Background: Recent publications have promoted physician patient communication on cost as a means of decreasing overall spending and minimizing patients’ financial burden in oncology. Studies show that most oncologists feel uncomfortable and ill-equipped to lead cost discussions, and many fear it may compromise the physician patient relationship. To date no study has assessed patients’ perspectives on cost communication in oncology. We sought to: describe patients’ attitudes toward communication about cancer costs, explore potential predictors for patients’ communication preferences, and assess how cancer patients consider cost when making management decisions. Methods: A 31 item questionnaire was developed to measure oncology patients’ communication preferences regarding the cost of cancer care. Items were adapted from other instruments when possible. After piloting, patients were recruited from an academic, ambulatory oncology practice. Basic descriptive statistics were applied. Bivariate analyses were performed using the Fisher exact test statistic. Results: Of the 771 patients approached, 256 responded (response rate 33%). Most (68%) prefer to know about out-of-pocket costs before they are treated. A majority (59%) would like their doctor to discuss these costs with them. While 76% report feeling comfortable discussing cost with their doctor, 74% are amenable to discussing cost with someone other than their doctor. Most patients do not consider out-of-pocket costs (57%) or the country’s health care costs (61%) in their decision making and do not believe their doctor should (55%). Patients on active chemotherapy were less likely to want to discuss cost with their doctor (p=0.035). Conclusions: This is the first study to evaluate oncology patients’ attitudes toward communication about cancer costs. Patients’ comfort and desire to discuss cancer costs exceeds that of oncologists, suggesting a need to educate oncologists on this important topic. Despite the substantial cost burden faced, the majority of cancer patients do not want cost to influence medical decision making. Employing an individual skilled in financial communication may be an alternative way to meet patients’ needs.