Factors associated with completion and improvement following integrative oncology acupuncture in a racially diverse population

Abstract

Acupuncture is an important integrative therapy in oncology settings as an adjunctive management option for cancer-related adverse effects. However, barriers to utilization of acupuncture in minority populations have been reported. This study sought to assess factors that impact completion of a recommended acupuncture regimen in a racially diverse cohort of cancer patients, along with determining the usefulness of functioning and well-being questionnaires in evaluating acupuncture outcomes. We prospectively enrolled 433 patients who completed at least one acupuncture visit from the Integrative Oncology and Survivorship Program at the Winship Cancer Institute. Demographic characteristics were collected. PROMIS-29 questionnaire was administered at baseline and follow-up to measure patient-reported outcomes across domains of functioning and well-being. Logistic regression models were created to examine factors associated with regimen completion among all patients, and domain improvement among patients with reported symptoms following regimen completion. There were 433 patients included: 153 (35.2%) attended eight or more sessions. 280 (64.7%) patients were White and 153 (35.3%) were non-White. There were 238 (55.1%) active cancer patients and 194 (44.9%) survivors. Multivariable logistic regression showed that non-White race (OR 0.63; p = 0.047) and active treatment (OR 0.54; p = 0.005) were associated with lower adherence to the acupuncture regimen. No differences in post-treatment improvement were observed across race or cancer status. Non-white patients had greater severity score of physical functioning (baseline: 54.2% vs. 32.4%; p = 0.019 | post-treatment: 50.0% vs. 18.1%; p <0.001) and pain interference (baseline: 34.3% vs. 62.5%; p = 0.005 | post-treatment: 60.4% vs. 27.6%; p = 0.001) domains. Additional analyses suggest obesity and delay in treatment were associated with any improvement of PROMIS-29 domains after completion. Race and active cancer treatment were notable barriers to completing a recommended acupuncture regimen. Although effective in managing cancer-related symptoms, non-white patients faced greater impairment in physical functioning, social participation, and pain interference. Future efforts to address these disparities and ensure appropriate schedule adherence can maximize the benefit of acupuncture among cancer patients.