Background: Disparities in cancer health outcomes are driven in part by social determinants of health (SDOH). Health-related social needs (HSRN) are downstream modifiable manifestations of SDOH. It is critical to identify patients with HRSN who may benefit from early intervention to improve health outcomes. Methods: We identified all patients who received radiation treatment (RT) for gynecologic cancer at an urban, academic center from January 2021-August 2023 and completed HRSN screening. HRSN screening queries patients on food, housing, transportation, and financial insecurity as well as help reading hospital materials. We extracted demographic and clinical data, self-reported HRSNs, and separately screened each chart for additional evidence of transportation insecurity. We extracted area deprivation index (ADI), a measure of neighborhood level socioeconomic disadvantage, based on home address. Any RT disruption was the primary outcome. We compared patients with and without any RT disruption using Fisher’s exact tests. Univariate Poisson regression was used to examine the magnitudes of association between individual and neighborhood level factors and RT disruption. Results: A total of 127 patients met inclusion criteria. Median age was 62 (interquartile range 25%-75%: 53-71). Most (54%, n=69) patients were White, 32% were Black (n=41), and 14% were another race (n=17). Sixteen percent (n=20) reported at least one HRSN. Six percent of patients (n=8) resided in neighborhoods in the 81st-100th percentile ADI. A total of 26% (n=33) of patients had any RT disruption, and these patients differed on individual and neighborhood factors (Table). Patients with public insurance were 2.4 times as likely to have RT disruption compared to those with private insurance (95% confidence interval [CI]: 1.4-4.2). Self-reporting at least one HRSN was associated with a 2.3 times higher risk of RT disruption (95% CI: 1.31-4.11). Chart-derived evidence of transportation insecurity was associated with a 2.6 times higher risk (95%CI: 1.5-5.6) of RT disruption. Residing in a neighborhood with an ADI above the 80%ile was associated with a 3.3 times higher risk (95% CI: 2.0-5.5) of disruption. Conclusions: A variety of measures of SDOH both at the individual and neighborhood-level were associated with RT disruptions. While we did not have the power to perform multivariate analyses, our results suggest the ADI – which can be readily obtained from a patient’s home address – could help identify those patients most at risk of disruption to care.