e18606 Background: At least half of people with cancer experience financial toxicity1 but financial advocacy has emerged as a promising intervention to mitigate it. How cancer programs and practices screen for financial toxicity among patients and the types of services they offer vary greatly. Standardization is needed to evaluate the outcomes and impacts of financial advocacy. Therefore, the Association of Community Cancer Centers (ACCC) Financial Advocacy Network set out to develop Oncology Financial Advocacy Services Guidelines (hereafter “the Guidelines”) to address this gap. Methods: To conduct this original, non-clinical trial research, ACCC convened a task force of seven multidisciplinary experts in financial advocacy to oversee a modified Delphi study. The task force assembled a panel of 49 experts, who represented oncology financial advocacy staff, multidisciplinary cancer care team members, financial advocacy subject matter experts, as well as patients and patient advocates. Based on a literature review and qualitative input from panelists, the task force drafted a list of 44 potential guidelines. In early 2022, panelists completed two rounds of anonymous voting, determining if each statement should not be a guideline, be a minimum guideline, or be an enhanced guideline. Consensus was set at 75% agreement. Results: The panel reached consensus that 43 statements should be guidelines. One guideline was rated minimum, while another 17 trended toward being considered minimum (60%-74% agreement among panelists). The panel rated one guideline as enhanced, with two others trending toward being enhanced. Twenty-two guidelines did not reach consensus one way or another on being minimal vs. enhanced. Conclusions: The Guidelines are publicly available in a report that includes implementation considerations extracted from Delphi panelists’ comments and task force input. Half of guidelines did not reach consensus on whether they are minimum or enhanced, reflecting the diversity of current financial advocacy practice and a need to develop greater standardization in the field. ACCC is taking several next steps to advance research and quality practice using the Guidelines, including collaborative policy development, assessment tools, and the creation of valid metrics and accountability measures.

Purpose To explain the January 6, 2016 written guidance (the “New Guidance”) issued by the Securities and Exchange Commission’s Division of Investment Management on payments made by mutual funds to intermediaries for distribution and non-distribution-related services. Design/methodology/approach Explains the SEC’s earlier guidance in the 1998 “Supermarket Letter,” the provisions of Rule 12b-1, the practice termed “distribution in guise,” the emphasis in the “New Guidance” on the role of a fund board’s business judgment, how Rule 12b-1 compliance fits into Rule 38a-1 compliance programs, specific fund activities and arrangements with intermediaries that are of concern to the SEC staff, and the focus of the New Guidance on an adviser’s fiduciary duty to mitigate or eliminate conflicts of interest. Findings The New Guidance articulates clear expectations that fund boards will have a process to evaluate the nature of intermediary payments and that fund advisers will provide boards with information in the advisers’ possession that the boards need to carry out that evaluation. Another intent of the New Guidance is apparently to give the SEC a clearer basis to bring enforcement actions concerning the use of fund assets to pay intermediaries for distribution-related activities. Originality/value Practical guidance from experienced investment management lawyers.

271 Background: Financial toxicity can be a devastating side effect for patients with cancer and their families, and may impact access to and delivery of care, treatment compliance, and outcomes. Financial advocates mitigate financial toxicity for patients and their families, liaise between payers/providers/pharmacies/patients, support shared decision-making and care planning processes through provision of cost and coverage information, and mitigate institutional financial toxicity. Training on effective financial navigation interventions, financial health literacy, patient engagement, oncology fundamentals, and measurement of impact is critical for advocates. Methods: The Association of Community Cancer Centers (ACCC) Financial Advocacy Boot Camp is a self-paced eLearning program consisting of 9 modules designed to build knowledge and skills of financial advocates. Users interact with education across two levels within the ACCC Learning Management System. To evaluate effectiveness of this content, pre- and post-assessments and evaluation forms for registered learners from 1/1/2020 to 12/31/20 were exported and exploratory analysis was performed on this data set of 538 participants. Results: 51% of respondents are oncology financial advocates; 7% are industry representatives; and the remaining 42% are a mix of patient navigators, nurse navigators, social workers, pharmacists, APPs, and nurses. 363 participants fully completed at least one of two levels. Most participants agreed or strongly agreed that each of the modules improved their knowledge and skills: 94% increased their ability to incorporate effective screening methods to identify patients at risk of financial toxicity, 95% are better able to review the evolving landscape of health insurance provided by public and private payers, and 97% both increased their ability to find patient assistance programs and resources for patients and can describe how to guide patients through the process of improving insurance coverage. 79% identified specific examples of what they will do differently after the training, including implementing screening and follow-up protocols, adjusting communication approaches with patients, proposing quality improvement projects, and accessing resources. Conclusions: Training, such as the Financial Advocacy Boot Camp, that builds knowledge and skills in financial screening, communication, and navigation can help cancer programs improve staffs’ ability to mitigate patient and institutional financial toxicity. Future research efforts should further define financial advocacy competencies, measure patient and institutional impact of financial navigation interventions, and assess effective practices for implementation of financial advocacy training in cancer programs.

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171 Background: In 2018, the Association of Community Cancer Centers (ACCC) developed the Financial Advocacy Services Guidelines to support cancer programs and practices with proactively addressing patients’ financial concerns along the cancer care continuum. Since then, research on financial hardship has expanded and the field of financial advocacy has continued to grow and evolve, necessitating new guidelines. Methods: To assess the current landscape of cancer financial advocacy interventions, ACCC conducted a literature scan of articles published between 2016 and 2021 using key words including financial advocacy, navigation, toxicity, oncology, and cancer. In May 2022, ACCC convened a multidisciplinary group of 49 national experts to begin developing new guidelines through a consensus-based Delphi process. To identify changes and additions to the 2018 guidelines, the panel completed a brief qualitative survey that asked which services are most important to include as a part of financial advocacy programs and necessary resources for effective delivery. Responses were compiled in a document and grouped by similarity using a rapid qualitative analysis approach. Results: The literature scan yielded a total of 55 articles. Several key recommendations emerged including the need to further integrate financial advocacy into care planning services, more training across team members to address financial toxicity, and ensuring services are accessible and equitable. Additional areas for research were ways to leverage technology to enhance services, when and how to screen for financial distress, and the development of care models. From the survey, responses clustered in the following domains and sub-domains: Financial Advocacy Services and Functions (Benefits Verification, Pre-Authorization, & Insurance Optimization; Financial Distress Screening; Patient Communication & Education; Financial Assistance); Program Management Functions (Staffing/Roles & Responsibilities, Staff Training, Infrastructure & Information Exchange, Monitoring & Evaluation); and Stakeholder Management Functions. Conclusions: Early input from the panel illuminated numerous areas for defining new guidelines to increase comprehensiveness, incorporate an explicit focus on health equity, and begin to tease out minimal and optimal services and program components and structure. The information from the literature scan and survey are being used by ACCC and a guidelines task force of field experts to draft new financial advocacy services guidelines, which will then go through at least two rounds of rating by the Delphi panel in order to find areas of consensus. ACCC will also hold a series of roundtables with patient advocacy, commercial, and pharmaceutical stakeholders to allow an opportunity to comment on the guidelines as well. The finalized guidelines are expected to be released before June 2023.