Predictors of financial hardship among adult cancer patients.

159 Background: Financial hardship (FH) and other health-related social needs (HRSN) are modifiable factors that adversely impact cancer-related outcomes. While FH is a known risk factor for poor health outcomes, there is a paucity of data about who develops FH during cancer treatment and its trajectory over the course of therapy. We evaluated the incidence of new FH and identified risk factors for developing FH during cancer treatment. Methods: This retrospective study evaluated data longitudinally collected in 3 oncology clinics at Columbia University Medical Center. Patients were prompted at 3 month intervals to complete a FH survey either via the electronic patient portal or on paper during clinic. FH was measured using an established, 2-item 5-point Likert scale survey adapted from the Comprehensive Score for Financial Toxicity (COST), which assesses 1) financial worry and 2) confidence in savings in relation to cancer care. A positive screen is defined as high worry (response 4–5) or low confidence (response 1–2). Patients who screened positive on their initial survey response were excluded. Patients were noted to have borderline FH if they answered neutrally (response 3) on either question. Follow up was defined as days between the first and last available surveys. Multivariable logistic regressions were used to compare subsets. Results: From 11/2022 to 2/2025, 10,346 FH surveys were completed by 4,364 unique patients and 2,046 (47%) had at least 1 follow up survey response. The 1,156 (56%) patients who had FH on their initial screen were excluded. Among the 890 patients without baseline FH, the median follow-up was 7.8 months with a median of 3 surveys; average age was 54 (SD 21); 90% female; 57% non-Hispanic white, 12% Hispanic (any race), and 11% non-Hispanic Black; 70% commercial insurance, 32% Medicare, and 10% Medicaid; 4% stage IV disease. Lower rates of stage IV disease, Medicaid, Hispanic ethnicity, and Black race reflect higher baseline FH in these groups. In total, 337 of 890 (38%) developed incident FH. In multivariable analysis, factors associated with developing FH included stage IV cancer (aOR 3.7, 95% CI 1.8-7.5), Medicaid insurance (aOR 2.2 CI 1.3-3.6), Hispanic ethnicity (aOR 2.6 CI 1.6-4.2), non-Hispanic Black race (aOR 1.7 CI 1.1-2.7), and having borderline FH at initial screen (aOR 1.8 CI 1.3-2.4). The model demonstrated modest discriminatory power with an AUC of 0.70. Conclusions: In this retrospective cohort of adults receiving cancer care without baseline FH, over a third of patients developed incident FH. In addition to previously reported factors associated with FH, this study offers insight into the importance of longitudinal screening and consideration of borderline FH, as this was associated with nearly twice the odds of developing FH. Additional work is needed to contextualize these findings with treatment timing and clinical developments to match high risk patients with interventions to improve cancer-related outcomes.