Background: The inability to afford healthcare has a widespread effect on cancer patients, notably impacting treatment decisions and outcomes. Patients receiving financial assistance to offset medication costs still face challenges overcoming cost of care barriers. This study investigated sources of concern and financial stress among racial groups and identified solutions to address patients’ needs beyond medication-related costs. Methods: This cross-sectional study utilized secondary survey data collected from cancer patients who received co-payment and/or financial aid from PAF in 2018. Respondents answered questions describing their financial distress and the COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 494 cancer patients surveyed, 72% were Caucasian, 11% were African American (AA), and 71% indicated a household income of < $48,000. Although this population received financial assistance, cost of medications was still a major barrier to adhering to treatment (59% vs 69%). AA patients reported greater financial burden caused by cost of deductibles/copay/coinsurance (58% vs 50%) and treatment costs not covered by insurance (49% vs 21%). AA patients highly rated day-to-day living expenses as an unmet need (64% vs 40%). COST scores differed significantly between Caucasian (mean 17.7, SD 8.6) and AA cohorts (mean 12.1, SD 8.6; p < .001), driven by the inability to meet monthly expenses at all (35% vs 11%). Of AA, 80% felt they do not have enough money in savings/retirement to cover treatment costs. Overall, the AA cohort reported higher frustration with not being able to work or contribute as much as usual (45% vs 26%). Conclusions: Under-resourced AA cancer patients identify a need for a comprehensive approach to cost of care conversation, to drive better adherence and improved treatment outcomes.