Background: Patients with gynecologic cancer and high financial toxicity (FT) are significantly more likely to report delaying care than patients with low FT. We compared time of symptoms onset to diagnosis and treatment stratified by FT in patients with gynecologic cancer. Methods: Patients with gynecologic cancer completed a cross-sectional survey at follow-up visits with gynecology oncology providers from 2017-2021. The survey included the Comprehensive Score for Financial Toxicity (COST) tool. Data were abstracted from medical records, including dates of symptom onset, initial biopsy, surgery and/or start of relevant treatment. FT was categorized as high (COST score ≤23) and low (COST score >23). Data are presented as n (%) and median (interquartile range). Results: There were 258 respondents, 54% with uterine cancer, 30% with ovarian and 16% with cervical. High FT was reported by 31% and low FT by 69%. Median age at diagnosis was 62 (53.8-69.9) years, 81% of respondents were Non-Latinx White, and 7% had a non-English primary language. Most cancers were stage I (59%), 10% stage II, and 31% stages III-IV. Most patients had surgery (91%), 50% had chemotherapy and 45% had radiation; 15% had recurrence. Median time of COST score since diagnosis was 13.6 months (5.7-41.1). Risk factors for high FT included age, race and ethnicity, education, employment, insurance status, income, and chemotherapy (all p<0.05). Median time from symptom onset to diagnosis in all gynecologic cancers was longer in the high FT [3.1 (1.1-5.8) months] compared to the low FT [1.8 (0.9-3.8) months] group (p=0.01). Time from biopsy to gynecologic oncology consult and time from consult to surgery did not differ based on FT (both p> 0.05). Among patients with cervical cancer, those with high FT had a longer median time from symptom onset to diagnosis [5.0 months (3.1–8.8)] compared to those with low FT [1.7 months (0.9–3.7); (p=0.04)]. Similarly, patients with uterine cancer and high FT had longer median time from symptoms onset to diagnosis [3.0 months (1.0–6.4)] than those with low FT [1.8 months (0.9–3.8); p=0.03]. In patients with ovarian cancer, time from symptom onset to diagnosis was not significantly different based on financial toxicity (p>0.05). Conclusions: Patients with uterine and cervical cancer who reported high FT had a longer time to diagnosis compared to patients with low FT. Delays in accessing care, initial evaluation and treatment may contribute to worse cancer outcomes and survival for patients with FT as reported in other studies. More work is needed to understand what financial and social factors lead to the longer time to diagnosis in patients with uterine and cervical cancer.