Background:“Financial toxicity” (FT) is increasingly recognized as an adverse outcome associated with cancer treatment. The degree of FT in the gynecologic oncology patient population has not been studied. This study used the comprehensive score for financial toxicity (COST) tool, a recently-validated survey, to examine FT in the gynecologic oncology population. Methods: All follow-up patients at a gynecologic oncology practice were invited to complete a cross-sectional survey including the COST (scale = 0-44) tool and a quality-of-life (QOL) survey, the EQ-5D-5L. Demographic and treatment data were gathered with additional survey questions and chart review. We dichotomized COST scores into low FT (top two tertiles) and high FT (bottom tertile); a lower COST score indicates higher FT. We assessed the correlation between COST and QOL scores using the Spearman correlation coefficient (r) and used univariable and multivariable linear regression to identify predictors of greater FT. We used log-binomial regression to calculate risk ratios (RR) and 95% confidence intervals (CI) for patient-reported financial outcomes. Results: Approximately 75% of approached patients responded; 224 were included in this analysis. The median FT score was 29.0. Greater FT was correlated with worse QOL (r = 0.43, p < 0.01). In multivariable regression, income < $50,000 (p < 0.01) and income from $50,000-$99,999 (p < 0.01) compared to income ≥$100,000; younger age (p < 0.01); and part-time employment (p = 0.01) and unemployment (p = 0.01) compared to full time employment were significant predictors of greater FT. The high FT group had an increased risk of delaying or avoiding care (RR: 4.5, 95% CI: 1.6-12.3); borrowing money or applying for financial assistance (RR: 17.0, 95% CI: 4.0-71.6); and using savings or reducing spending to meet healthcare costs (RR: 2.5; 95% CI: 1.9-3.4) relative to the low FT group. Conclusions: High FT was common in the gynecologic oncology population and was strongly associated with delays or avoidance of clinical care, requiring financial assistance, and worse QOL scores. Further study is needed to investigate FT in a broader patient population within gynecologic oncology and to identify strategies for intervention in clinical practice.