Financial toxicity screening: Who do we miss?

64 Background: Financial toxicity (FT) is associated with delayed care, reduced quality of life, and poor outcomes. FT screening is recommended to mitigate risk and facilitate resource referral; however, evaluation metrics are limited, and non-response may limit ability to identify and help those at high risk. This analysis examined clinical and demographic associations with completion of FT screening. Methods: Screening occurred at an urban comprehensive cancer center as standard of care. A survey was sent via patient portal before a treatment visit in breast, gynecologic, gastrointestinal (GI), and thoracic clinics. An iPad was offered at check-in for those who did not screen in advance or did not have portal access; interpreter services were available upon request. The screening included a 12-item FT assessment and an essential needs checklist, and it was intended to be repeated every 4 months. Multivariable logistic regression (MVA) assessed demographic and clinical associations with completing ≥1 screen. Data were collected from 3/2023-12/2024. Results: Of 83,978 unique patients, 50,949 completed ≥1 survey (61% response rate). Screening completion was lower at the extremes of age (emerging adults, those 80+); patients with breast cancer or earlier stage disease; and those who identified as Black or had a non-English primary language. See Table for results. Conclusions: FT screening was operationally feasible, but groups known to be at higher risk for FT —including Black and non-English speaking patients— were less likely to complete screening than their counterparts. Screening optimization, including targeted follow up, may be necessary to avoid unintentionally widening gaps in support; workflows have since been adapted to increase screening uptake. MVA Completed ≥1 screenn=50,949 (%) Did not respond n=33,029 (%) Odds Ratio 95% Confidence Interval p-value Age &lt;0.001 18-25 298 (0.6) 284 (0.9) 26-39 3,328 (7) 2,164 (7) 1.47 1.10, 1.95 40-64 25,010 (49) 15,335 (46) 1.48 1.12, 1.94 65-79 18,871 (37) 11,671 (35) 1.38 1.05, 1.82 80+ 3,442 (7) 3,575 (11) 0.79 0.60, 1.04 Gender 0.6 Female 37,591 (74) 26,090 (79) Male 13,358 (26) 6,939 (21) 1.01 0.96, 1.07 Primary Language &lt;0.001 Non-English 2,067 (4) 3,334 (10) English 48,882 (96) 29,695 (90) 2.53 2.33, 2.74 Race &lt;0.001 White 38,856 (82) 23,503 (80) <jats:td c