Financial toxicity and gaps in survivorship care among cancer survivors in Peru.

511 Background: Long-term survivorship care is essential for cancer patients, encompassing surveillance, symptom management, psychosocial effects, chronic condition care and health promotion. In low-resource settings such as Peru, financial toxicity (FT) is a pervasive challenge that may hinder access to these services. However, the extent of FT and its association with survivorship care gaps remains understudied in Latin America. Methods: A cross-sectional online survey was conducted among 218 adult cancer survivors in Peru (2024). FT was assessed using the validated COST-FACIT tool. Survivorship care was evaluated across five domains: (1) recurrence and new cancer surveillance, (2) physical effects, (3) psychosocial effects, (4) health promotion, and (5) chronic conditions. Data included demographics, cancer history, monthly income and type of insurance. Multivariable logistic regression identified predictors of severe FT, adjusting for demographics, income, insurance, and urban/rural residence. Results: Participants were predominantly female (78%), aged 45–64 (50.5%), and urban-dwelling (50.9% reside in the capital city). Breast (42.2%), cervical (18.3%), and ovarian (12.4%) cancers were most common. All respondents reported FT, with 66.5% severe and 30.3% moderate. Only 4.1% received care in all five domains. Gaps were highest in chronic condition care (20.2%) and health promotion (22.9%). Insurance coverage included public (70.7%), private (15.8%), and none (13.4%). In adjusted analysis, survivors reporting perceived adequate survivorship care (OR = 0.27, p = 0.002) and recurrence surveillance (OR = 0.30, p = 0.013) had lower odds of severe FT. Higher income was protective (OR = 0.15, p = 0.024). Conclusions: FT is universal among Peruvian cancer survivors and linked to critical gaps in survivorship care, particularly chronic disease and preventive health. The inverse association between comprehensive care and FT severity suggests that structured survivorship programs that integrate financial navigation, care coordination, and insurance expansion could mitigate FT. Findings underscore the urgency of policy reforms to reduce out-of-pocket costs and adapt survivorship models tested in low- and middle-income countries. While this cross-sectional study identifies strong associations, it cannot establish causality, and findings may be subject to selection bias inherent in online surveys.