Acupuncture, a form of traditional Chinese medicine, has been gaining attention for its uses in managing pain and side effects of cancer therapy, including but not limited to neuropathy. In fact, more than 70% of National Cancer Institute-designated Comprehensive Cancer Centers offer acupuncture to their cancer patients. Yet, implementation of acupuncture and other forms of traditional Chinese medicine including herbal medicine are not mainstream options for all cancer patient care plans. To grasp the scope of likely barriers that limit acupuncture and herbal medicine use for cancer patient care, Dr. Susan Veleber in the Integrative Medicine Program at Fred Hutchinson Cancer Center led a study to review several integrative medicine centers and survey acupuncture providers to provide vital insight. This study published in Integrative Cancer Therapies reported that the cost of acupuncture was the primary limitation when implementing this form of care for cancer patients, suggesting that policy changes are needed to increase implementation.
“In this paper, we explored different integrative oncology practice business models to identify facilitators and challenges to providing acupuncture in cancer centers,” shared Dr. Veleber. The researchers evaluated five oncology settings in which acupuncture services were provided and collected survey data primarily from practitioners. The oncology centers included the following: Memorial Sloan Kettering Cancer Center (New York, NY), California Cancer Associates for Research and Excellence (San Diego and Fresno, CA), Chicken Soup Chinese Medicine (San Francisco, CA), Seattle Cancer Care Alliance (Seattle, WA), and Refuot (Tel Aviv, Israel). Patients seeking care at these centers were treated for conditions including pain, chemotherapy-induced peripheral neuropathy (CIPN), general support during active treatment, insomnia, fatigue, nausea/ digestive disorders, hot flashes, and quality of life care. The five oncology centers differed in the types of insurance accepted for payment and only one center, the Seattle Cancer Care Alliance, accepted private insurance, Medicare and Medicaid. Acupuncture initial consultations and treatments cost between $130-150, and follow-up acupuncture treatments cost between $65-125 (inpatient acupuncture was provided free of charge at Memorial Sloan Kettering Cancer Center). For Chinese Herbal Medicine consultation, fees ranged from a $150 flat fee up to $295 per hour. These centers also differed in the number of available providers, with four of the centers having between 1-6 providers and Memorial Sloan Kettering Cancer Center having 35 providers which included 6 oncology providers—two of which were part-time—and 4 physician acupuncturists. With the demand for acupuncture and limited integrative medicine providers at four of the oncology centers, the waitlist could be 2-4 weeks or longer. Together, these findings highlight the high cost of therapy, limited number of providers, and long wait times as potential barriers to care. Additionally, accessibility to integrative medicine centers is generally limited across the United States since “50% of licensed acupuncturists are located in California, Florida, and New York,” commented the researchers.
The researchers also distributed surveys and received responses predominantly from practitioners—physician oncologists and nurses—as well as several allied health providers/administrative staff members, caregivers, and others. These individuals were asked to answer several questions including “What is the primary barrier to referring to an acupuncturist?” To this question, 70% ranked cost as the first barrier and 36% responded that concerns about competency and/or training was their second barrier to care. “Another well-founded question was on the safety of using Chinese herbs with patients undergoing cancer treatment,” shared Dr. Veleber. “We hope to contribute to the research in the safety and efficacy of Chinese herbs during and after cancer treatment.” To address these highlighted barriers, involvement of policymakers to mitigate cost limitations on receiving care is needed as well as additional research on the use of Chinese herbal medicine for cancer patient care, training of more providers on Chinese medicine approaches, and continued discussions amongst integrative medicine providers, oncologists, and pharmacists.
This work provides a baseline for effective methods and challenges in implementing acupuncture and Chinese herbal medicine into cancer patient care plans. A common concern was the “lack of oncology-specific acupuncture training for acupuncturists working with complex oncology patients,” commented Dr. Veleber. “Future steps include the development of a guide to assist patients and providers in choosing an oncology trained acupuncturist. Additionally, more formal oncology acupuncture education and fellowship programs are needed to address the demand for specialized training in this new field. Here at the Fred Hutchinson Cancer Center, our Integrative Medicine Program provides acupuncture clinical care to our patients by our highly trained acupuncture staff. We also conduct clinical trials to develop and test acupuncture protocols to prevent and manage treatment-related side effects. We hope that this published research and our continued efforts help facilitate increased accessibility to acupuncture services that have been proven to decrease cancer treatment side effects.”
No funding was received to conduct this study. The researcher's time was provided on a volunteer basis.
Veleber S, Cohen MR, Weitzman M, Maimon Y, Adamo CA, Siman J, Lu W, Sajdyk T, Stone JAM. 2024. Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integr Cancer Ther. 23:15347354241226640.