ABSTRACT The proposed supplemental project leverages the existing survey design for Lessening the Impact of Financial Toxicity (LIFT) Study (5R01CA240092-02) to examine the effects of financial toxicity on healthcare help- seeking and care utilization among rural cancer patients. The parent grant funds a prospective study designed to evaluate the implementation and effectiveness of a Financial Navigation (FN) intervention within rural oncology settings in North Carolina, (1) leveraging key informant stakeholder interviews to produce process maps to characterize the context of rural oncology practices; (2) offering training, technical support, and coaching for financial navigators in rural oncology settings to improve FN implementation; and 3) evaluating the effect of FN on FT, health-related quality of life (HRQoL), harmful care-altering behavior, program acceptability, and responsiveness to patients’ concerns. Whereas the objective of the parent grant is to evaluate the implementation and effectiveness of FN within rural oncology settings, the proposed supplemental project leverages the research infrastructure developed by the team to further map out the effects of FT on healthcare help-seeking among rural cancer survivors across five (5) intervention sites in rural North Carolina. The proposed supplemental project seeks to adapt existing models of healthcare help-seeking to explain healthcare access and utilization to understand how rural cancer survivors enrolled in a FN intervention in North Carolina access care. The overall objective of the proposed supplemental study is to examine how FT) and care access are experienced differentially by rural cancer populations. This supplemental project will link the survey data with spatially-referenced data, including area-level characteristics, such as socio-economic status, income, and racial/ethnic composition, as well as patient-level data, such as travel distances/times to cancer care and routine (primary) care. The central hypothesis is that both FT and the spatial (in)accessibility of healthcare modify rural cancer survivors’ healthcare use patterns. The central hypothesis will be tested through three (3) aims: (1) To explore the relationship between FT and the spatial barriers to care prior to and after receipt of cancer diagnosis and financial toxicity among rural cancer survivors (2) To analyze the associations between spatial access to cancer care and level of FT among rural cancer survivors. (3) To examine the relationships between FT, and care continuity among rural cancer survivors, controlling for spatial access to care. The research proposed in this application is innovative, with a focus on adapting models of access to health care to better address the experiences of rural cancer patients.