Financial toxicity screening embedded in a holistic supportive care needs ePRO assessment: Findings from initial implementation.

335 Background: Cancer-related financial hardship and other supportive care needs remain under-detected in routine oncology practice. We developed a modular electronic patient-reported outcome (ePRO) framework integrated within the electronic health record to systematically assess supportive care needs among head and neck cancer (HNC) patients. This report describes the development and initial implementation of financial toxicity screening embedded within a comprehensive supportive care infrastructure. Methods: Through a user-informed developmental approach guided by the Consolidated Framework for Implementation Research (CFIR v2.0), we conducted 46 formative qualitative interviews with healthcare professionals (n = 20) and HNC patients (n = 26) to inform intervention design. Through these interviews, financial toxicity was identified as a critical yet under-addressed need with strong consensus for integration in supportive care screening. The resultant modular ePRO framework assessed multiple domains: financial toxicity, symptom burden, psychological distress, malnutrition, and treatment complications. Financial toxicity was screened using a validated single screening item from the FACIT-COST measure ("My illness has been a financial hardship to my family and me") with responses ranging from "not at all," “a little bit,” “somewhat,” “quite a bit,” to "a lot." Patient responses of "quite a bit" or "a lot" were considered a positive screening, and triggered dynamic clinical decision support for financial counseling referrals. Results: During phased implementation from January 2024 to May 2025, 2,762 automated screenings were delivered via MyChart to patients with HNC, with 60% (n = 1,647) patient completion. Among respondents completing the financial assessment (n = 1,599), 50% (n = 800) reported no financial burden, 39% (n = 620) reported mild to moderate burden, and 11% (n = 179) screened positive for severe financial hardship. Positive financial toxicity screening was significantly associated with younger age, male gender, and worse symptom burden including pain, depression, anxiety, fatigue, and overall wellbeing. Conclusions: Integration of financial toxicity screening within comprehensive supportive care assessment is feasible and identifies a meaningful subset of patients with unmet financial needs. The strong association between financial hardship and symptom burden underscores the interconnected nature of social determinants and clinical outcomes in cancer care, highlighting the need for multidisciplinary approaches to address complex needs in financially vulnerable cancer patients.