Background: Financial toxicity, or the strain caused by paying for health care services, can undermine the mental health and QoL of patients (pts) in cancer care. This study examined associations of FT with depression, anxiety, and QoL in older pts with advanced cancer. Methods: This is a secondary analysis of baseline data from a Geriatric Assessment intervention study conducted by UR NCORP (URCC 13070; PI: Mohile). At baseline, pts were categorized as experiencing FT if they reported any one of the following: delaying medications due to cost, insufficient income in a typical month for food and housing, or insufficient income in a typical month for other basic needs. This definition of FT is consistent with those used in previous research. Pts also completed the Geriatric Depression Scale (GDS, score 0-15), the Generalized Anxiety Disorder-7 (GAD7, score 0-21), and the Functional Assessment of Cancer Therapy- General (FACT-G) to assess overall QoL. Associations of FT with depression, anxiety, and QoL were assessed in separate multivariate linear regression models controlling for covariates at p < 0.1. Results: Among 544 pts (mean age 77; range 70-96; 49% female), 18% (98 pts) experienced FT. In multivariate regression analysis, FT was significantly associated with all 3 outcome measures. On average, pts experiencing FT scored 0.77 points higher (p = 0.02) on the GDS (indicating greater depression severity), 1.77 points higher (p < 0.01) on the GAD7 (indicating greater anxiety severity), and 5.2 points lower (p < 0.01) on the FACT-G (indicating lower QoL). Conclusions: Older pts with advanced cancer who experience income and cost-related barriers to quality cancer care reported worse depression, anxiety, and QoL than those without FT. Given the association between FT and these measures, these 3 FT questions may help with screening to identify vulnerable older pts who may have lower QoL and be at increased risk for depression and anxiety due to FT.