Background: Financial toxicity (FT) is reported by up to 50% of cancer survivors and is associated with decline in HRQoL, delaying care and higher mortality. Early data in bladder cancer (BC) suggests the same. Existing data have largely focused on cohorts that have homogeneity in terms of race/ethnicity, insurance type and socioeconomic status. No thresholds for FT in BC have been defined. Hypothesis: Our central hypothesis is that FT is highly prevalent in BC and impacts HR-QoL and treatment decisions. Our secondary hypothesis is that sociodemographic factors will impact the extent and type of FT that is experienced. Methods/Approach: 140 patients with existing BC diagnosis who are receiving treatment at a large, public hospital (site 1) and a tertiary cancer center (site 2) will be recruited to complete validated instruments of (1) financial toxicity/distress, (2) general and disease specific QoL, items pertaining to coping strategies including non-adherence. Clinicopathologic data will be collected from the medical record. 20 patients in each arm who were screened as having FT will undergo semi-structured interviews and this will be synthesized with quantitative data. Concurrent validity between the 2 validated FT measures will be performed and used to generate thresholds of FT associated with risk of decline in HRQoL and non-adherence. A focus group of 8 urologic bladder cancer experts followed by an exploratory survey of 100 urologists, medical oncologists and radiation oncologists will be conducted to assess provider awareness and attitudes. Applicability: FT is a critical factor in these PSN questions and thus necessitates thorough investigation: 1.How does a patient with invasive BC choose between preserving and removing the bladder? 2. How do we improve patient education about expectations for recovery and treatment success after radical cystectomy? 3. How can caregivers of patients with metastatic BC reduce their burdens?