OBJECTIVE:To assess the feasibility of implementing an automated social determinants of health screening survey for gynecologic oncology into the electronic health record. METHODS:From May 2022 to July 2023, patients at 5 academic gynecologic oncology practices received a social determinants of health screening survey as an electronic message through the patient portal before an in-person or telemedicine visit. Each patient was eligible to complete the survey once; new patients received the survey prior to their initial visit, whereas returning patients received it around a single encounter during the study period. We assessed descriptive statistics of respondents compared with non-respondents using χ2 tests. We used multi-variable regression analyses to examine the association between survey completion and social needs with patient characteristics. RESULTS:Of 4369 patients seen, 1592 patients completed the social determinants of health survey (36% response rate). The mean age of survey completers was 56 years; 63% identified as White, 26% as Black, 4% as Asian, and 7% as Other. Patients who were younger and had private insurance were more likely to complete the screening. Black patients were more likely to complete the screening than White patients (p =.01). Of the 1592 patients who completed the survey, 380 (24%) identified 1 or more social needs: 189 (12%) financial worry, 150 (9%) food insecurity, 136 (9%) housing needs, and 78 (5%) transportation needs. Patients identifying as Asian, Black, or a race other than White and patients with Medicaid or Medicare Advantage insurance were more likely to report social needs compared with White patients and those with private insurance. CONCLUSION:In gynecologic oncology practices, social needs were prevalent and easily collected from an automated survey embedded in the electronic health record, with 1 in 4 patients reporting social needs. Integration of an automated social determinants of health screening in gynecologic oncology can identify patients at risk for referral to supportive care services.

BACKGROUND:Financial toxicity (FT) is linked to adverse health outcomes and increased mortality. Financial navigation with direct financial relief is a promising clinical intervention. METHODS:This sequential explanatory study evaluated Financial Treatment Program (FTP) in patients with incomes ≤400% of federal poverty line. We assessed pre- to post-intervention change in FT, health-related quality of life (HRQOL), anxiety and depression, and interviewed an intensity sample of participants to understand factors influencing FTP success. RESULTS:152 patients enrolled, 109 completed baseline and follow-up with significant improvements in FT, physical functioning HRQOL, and anxiety. 21 interviews yielded three themes: (1) cumulative stressors and disadvantage; (2) social support and asking for and receiving help; (3) disappointment in and difficulty accessing assistance and public benefits. CONCLUSIONS:FTP was associated with significant improvements in FT and anxiety. Participants with greatest benefit had more practical support from friends, family, and employers. Participants valued FTP's personalized care and found it easier to engage with than other financial assistance and government benefit programs. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS AND POLICY:Clinical FT interventions are necessary but may be limited in severe FT, which is driven by structural inequities in employment and income protections. Policy efforts are also needed.

We conducted a scoping review to determine what is known about the prevalence and consequences of unmet social needs in U.S. cancer survivors, what screening tools are used to assess these needs, and what interventions have been developed to meet the needs of cancer survivors. We identified records from six databases. Inclusion criteria were peer-reviewed journal articles in English with empirical data from U.S.-based samples of people diagnosed with cancer as adults and assessing one of the following modifiable, individual-level needs commonly included in clinical screening: food insecurity, financial hardship, utility assistance, employment, housing, transportation, or personal safety. The search yielded 11,074 abstracts; 543 records underwent full-text review, and 189 were retained for data extraction. Most studies were quantitative and observational (88

Transportation barriers can lead to delays in care and suboptimal treatment. Our objective was to assess the utilization of a novel transportation pilot intervention in gynecologic oncology. Since May 2022, we have provided donor-funded transportation to patients receiving gynecologic cancer treatment at 5 University of Pennsylvania practices. Patients are screened for transportation barriers at first visit and re-screened during care. Patients who screen positive are referred to the intervention, a HIPAA-compliant ride-sharing service. There are no income or insurance restrictions; distance was limited to 25 miles. We report descriptive statistics on ride completion, distance traveled, and cost. In the 15-month pilot, 133 of 4,376 patients (3

Purpose Mental health inequalities based on race and ethnicity in the USA and globally persist despite efforts to address them. The COVID-19 epidemic accentuated these inequalities and demonstrated the extent to which they are linked to social determinants. However, the organizations that are best placed to ameliorate mental health inequalities are often underfunded and under-resourced. Investment strategies that restrict funding for programmatic costs rather than general operating costs often disproportionately impact small organizations that serve communities of color. This study aims to argue that effectively addressing mental health inequalities requires investing in these organizations by applying the lessons learned from implementation science. Findings This study demonstrates how organizational factors such as leadership, supervision and organizational culture and climate are key to programmatic success and how implementation strategies can target these factors. As promoting health equity is increasingly recognized as a priority outcome for implementation science research, these organizational approaches can inform funders on how to support small organizations that serve marginalized communities, giving them the capacity and flexibility to address mental health inequalities. Originality/value This paper applies the findings from implementation science to consider how best to support mental health organizations, particularly those well suited to serving the mental health needs of diverse communities.

Supplemental Table 1 shows the twopart analysis of the relationship between time since diagnosis (IV) and cost-related nonadherence (DV1) and administrative burden (DV2)

By targeting income and financial stress as key social determinants of health, unconditional cash transfers (UCTs) may improve cancer health outcomes and reduce cancer health disparities. Described in policy circles as guaranteed or basic income, UCTs have been shown to improve a range of health outcomes in low-income populations but have not yet been examined as a targeted intervention for people with cancer. This article describes some of the lessons learned from launching the Guaranteed Income and Financial Treatment trial, a two-arm randomized controlled trial of UCTs in oncology, along with a rationale for studying UCTs in people with cancer who have low incomes, and presents an introductory primer on UCT research for oncology clinicians and researchers and future directions for research.

Abstract Background: Treatment of ovarian cancer often involves expensive, sequential treatments, such as chemotherapy and surgery followed by long-term maintenance therapy. The direct and indirect costs of these treatments may create a significant financial burden and new care needs for patients. Our objective was to characterize financial toxicity and social needs in patients with ovarian cancer seen in a multi-practice health system. Methods: Patients in the University of Pennsylvania gynecologic oncology practices from January 2020 to February 2022 who had a patient portal account (n=6,925) were surveyed twice between March and April 2022, on financial toxicity. Those with ovarian cancer were included in this study. The survey included the 11-item Comprehensive Score for Financial Toxicity (COST) tool and a social needs question, “What service would be of most benefit to you in reducing financial toxicity of your treatment?” Responses were categorized as: very important; important; slightly important; and not at all important. We defined responses of “very important” and “important” as meeting high social need. Chi-squared and z-tests were used to compare differences between patients reporting high (COST< 26) and low (COST ≥26) financial toxicity. Results: 111 of 498 survey respondents identified as having ovarian cancer. The median COST score was 29 (range 6-44). 39% (n=37) had high financial toxicity, and 7% (7) had severe financial toxicity (COST<14). 19%(18) described their ovarian cancer as causing financial hardship to them and their family. 48% (26) of patients with private insurance and 48% (25) of patients under age 65 experienced high financial toxicity. Patients with private insurance were more likely to experience high financial toxicity (p=0.03) compared to patients with Medicare. Younger patients were more likely to experience high financial toxicity (p<0.001). Patients who were unemployed were more likely to experience high financial toxicity than those who were employed (p<0.001). Patients reported assistance with indirect costs of care (e.g., lost work) would be the most helpful in reducing financial toxicity (36%, 38) followed by assistance with out-of-pocket costs (29%, 31); housing and heating costs (27%, 28); and transportation (22%, 23). Conclusions: In a multi-practice survey, 39% of patients with ovarian cancer experienced financial toxicity, and 19% experienced financial hardship due to their cancer. Half of patients under age 65 and half of privately insured patients experienced financial toxicity. Patients identified assistance with direct and indirect costs of care (e.g., lost work, out-of-pocket costs) as the most helpful interventions. Interventions to address social needs and reduce financial toxicity are needed for patients with ovarian cancer. Citation Format: Anna Jo B. Smith, Maya H. Sharma, Kristina Powell, Meredith Doherty, Stefanie N. Hinkle, Emily M. Ko. Financial toxicity and social needs in patients with ovarian cancer: a multi-practice survey [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A001.

Nearly 2% of the population is born with intersex traits or variations of sex characteristics (VSC). Marginalization of people with VSC whose experience of social isolation and stigma can lead to mental health challenges and low degrees of medical and self-empowerment. Infants and children with VSC rely on caregivers to make decisions which impact their medical and social-emotional wellbeing. Interview recordings were analyzed using Interpretive Phenomenological Analysis (IPA) and generated four preliminary themes that will be used to develop a logic model to inform the development of a novel peer-empowerment intervention: (1) the isolating and overwhelming experience of learning about child’s VSC; (2) caregivers desire early access to education and information; (3) connecting with peer support provides reassurance and lessens stigma; (4) developing skills of communication and advocacy help empower parents. Features of post-traumatic growth were endorsed by caregivers. In partnership with an advisory group of stakeholders, findings from this study will be used to develop a logic model of the psychological, social, and environmental determinants that our intervention will target to improve health and quality of life outcomes for new parents of children with VSC. Project LISTEN (Let Intersex Stories Teach, Enlighten, and Nurture) applies the concepts of epistemic justice and health liberation to support, educate, and empower caregivers of children with VSC. Clinical social workers are ideal champions for peer empowerment programs that work to develop critical consciousness in those who have been socially marginalized.

169 Background: Cancer-related financial hardship is associated with treatment delays, non-adherence and adverse survival outcomes. Racial/ethnic minorities and low-income households are disproportionately impacted by financial toxicity. The Comprehensive Score for Financial Toxicity (COST) measure is used to measure financial toxicity in research but has not been validated in low-income, racially diverse cancer patient populations. Methods: We conducted this study at a large urban medical center from January-August 2023. We included cancer patients on systemic therapy for at least 2 months with ECOG performance status 0-2. Participants completed the COST measure, the Functional Assessment of Cancer Therapy: General (FACT-G) and the European Organization for Research and Treatment of Cancer (EORTC) QOL to assess health-related quality of life (HRQOL). Cancer diagnosis/stage, demographic data, and social work/financial counseling interventions were abstracted. Factor analyses were conducted to determine the underlying factor structure of the COST measure responses and bivariate analyses were conducted to identify relationships between COST scores and other data. Results: 100 patients participated in the study; the average age was 65 and both sexes were equally represented. Most patients reported African American (67%) race/ethnicity. 72% of patients held less than a 4-year college degree, 22 % were unemployed and 55% reported a yearly household income of less than $35,000. Lung (46%) and gastrointestinal (38%) cancers were the most represented. 73% were enrolled in a government sponsored insurance program (Medicare, Medicaid). The average COST score among participants was 22 [range 0-44] and mean FACT-G and EORTC scores were 16.5 [range 0-28] and 59.6 [ range 0 – 100] respectively. Fifty-eight patients were referred to social work or financial counseling for financial interventions. Factor analysis revealed three predominant factors among the COST responses (Eigenvalues > 1) including Factor 1: items 3, 7, 8, 9, 10, 11; Factor 2: item 4; Factor 3: item 5. COST was weakly associated with FACT-G and EORTC (Pearson range 0.27 – 0.37). The most highly correlated value was between the COST and EORTC physical wellbeing subscale (Pearson 0.38). The COST score was significantly associated with income, with higher incomes reporting less financial toxicity (p = 0.004). No significant differences in COST scores were noted across gender, race, or level of education. Conclusions: Low levels of financial toxicity were detected using the COST measure in a diverse, low-income cancer patient population despite many patients being referred to social work/financial counseling. Compared to similar studies, we found a weaker correlation between the COST measure and HRQOL. These findings suggest that the COST measure may need to be further adapted for use in underserved populations and patients with government sponsored insurance.

Objective: Oncology social workers (OSWs) deliver services that address social determinants of health affecting cancer patients and families. Yet, a clear delineation of activities that define an OSW role is needed, particularly given recommendations for practice standardization to expand reimbursement for social work services in health care settings. This study is an effort to delineate the OSW role in cancer care. Method: This is a cross-sectional cohort investigation, with data derived from a nationwide survey of OSWs. Through an online survey, respondents indicated the relevance of 91 tasks related to their practice. We used exploratory factor analysis to compute a theoretically interpretable factor structure by which to organize relevant practice behaviors. Results: Responses from 713 OSWs yielded a 9-factor solution consisting of 49 tasks. The first three factors represented fundamental social work competencies, including assessment and provision of emotional support, therapeutic intervention, and care coordination/access. Additional factors reflected activities related to patient, community and professional education, equity and justice, distress screening and compliance, family-centered care, treatment decision-making, and care for vulnerable populations. Conclusion: The findings provide a framework for distinguishing core practice behaviors, informing professional education and advocacy efforts, and expanding reimbursement for OSW services.

Transportation is an underrecognized, but modifiable barrier to accessing cancer care, especially for clinical trials. Clinicians, insurers, and health systems can screen patients for transportation needs and link them to transportation. Direct transportation services (i.e., ride-sharing, insurance-provided transportation) have high rates of patient satisfaction and visit completion. Patient financial reimbursements provide necessary funds to counteract the effects of transportation barriers, which can lead to higher trial enrollment, especially for low socioeconomic status and racially and ethnically diverse patients. Expanding transportation interventions to more cancer patients, and addressing knowledge, service, and system gaps, can help more patients access needed cancer care.

BACKGROUND:Financial toxicity is associated with worse cancer outcomes, including lower survival. OBJECTIVE:To characterize the prevalence of, and patient risk factors for, financial toxicity among gynecologic oncology patients in a multi-site health system. METHODS:We identified patients seen in University of Pennsylvania gynecologic oncology practices between January 2020 and February 2022 with a patient portal account. We sent a survey to all alive patients twice between March and April 2022, including the 11-item Comprehensive Score for Financial Toxicity (COST) tool. We compared differences between patients reporting high (COST score <26) and low financial toxicity (COST score ≥26) in Χ2 and regression analyses. RESULTS:Of 8239 patients, 6925 had a portal account, and 498 completed the survey for 7.2% response rate. 44% had a COST score <26, indicating financial toxicity. Patients with high financial toxicity were more likely to be younger (mean age 54 vs 60), have cervical cancer (10% vs 4%; p=0.008), be privately insured (71% vs 57%; p=0.003) or have Medicaid (7% vs 3%; p=0.03), or be unemployed (18% vs 3%; p=<0.001), and less likely to be white (79% vs 90%, p=0.003) than those with low financial toxicity. Patients with Medicare were less likely to experience financial toxicity than privately insured patients (RR=0.59, 95% CI 0.37 to 0.95). CONCLUSION:In this study of patients with gynecologic cancer or pre-cancer, 44% had financial toxicity. Financial toxicity was higher in patients who were younger, did not identify as White, and had private insurance. Targeted measures to address financial toxicity are needed to minimize disparities in patient burden of cancer treatment.