treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2047-2047 ◽  
Author(s):  
Chris Sidey-Gibbons ◽  
Malke Asaad ◽  
André Pfob ◽  
Stefanos Boukovalas ◽  
Yu-Li Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Decision Making ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Support Vector ◽  
Financial Toxicity ◽  
Operating Characteristics ◽  
Patient Reported

2047 Background: Financial burden caused by cancer treatment is associated with material loss, distress, and poorer outcomes. Financial resources exist to support patients but objective identification of individuals in need is difficult. Accurate predictions of an individual’s risk of financial toxicity prior to initiation of breast cancer treatment may facilitate informed clinical decision making, reduce financial burden, and improve patient outcomes. Methods: We retrospectively surveyed 611 patients who had undergone breast cancer therapy at MD Anderson Cancer Center to assess the financial impact of their care. All patients were over 18 and received either a lumpectomy or a mastectomy. We collected data using the FACT-COST patient-reported outcome measures alongside other financial indicators including income and insurance status. We extracted clinical and perioperative data from the electronic health record. Missing data were imputed using multiple imputation. We used this data to train and validate a neural network, LASSO-regularized linear model, and support vector machines. Data were randomly partitioned into training and validation samples (3:1 ratio). Analyses were informed by international PROBAST recommendations for developing multivariate predictors. We combined algorithms into a voting ensemble and assessed predictive performance using area under the receiver operating characteristics curve (AUROC), accuracy, sensitivity, and specificity. Results: In our validation sample, 48 of 203 (23.6%) women reported FACT-COST scores commensurate with significant financial burden. The algorithm predicted significant financial burden relating to cancer treatment with high accuracy (Accuracy = .83, AUROC = .82, sensitivity = .81, specificity = .82). Key clinical predictors of financial burden from linear models were neo-adjuvant therapy (βregularized 0.12) and autologous, rather than implant-based, reconstruction (βregularized 0.10). Conclusions: Machine learning models were able to accurately predict the occurrence of financial toxicity related to breast cancer treatment. These predictions may be used to inform decision making and care planning to avoid financial distress during cancer treatment or to enable targeted financial support for individuals. Further research is warranted to further improve this tool and assess applicability for other types of cancer.

Evaluating uptake and patient satisfaction with an out-of-pocket cost tracker for gynecologic cancer patients undergoing treatment.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 101-101
Author(s):  
Margaret Liang ◽  
Sarah S. Summerlin ◽  
Teresa KL Boitano ◽  
Christina T. Blanchard ◽  
Smita Bhatia ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Distress ◽  
Financial Burden ◽  
Tertiary Care ◽  
Gynecologic Cancer ◽  
Medical Costs ◽  
Cancer Center ◽  
Outpatient Services ◽  
Patient Reported ◽  
The Cost

101 Background: Tracking expenses may be useful to minimize financial distress in cancer patients. Our objective was to evaluate uptake and satisfaction with an out of pocket (OOP) cost tracker for gynecologic cancer patients on treatment. Methods: Within a longitudinal survey to assess financial burden among gynecologic cancer patients starting a new line of systemic therapy at a tertiary-care cancer center, we provided worksheets for participants to track their OOP expenses voluntarily. We assessed patient usage and satisfaction at 3 and 6 months. Financial distress was measured using Comprehensive Score for Financial Toxicity < 26. Results: Among 121 participants with an average age of 59 years, 34 (28%) were African-American and 33 (27%) had a high school diploma or less. Half (55/110, 50%) of participants reported annual income < $40,000. Most participants had health insurance (113/121, 93%) and were unemployed (77/118, 65%). Forty-nine of 121 (40%) participants reported ever using the OOP cost tracker at 3 or 6 months. Those who used the cost tracker stated it was helpful to track costs (86%, 73%), easy to use (97%, 100%), and useful for budgeting (42%, 24%) at 3 and 6 months. Participants reported using the cost tracker at least weekly (33%, 19%), every 2 weeks (36%, 27%), or monthly (31%, 54%) at 3 and 6 months. Twelve participants returned their OOP cost trackers for review with a median use of 5.5 months (range 3-10). Average monthly patient-reported OOP costs (range) were: $41 ($0-$584) for direct non-medical costs (i.e., transportation, lodging), $15 ($0-$120) for outpatient services, $13 ($0-$150) for medications/supplies, and $9 ($0-$100) for hospital services. Use of the OOP cost tracker at 3 months was not associated with financial distress at baseline (p = 0.30) or at 3 months (p = 0.89). Qualitative analysis showed the OOP cost tracker reminded patients to save receipts and to track categories of cost they would not have otherwise considered. Conclusions: 40% of gynecologic cancer patients undergoing treatment used an OOP cost tracker worksheet and found it helpful and easy to use. Direct non-medical costs accounted for the highest average monthly patient-reported OOP cost.

scholarly journals Development and validation of a patient-reported outcome tool to assess cancer-related financial toxicity in Italy: a protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031485 ◽  
Author(s):  
Silvia Riva ◽  
Jane Bryce ◽  
Francesco De Lorenzo ◽  
Laura Del Campo ◽  
Massimo Di Maio ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Burden ◽  
External Validation ◽  
Patient Reported Outcome ◽  
Health Coverage ◽  
Financial Toxicity ◽  
Internal Validation ◽  
Concept Elicitation ◽  
Research Guidelines ◽  
Patient Reported

IntroductionFinancial toxicity (FT) is a well-recognised problem in oncology. US-based studies have shown that: (a) cancer patients have a 2.7 times risk of bankruptcy; (b) patients who declare bankruptcy have a 79% greater hazard of death; (c) financial burden significantly impairs quality of life (QoL) and (d) reduces compliance and adherence to treatment prescriptions. The aim of the project is to develop and validate a patient-reported-outcome (PRO) measure to assess FT of cancer patients in Italy, where, despite the universal health coverage provided by the National Health Service, FT is an emerging issue.Methods and analysisOur hypothesis is that a specific FT measure, which considers the relevant sociocultural context and healthcare system, would allow us to understand the main determinants of cancer-related FT in Italy, in order to address and reduce these factors. According to the International Society for Pharmaco-economics and Outcomes Research guidelines on PROs, the project will include the following steps: (1) concept elicitation (from focus groups with patients and caregivers; literature; oncologists; nurses) and analysis, creating a coding library; (2) item generation (using a format that includes a question and a response on a 4-point Likert scale) and analysis through patients’ cognitive interviews of item importance within different coding categories to produce the draft instrument; (3) factor analysis and internal validation (with Cronbach’s alpha and test–retest for reliability) to produce the final instrument; (4) external validation with QoL anchors and depression scales. The use of the FT measure in prospective trials is also planned.Ethics and disseminationThe protocol is approved by the ethical committees of all the participating centres. The project will tentatively produce a validated tool by the spring 2021. The project might also represent a model and the basis for future cooperation with other European countries, with different healthcare systems and socioeconomic conditions.Trial registration numberNCT03473379.

scholarly journals Financial toxicity in cancer care: origins, impact, and solutions

2021 ◽  
Vol 11 (11) ◽  
pp. 2043-2054 ◽  
Author(s):  
Hannah R Abrams ◽  
Sienna Durbin ◽  
Cher X Huang ◽  
Shawn F Johnson ◽  
Rahul K Nayak ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Financial Burden ◽  
Indirect Costs ◽  
Future Research ◽  
Financial Toxicity ◽  
Patients With Cancer ◽  
The Past ◽  
Financial Burdens ◽  
The Impact

Abstract Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term “financial toxicity” has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.

Effect of 9–11 on U.S. national cancer clinical trials accrual and lack of effect of National Cancer Institute budget increases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6551-6551 ◽  
Author(s):  
A. Bleyer
Keyword(s):  
Clinical Trials ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
National Cancer Institute ◽  
Age Groups ◽  
Cooperative Groups ◽  
Treatment Trials ◽  
The Past ◽  
Beneficial Impact ◽  
The Impact

6551 Background: During the past decade, a variety of initiatives have been implemented to improve the accrual of cancer patients on clinical trials. In the U.S., these have included comprehensive reviews and recommendations by the two most recent National Cancer Institute (NCI) administrations, reorganization of the clinical trials infrastructure at the NCI, and campaigns by the NCI Cooperative Groups and their Coalition. During the past six years, additional funds were allocated to this effort as part of the doubling of the NCI budget. The impact of these efforts on national cancer treatment clinical trials was evaluated, with emphasis on age groups. Methods: Accrual data from NCI-sponsored treatment trials conducted between 1997 and 2006 were obtained from the NCI Cancer Therapy Evaluation Program. Entries were analyzed by patient age, gender, race, type of cancer treated, and calendar year of trial entry. Results: Overall, national cancer treatment trial entries declined after 9–11–2001 and in 2003 reached the lowest levels since 1997. As of 2005 accrual recovered to pre 9–11 levels only in 15–29 and >60 year-olds, with the former demonstrating the greatest gain ( Table ). Entries among <15 and 30–49 year- olds declined steadily since 1997 with no evidence for recovery as of 2005 ( Table ). Overall, the estimated proportion of the nation's cancer patients entered onto national treatment trials remains below 3%. Conclusions: Despite continued national and local efforts to increase the participation of cancer patients on clinical trials, accompanied by significant increases in the NIH and NCI budgets, there is little evidence of a beneficial impact. The effect of 9–11 has yet to be overcome, except in young and elderly adults, in whom specific, targeted initiatives appear to have been successful. The latter approaches may be useful to apply to other age groups, particularly in view of the recent cuts in the cooperative group budgets and current mandated decreases in study accruals. No significant financial relationships to disclose. [Table: see text]

Short and long term impact of financial toxicity on quality of life in the Carolina Breast Cancer study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18299-e18299 ◽  
Author(s):  
Jennifer Spencer ◽  
Katherine Elizabeth Reeder-Hayes ◽  
Laura C Pinheiro ◽  
Lisa A. Carey ◽  
Andrew F Olshan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
White Women ◽  
Financial Burden ◽  
Financial Toxicity ◽  
Breast Cancer Patients

e18299 Background: High cancer treatment costs are associated with considerable distress and worse outcomes in cancer patients, a phenomenon known as “financial toxicity”. We examined changes in health-related quality of life (HRQoL) among women experiencing financial toxicity after cancer diagnosis compared to cancer patients without financial toxicity in a racially diverse cohort of breast cancer patients. Methods: HRQoL was self-reported at approximately 5 and 25 months post-diagnosis using the Functional Assessment of Cancer Treatment (FACT-G) in a prospective, population-based, cohort study with oversampling of Black and young (<50 years old) women. Women reported on the financial burden of their breast cancer, including whether they had declined or delayed care due to cost or transportation barriers and whether they lost a job, experienced a reduction in household income, or lost insurance coverage after their cancer diagnosis. We assessed changes in HRQoL from 5 to 25 months according to financial toxicity experience. Results: 2,432 women completed 5- and 25-month HRQoL surveys and were included in analyses. Forty-nine percent were non-Hispanic Black and 51% were non-Hispanic White; other minorities were excluded due to small numbers. Overall, 49% of women reported at least one indicator of financial toxicity (59% Black vs. 39% White). Women who reported any financial toxicity had significantly lower scores on the FACT-G at baseline (75.5 vs 87.2, p<0.001) and reported significantly less improvement in HRQoL from 5- to 25-months than women who did not report financial toxicity (incremental difference: +1.4 vs +3.8, p=.01). Black women reported lower overall HRQoL than White women (p=0.03), but impact of financial toxicity on HRQOL was similar among black and white women in stratified analyses. Conclusions: Financial toxicity is associated with lower HRQoL and with less improvement in HRQoL in the two years following breast cancer diagnosis. [Table: see text]

Financial Burden and Patient-Reported Outcomes after Hematopoietic Cell Transplantation: Impact of Pre-Treatment Awareness of Transplant-Associated Costs

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 684-684
Author(s):  
Diana Y Salas Coronado ◽  
Theresa Hahn ◽  
Randy Albelda ◽  
Nandita Khera ◽  
Oreofe O. Odejide ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Perceived Stress ◽  
Patient Reported Outcomes ◽  
Hematopoietic Cell Transplantation ◽  
Financial Burden ◽  
Hematopoietic Cell ◽  
Financial Hardship ◽  
Patient Reported ◽  
Pre Treatment ◽  
The Impact

Abstract Background: Financial burden during cancer treatment is associated with compromised patient-reported outcomes (PROs). Being aware of impending costs may help preserve affected PROs during treatment, as patients can adjust their financial expectations. We aimed to determine if the relationship between financial burden and PROs differs among those who were aware versus unaware of transplant-related costs before hematopoietic cell transplantation (HCT) for hematologic malignancy. Methods: In 2015, we administered a mailed survey to adult patients at least 150 days after autologous or allogeneic HCT at three centers: Dana-Farber Cancer Institute, Roswell Park Cancer Institute, and Mayo Clinic Arizona. We assessed pre-treatment awareness of transplant-related costs, decreased household income after HCT, and financial hardship (defined as any one or two of the following: reporting being either unsatisfied with present finances, having difficulty meeting monthly bill payments, or not having enough money at the end of the month; given that experiencing all three would represent extreme hardship likely to impact PROs regardless of awareness, we excluded this group). A seven-point scale was provided for perceptions of overall quality of life (QOL, and patient-reported stress was measured with the Perceived Stress Scale (PSS-4). We fit regression models-stratified by awareness-to assess for the association of income decline and financial hardship with QOL below the median and perceived stress above the median (adjusting for transplant type, sex, age, race, marital status, income, distance to transplant center, and time since diagnosis). Results:In the overall survey cohort (n=325; response rate = 65.1%), 21.6% reported being unaware of HCT-related costs, with no differences due to age, race, income, or education as compared to those who were aware. Patients who reported being aware prior to transplant most often reported being informed of costs by a social worker (40.6%) and least often by a physician (23.4%; sources not mutually exclusive). Among aware patients, income decline after HCT was not associated with QOL below the median (AOR 1.4 [0.8, 2.5]; p=0.24); in contrast, among the unaware, income decline increased the odds of reporting worse QOL (AOR 4.3 [1.1, 16.7]; p=0.04). Among the aware, self-reported financial hardship was associated with worse QOL after HCT (AOR 2.7 [1.5, 4.8]; p=&lt;.001), but the odds were even higher among the unaware (AOR 4.7 [1.2, 19.4]; p=0.03). Similar increases were observed among the unaware for the association of decline in income and financial hardship with increased perceived stress. Conclusions: In this large multi-institutional cohort of patients post-HCT, more than one-fifth reported being unaware of transplant-related costs before the procedure. Moreover, this analysis suggests that pre-treatment awareness of transplant-related costs may ameliorate the impact of post-HCT financial burden on patient-reported outcomes. Figure Figure. Disclosures Khera: Novartis: Consultancy. Zafar: Novartis: Other: Spouse's Employment.

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