Abstract Background: Patients with advanced-stage breast cancer and their spouse/romantic partners experience various challenges throughout their cancer journeys, including economic hardships sustained from treatment known as financial toxicity. Financial toxicity has been associated with poor physical and mental health, with some findings suggesting a bidirectional effect of financial toxicity on the dyad’s wellbeing. Previous literature indicates couples’ open and supportive communication behavior is associated with improved cancer-related adjustment. However, these associations have not yet been studied in the context of financial toxicity. This study aims to identify prevalent financial concerns, examine convergence and divergence in the reported financial concerns between patients and their spouse, and explore the associations between the couples’ communication behaviors and psychosocial wellbeing. Methods: The current cross-sectional data are part of a longitudinal study examining the psychological and behavioral impact of financial stress on patient-caregiver dyads. Eligible participants included women with stage III-IV breast cancer and their spouse. Upon enrollment, dyads completed separate baseline assessments for financial toxicity (COST), depressive (CES-D) and anxiety (GAD-7) symptoms, relational wellbeing (DAS-7), and positive and negative affect (PANAS). Afterwards, participants engaged in a standardized 30-minute spousal interaction task, where each dyad member identified and discussed a finance-related concern with a focus on problem solving for the selected issues. Results: 85 dyads (n=2 same-sex dyads; 100, 000 income: 64%; DAS-7 21: P=15%, S=12%; ≥Grade 1 COST: P=52%, S=47%) completed the spousal interaction task. Concerns regarding treatment side effects (P. = 19%, S. = 28%), future financial stability (P = 13%, S=20%) and discussing financial stressors with each other (P = 12%, S = 19%) were rated as most frequent concerns for both members of the dyad. Yet participants tended to avoid selecting some of the most pressing financial concerns as a discussion topic for the spousal interaction task. For instance, although spouses reported maintaining a steady income as a frequent concern (20%) but rarely (5%) discussed this topic during the interaction task. Changes in both positive and negative affect after participating in discussion were compared using paired t-tests. A significant reduction in negative affect (P 0. 001) was found for spouses, but not for patients. Significant correlations were found between COST to DAS-7, GAD-7 and CES-D for patients and spouses. For patients only, significant correlations were found between COST to Cancer Communication Assessment Tool (CCAT) and discrepancy and Social Provisions Scale (SPS) total score. Discussion: The results of this study support the notion that even well-adjusted, affluent couples may benefit from professional assistance in discussing and solving financial concerns. For the issues listed as most frequently concerning that remained unaddressed, there may be several underlying explanations (e. g. a perceived lack of control, a desire to avoid confrontation, etc. ) for why dyad avoid discussion for certain topics. However, our results demonstrated that couples’ problem-solving discussions regarding financial toxicity decreased - rather than increased - negative affect in caregivers, indicating that dyads should embrace discussion of financial topics they may find distressing. We recommend that healthcare providers consider encouraging this behavior in breast cancer dyads to reduce stress and negative affect overall. Citation Format: W. N. Riley, A. Ahn, J. Kroll, M. Chavez Mac Gregor, M. R. Jones, G. Smith, K. Milbury. Associations between Financial Toxicity and Illness-related Communication among Advanced Breast Cancer Patients and their Spouses abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32 (4 Suppl): Abstract nr PS1-01-26.
Riley et al. (Tue,) studied this question.