Background: Prior research has shown that cancer patients (pts) are willing to discuss the costs of their care. Professional societies have thus encouraged physicians to discuss these costs with their pts. We assessed the preferred communicator from the pts’ perspective and the predictors of this preference. Methods: Pts with advanced cancers who had completed at least 3 months of chemotherapy were asked for their preferred cost communicator. Pts were allowed to choose one or more cost communicators. Options included physician, financial counselor, social worker, nurse, and other. We collected demographics, therapy type, mood states, income, length of disease (LoD), clinical trial status, ECOG PS, and health-related quality of life (HRQoL). FD was assessed by the COmprehensive Score for financial Toxicity (COST – FACIT) instrument. Multivariable logistic regression was used to identify factors associated with the preferred cost communicator. Results: 233 patients were assessed. Most pts were female (58.4%), Caucasian (66.4%), and privately insured (67.4%). In total, 114 pts (48.9%) preferred speaking about costs to financial counselors, followed by physicians (n = 74, 31.8%), social workers (52, 22.3%), nurses (16, 6.9%), and others (7, 3.0%). In total, 91 patients (39.1%) had no FD, while 142 (60.9%) had some degree of FD. Restricting the analyses by the preferred cost communicator and controlling for sociodemographics, HRQoL, mood states, LoD, clinical trial status, and ECOG PS, the presence of any degree of FD was associated with willingness to discuss costs with financial counselors (OR = 1.94, p = 0.03). In contrast, the absence of FD (OR = 1.93, p = 0.03) was associated with willingness to discuss cancer costs with physicians. A trend was seen with pts on oral therapy willing to discuss costs with their physicians (OR = 1.78, p = 0.06). Lastly, non-Caucasians were more willing to discuss costs with a social worker (OR = 2.28, p=0.01). Conclusions: Physicians are not the preferred cost communicators for pts with FD. These pts are willing to discuss costs with financial counselors. Following an evidence-based approach that integrates patients’ preferences may facilitate the inclusion of cost discussions in clinical practice.