Medical oncology fellows’ exposure and comfort with addressing patient social and financial needs: An ASCO State of Cancer Care in America analysis.

364Background: High-quality cancer care encompasses meeting patients’ social and financial needs. This analysis describes oncology fellows’ exposure to and comfort with addressing health-related social needs (HRSN; e.g., childcare, time off work, transportation), discussing costs of care, and appealing insurance denials. Methods: Medical oncology fellows were asked about their continuity clinic experience and exposure to and comfort with addressing patient social and financial needs in questions included after the 2025 ASCO In-Training Exam (ITE). Among those in their final year of training and close to practicing independently, data were summarized as the number and percentage who received different types of exposure for given social and financial activities. Data were stratified by whether fellows’ continuity clinic experience was predominantly fellow-led vs. attending-led. Number and proportion who reported they would be comfortable performing an activity in the future were summarized among different types of exposure to the activity. Results: Of 2360 fellows who took the ITE, 1726 (73%) responded to the survey and 573 (24%) were in their final year of training. 25% of final-year fellows had spent most of their time in a fellow-led continuity clinic; 63% had spent most of their time in an attending-led continuity clinic. Most respondents reported referring patients for HRSN (77%), 53% reported engaging in cost of care discussions, while 43% reported conducting peer-to-peer calls to appeal insurance coverage denials. Most fellows in both predominantly fellow-led continuity clinic (87%) and attending-led clinic (79%) made referrals for HRSN. Among those who made referrals for HRSN, 92% reported they would be comfortable doing so in the future. Among those predominantly in fellow-led continuity clinic, 66% engaged in cost of care discussions vs. 51% among those mostly in attending-led continuity clinics. A large majority (84%) of final-year fellows who engaged in cost of care discussions indicated they would be comfortable doing so in the future. In contrast, only 24% who reported no training in this area expressed similar comfort levels. Likewise, 53% of those in predominantly fellow-led continuity clinics conducted peer-to-peer calls to appeal insurance coverage denials compared to 42% in attending-led continuity clinics. Most (83%) fellows who conducted peer-to-peer calls reported future comfort with this activity compared to only 23% among those who reported no training in this area. Conclusions: Experiential learning—facilitated by more time spent in fellow-led continuity clinic—was associated with increased exposure to and comfort with addressing patients’ social and financial needs. While many fellows report comfort with making referrals for patients’ HRSN, fewer are comfortable with addressing financial aspects of patient care.