NCI Diversity Supplement Abstract This application is a diversity supplement to the Children’s Oncology Group (COG) National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base Grant (UG1CA189955). Financial distress in parents/guardians (“parents”) of children and adolescents undergoing treatment for ALL is being evaluated by the NCI approved protocol ACCL20N1CD that is funded under the COG NCORP Research Base Grant. This COG parent protocol leverages the NCORP network to collaborate with Community and Minority/Underserved pediatric cancer institutions across the U.S. to recruit diverse participants and improve the generalizability of the research findings. Financial distress is the psychological distress related to money resulting from harmful financial burden of cancer care. ALL is the most common type of childhood cancer with treatment requiring over two years of frequent outpatient and inpatient visits. This prolonged and complicated treatment regimen contributes to financial toxicity and financial distress. Financial distress may then precipitate financial coping behaviors that negatively impact cancer treatment adherence. Certain family characteristics, such as Latinx ethnicity or preferred language other than English, are associated with a greater risk of financial distress. The knowledge of Latinx ethnicity or preferred language other than English as risk factors for financial distress and the overall clinical impact of financial distress in childhood cancer is limited. Joanna Robles, MD, is a bilingual Latina early career physician scientist at Wake Forest University School of Medicine, with a background in pediatric cancer disparities and a long-term goal of improving equitable cancer care delivery and quality of life for underserved populations. As a diversity supplement to the parent protocol, she proposes to: 1) To qualitatively explore the experiences of language and cultural barriers on Latinx and/or Spanish-speaking parents regarding financial burden including financial distress screening and financial navigation services provided during their child’s treatment for ALL, 2) To describe characteristics of financial distress screening and financial navigation at NCORP sites that serve pediatric cancer patients. Our hypothesis is that pediatric cancer sites serving higher percentages of Latinx and Spanish-speaking populations will be less likely to provide financial distress screening and navigation services and Latinx and/or Spanish-speaking parents will report financial distress is increased by cultural and language barriers. The findings from this supplement will highlight potential opportunities for future interventions targeting financial distress in Latinx families of children undergoing pediatric cancer treatment.