Evaluating the impact of a virtual oncology financial and legal navigation intervention on cancer-related financial toxicity.

536 Background: Virtual oncology financial and legal navigation (OFLN) programs could help overcome geographic and structural barriers to supportive care services, particularly rural and other hard to reach populations. The purpose of this study was to evaluate the impact of a virtual OFLN intervention offered in partnership with Triage Cancer , on the FT and quality of life (QOL) of pediatric and adolescent and young adult (AYA) patients and caregivers. Methods: We enrolled 124 patients (n=36) and caregivers (n=88) from a pediatric and AYA oncology clinic embedded within a larger academic health system. Inclusion criteria: English-speaking; patient or caregiver of patient in active treatment; 18 years of age or older. Implementation period: March 2024 to May 2025. Pre/post surveys were collected on demographics, financial toxicity, health-related quality of life, and intervention acceptability, appropriateness, feasibility. Data were analyzed using descriptive statistics and paired t-tests. Results: Average of participants at baseline was 34 years, and most identified as female (73%), non-Hispanic, White (85%), had completed high school or beyond (91%), resided in a rural region (61%), and had incomes above the FPL (71%). At baseline all participants reported moderate levels of FT with mean Comprehensive Score for Financial Toxicity (COST) scores of 20.9 (SD=11.14) for patients and 19.3 (SD=10.12) for caregivers. Following the intervention, COST significantly improved for all participants (mean difference ± SD, 1.09 (5.43), p = 0.04). When examining COST by group, caregivers reported a significant improvement (mean difference ± SD, 1.46(4.87), p =0.01) but not patients (mean difference ± SD, 0.19 (6.59), p =0.87). There were not significant changes in QOL outcomes for caregivers, but patients reported a significant decreased in physical health (mean difference ± SD, -2.70 (6.34), p =0.02) and a significant increase in anxiety (mean difference ± SD, 4.44 (8.17), p <0.01). A total FT score, a composite of the reversed COST score, material conditions score, and coping behaviors score, correlated with QOL outcomes in the expected direction (inversely associated with physical and mental health, positively associated with anxiety and depression). Participants rated the intervention highly across implementation outcomes of acceptability (76%), appropriateness (76%), and feasibility (75%). Participants strongly agreed/agreed that they had actionable next steps (80%), were better prepared to navigate financial/legal issues (82%) and decreased stress/anxiety after speaking with Triage Cancer (74%). Conclusions: Our virtual OFLN intervention demonstrated improvements in FT among pediatric and AYA cancer patients and caregivers with high acceptability. Future research is needed to address implementation factors including reach and scalability in cancer centers.