WHO IS AT GREATEST RISK FOR FINANCIAL TOXICITY? A NATIONWIDE SURVEY OF BURN SURVIVORS.

Financial toxicity is increasingly recognized as an important determinant of recovery, yet limited data exist regarding its prevalence among burn survivors. We evaluated financial toxicity in a nationwide cohort of burn survivors and sought to identify predictors of increased risk. We hypothesized that financial toxicity would be more common among survivors with larger burns. An online survey was distributed to burn survivors recruited through the Phoenix Society for Burn Survivors in 2023. The primary outcome was any financial toxicity, defined as survivors identifying 'financial assistance' or 'impact of injury on income' among their greatest unmet needs. Multivariable logistic regression determined independent predictors. Qualitative responses were analyzed for financial-related themes. Among 178 respondents, 31.5% reported financial toxicity. Financial toxicity was most common among survivors aged 18-44 years (41.8%) and those within 3 years of injury (50.0%). On multivariable analysis, younger age (aOR 3.37, 95% CI 1.21-9.40), larger burns (21-40% TBSA: aOR 4.76, 95% CI 1.34-16.83; >40% TBSA: aOR 7.85, 95% CI 2.21-27.92), and shorter time since injury (< 1 year: aOR 4.72, 95% CI 1.38-16.19; 1-3 years: aOR 5.98, 95% CI 1.98-18.07) were independently associated with increased odds. Qualitative responses highlighted ongoing challenges related to insurance coverage and access to reconstructive and supportive therapies. In conclusion, financial toxicity is an important yet underrecognized component of burn survivorship, particularly among younger survivors, those with larger burns, and those earlier in recovery. Additional efforts are needed to better understand its long-term impact and identify effective interventions to mitigate financial hardship after burn injury.