IntroductionFinancial toxicity is common among patients with cancer, as are co-occurring health-related social risks (HRSR). There is limited evidence to support best practices in screening for HRSR and financial toxicity in the cancer context. This analysis sought to understand variations of identified needs based on treatment course using data from a large screening program. MethodsThis 2022-2023 screening quality improvement program included four services (breast, gastrointestinal, gynecological, thoracic) at an urban comprehensive cancer center. The Comprehensive Score for Financial Toxicity (COST) measured financial toxicity. Patients completed a HRSR checklist documenting food, housing, medication, and/or transportation insecurity and financial borrowing practices. Differences were evaluated by treatment course (radiation therapy [RT] vs. other treatment and RT+chemotherapy vs. other treatment). ResultsScreening surveys were sent to 70,983 unique patients; 38,249 completed a screening survey (54% response rate). Of responders, 4% (n=1686) underwent RT in the 120 days prior to their survey, and 3% (n=1033) received RT in combination with chemotherapy. Overall, RT patients had lower unadjusted COST scores, indicating worse financial toxicity. The proportion of RT patients reporting unmet transportation (15% vs. 12%, p<0.0001) and housing (13% vs. 12%, p=.02) needs was significantly higher than for non-RT patients. More RT patients borrowed money than did non-RT patients (17% vs. 15%, p=.02). In multivariable models, RT (alone or in combination) was associated with worse financial toxicity and transportation difficulties, and a great likelihood of borrowing money for treatment. ConclusionsScreening for financial toxicity and HRSR is possible at a large cancer center. Patients receiving RT have higher transportation insecurity and worse financial toxicity compared to those receiving other treatments. Tailored intervention throughout the treatment trajectory is essential.