Introduction: Little is known about the financial impact of renal cell carcinoma (RCC). We sought to ascertain real world data on financial implications and how FT impacts quality of life in patients following surgery for localized RCC. Methods: An online survey was conducted by the Kidney Cancer Research Alliance (KCCure), a non-profit patient advocacy organization, from 7/22 to 9/22 . The survey included questions about costs and financial concerns related to the diagnosis of cancer, and the COST questionnaire. Pearson’s correlation (r) and Kendal’s tau test were used to analyze the COST questionnaire, financial burden and hardship. Results: Out of 1062 responders 623 had initially localized RCC. Out of these patients 395 did not recure and 204 were willing to answer questions related to cost and financial hardship. Median age was 54 (range 19-84). Patients identified as white (89%), living in the US (84%) and had a bachelor's degree or beyond (53%). 15%, 59%, and 26% lived in urban, suburban, and rural locations. The approximate annual household income was <50.000US$ in 13%, <100,000US$ in 32% and >200,000US$ in 17%. 65% had private insurance, 13% are on Medicare, 3% on Medicaid and 0.5% were uninsured. 55% of patients work full time, 11% work part time, 4% are unemployed looking for work, 8% unemployed not looking for work, 18% are retired and 4% are on disability. 28% of patients reported that their medical diagnosis has not reduced their income at all and 26% report that their diagnosis has reduced their income very much. 31% of patients reported experiencing insurance denials for imaging scans, 30% faced delays in care due to pre-approval requirements, 45% reported facing high out-of-pocket costs for medical care, 18% reported being unable to go outside of a provider network. 25% reported spending over $100 a month on health-related products not covered by insurance. To cover medical costs 24% of patients reported taking a hardship withdrawal from a retirement account, 28% stopped funding or lowered contributions to an existing retirement account, 20% borrowed from friends or family. Median COST score was 32 (range 19-44)) and was significantly correlated to age, NCCN distress score, risk of recurrence and supplement intake (p < 0.05). Conclusions: Patients diagnosed with localized RCC are impacted by financial hardship and financial toxicity, with more than a quarter of patients reporting that the diagnosis significantly reduced their income. More research is needed to characterize the full extent and root cause of financial implications to this group of patients. Financial counseling should be recommended as part of every cancer diagnosis regardless of stage. SOURCE OF Funding: None