Kim, Seongho

e13730 Background: Financial toxicity, the burden of treatment cost, affects up to half of people with cancer and can affect survival. Financial toxicity is a health equity issue, disproportionately affecting Black patients. This cross-sectional study used baseline data from the Discussions of Cost (DISCO) Trial, an RCT to improve patient-provider treatment cost discussions and, in turn, mitigate financial toxicity, to examine whether Black and White patients differed in patient-provider communication perceptions and financial toxicity correlates. Methods: Data were collected from 2021-2025 at an NCI-designated comprehensive cancer center. Participants were Black or White patients diagnosed with solid tumor cancers. At baseline, patients completed demographic measures; communication measures of self-efficacy in patient-provider interactions (e.g., “I am confident I know what questions to ask a provider”); self-efficacy in managing cancer treatment costs (e.g., “I am confident I can understand treatment costs”); and whether they have a provider- or patient-centered approach (e.g., “the provider should decide what gets talked about”); and financial measures including economic burden (e.g., “it’s difficult to live on my income”); treatment cost distress (e.g., “worries about paying for my cancer treatment keep me up at night”); and anticipated material hardship (e.g., “I worry about the financial problems I will have in the future as a result of my treatment”). Comparisons were conducted by patient race. Results: A total of 202 patients participated (116 Black patients, 86 White patients). White patients were more likely to have advanced degrees, a higher annual income, and less likely to have Medicaid compared to Black patients. Black patients reported higher self-efficacy for managing treatment costs ( p = .002) and a higher provider-focused orientation to the patient-provider relationship ( p = .001), than White patients. Black patients reported greater levels of financial burden ( p < .001), cost distress ( p = .005), and anticipated material hardship ( p = .003). There was no difference in self-efficacy for interacting with providers. Conclusions: These results suggest that a communication intervention for patients may help mitigate the experience of financial toxicity, especially for Black patients. Clinical trial information: NCT04766190 . Patient characteristics. Black Patients White Patients p -value Race 116 86 Education < High School High School/GED Some College 2 or 4-year College Degree Graduate/Professional College Trade/Technical/Vocational School 10352626712 0141631187 < .001 Annual Household Income 0 - $19,999 $20,000 - 39,999 $40,000 - 59,999 $60,000 - 79,999 $80,000 - 99,999 $100,000 - 149,999 $150,000 + 53201611431 51215991716 <.001 Insurance Type* Medicaid Medicare Medicare supplement Private None 604911330 113726393 <.001>.99<.001.20.15 *Patients could select more than one

e13729 Background: Financial toxicity, the burden of treatment cost, affects up to half of people with cancer and can affect survival. Financial toxicity is a health equity issue, disproportionately affecting Black patients. Patient education about cost and patient-provider cost discussions are recommended to mitigate financial toxicity but occur infrequently. The Discussions of Cost (DISCO) App, designed to mitigate financial toxicity through a tailorable education and communication intervention, was assessed for efficacy in an RCT with Black and White patients. Here we describe the DISCO App's feasibility and acceptability. Methods: Data were collected from 2021 to 2025 at an NCI-designated comprehensive cancer center. Participants were Black or White patients diagnosed with solid tumor cancers. While waiting to see their provider, patients randomized to the intervention arm used the DISCO App on a tablet. The DISCO App includes a video about treatment costs, ways to manage costs, and the importance of discussing costs with providers. Once patients enter their socio-demographic information (e.g., employment) and financial concerns, they receive a tailored list of cost questions to ask their provider. Patients responded to measures immediately after using the DISCO App. Feasibility was assessed by patient reports of how much time they needed to use the DISCO App and if they were able to use the DISCO App before the provider entered the exam room. Acceptability was measured by items assessing patient perceptions of the DISCO App (1 = strongly disagree; 5 = strongly agree). Descriptive statistics summarized results and mean comparisons were used to assess perceptions by patient self-identified race. Results: Of the 202 patients recruited, 124 were randomized to the intervention arm (67 Black patients; 57 White patients). All patients completed using the DISCO App prior to their provider entering the exam room and 80% of patients needed 15 minutes or less to use the DISCO App, with no difference by patient race. Black patients ( M = 4.4) reported finding the DISCO App more helpful than White patients ( M = 3.9; p = .02) and it brought up cost issues they had not considered (Black patients = 3.5; White patients = 3.0; p = .05). Patients reported the questions were easy to understand ( M = 4.4), helped them feel it was okay to talk with their provider about cost ( M = 4.0), that it prompted cost questions ( M = 3.3), that they learned what costs to consider (55%), and learned ways to manage cost (62%) with no differences by patient race. Conclusions: The DISCO App was feasible and acceptable to Black and White patients with cancer, with Black patients reporting more favorable perceptions than White patients. Next steps include assessing effectiveness in improving outcomes including prompting patient-provider treatment cost discussions and related financial toxicity outcomes (e.g., treatment adherence). Clinical trial information: NCT04766190 .

TPS1659 Background: Financial toxicity, the material and psychological burden of treatment cost, affects up to half of people with cancer and can affect adherence and survival. Financial toxicity is a health equity issue, disproportionately affecting Black patients. Patient education about cost and patient-provider cost discussions are recommended to mitigate financial toxicity but occur infrequently. Our goal is to mitigate financial toxicity through a tailorable education and communication intervention, the DISCO App. The DISCO App was shown to be feasible, acceptable, and preliminarily effective at prompting cost discussions and improving related outcomes in a pilot trial. The aim of the ongoing trial is to test the effectiveness of the DISCO App on short- and longer-term outcomes for Black and White patients with cancer. Methods: This study is a longitudinal RCT. Oncologists are eligible if they treat patients with solid tumors at the trial site. Patients of participating oncologists are eligible if they are ≥ 18 years of age; identify as Black or White; can read and write in English; have an email address; and were diagnosed with a solid tumor for which systemic therapy is a likely recommended treatment. Strata were created to balance arms by patient race, income, age, and sex. Upon consent, patients are randomized to one usual care arm (1) or one of two intervention arms (2 and 3). All patients are asked to allow one treatment discussion with their oncologist to be video recorded for analysis. Prior to the recording, intervention patients utilize the DISCO App on an iPad. The DISCO App includes a video about treatment costs, ways to manage costs, and the importance of discussing costs with oncologists. Once patients enter their socio-demographic information (e.g., employment, insurance) and any financial concerns, they receive a tailored list of questions to ask their oncologist. Arm 3 patients receive an intervention booster via email two months after the recording. Patients complete measures at baseline, right after the recording, and at 1, 3, 6 and 12 months after the recording. Measures assess outcomes including cost discussions, communication quality, cost knowledge, self-efficacy for cost management, referrals for support, short- and longer-term financial toxicity, and treatment adherence. The patient-oncologist interaction is the unit of analysis and we will use multi-linear models to compare outcomes by arm. We anticipate recruiting up to 15 oncologists and 240 patients. Data collection began in March 2021 and will continue until July 2025. Participants to date include 13 oncologists and 192 patients (116 Black, 76 White). Most patients completed the baseline assessment (n=164), the post-interaction assessment (n=137), and at least 1 follow-up assessment (n=132); 125 treatment discussions have been recorded. The IRB reviewed the trial in December 2024 and approved continuation. Clinical trial information: NCT04766190 .