Identifying factors associated with disparities in accessing an Integrative Oncology program

Noah Samuels; Orit Gressel-Raz; Nir Peled; Nili Stein; Inbal Granot; Eran Ben-Arye

doi:10.1016/j.jpainsymman.2024.11.022

Identifying factors associated with disparities in accessing an Integrative Oncology program

J Pain Symptom Manage. 2024 Dec 5:S0885-3924(24)01191-6. doi: 10.1016/j.jpainsymman.2024.11.022. Online ahead of print.

Authors

Noah Samuels¹, Orit Gressel-Raz², Nir Peled³, Nili Stein⁴, Inbal Granot³, Eran Ben-Arye²

Affiliations

¹ Center for Integrative Complementary Medicine (N.S.), Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. Electronic address: noahs@szmc.org.il.
² Integrative Oncology Program (O.G.R., E.B.A.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel; Rappaport Faculty of Medicine (O.G.R., E.B.A.), Technion-Israel Institute of Technology, Haifa, Israel.
³ Helmsley Cancer Center (N.P., I.G.), Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Department of Community Medicine and Epidemiology (N.S.), Carmel Medical Center, Haifa, Israel.

PMID: 39645057
DOI: 10.1016/j.jpainsymman.2024.11.022

Abstract

Introduction: Integrative oncology (IO) programs provide patients with evidence-based complementary medicine therapies within a supportive and palliative cancer care setting. This study retrospectively examined characteristics of patients with lung cancer predicting utilization of a freely-provided IO consultation at two medical centers in Israel.

Methods: Electronic medical files of 832 patients with lung cancer attending/not attending the IO consultation were searched for socio-demographic (age, gender, country of birth, place of residence, primary language spoken) and personal health (Body Mass Index; smoking; disability) characteristics; cancer-related parameters (primary tumor site, localized vs. metastatic); and reported pain- and emotional-related concerns.

Results: Only 120 (14.4%) of eligible patients attended the IO consultation, with multivariate analysis finding a significantly lower likelihood of attendance among patients who were older (OR: 0.98, 95% CI = 0.96-0.99; P = 0.02); male (OR: 0.53, 95% CI = 0.34-0.83; P = 0.005); primarily non Hebrew-speaking (i.e., primarily Arabic or Russian speakers; OR: 0.34, 95% CI = 0.14-0.82; P = 0.016); without disability (OR: 0.52, 95% CI = 0.33-0.92; P = 0.025); and not reporting pain (OR = 0.40,95% CI = 0.17-0.98-; P = 0.046).

Conclusions: The present study suggests that age, gender and culture-related factors (reflected by the patient's primary language) may contribute to disparities in accessing a freely-provided IO consultation, as shown in a diverse population of patients with lung cancer from two medical centers in Israel. Further research is needed to better understand the role of these programs within a diverse, equitable and inclusive setting of effective and safe integrative care of oncology patients.

Keywords: Chemotherapy; Cross-cultural; Disparities; Diversity, Equity and inclusion; Integrative oncology; Lung cancer.