Identifying Factors Associated With Disparities in Access to Integrative Oncology Program

Eran Ben-Arye, Ana Maria Lopez, Nihaya Daoud, Lilach Zoller, Eleanor Walker, Michal Davidescu, Katerina Shulman, Orit Gressel, Nili Stein, Shani Brosh, Elad Schiff, Noah Samuels

Research output: Contribution to journalArticlepeer-review


Context and Objectives: Cancer centers are increasingly providing complementary medicine as part of an emerging discipline termed ‘integrative oncology’ (IO). The present study explored factors associated with disparities in referral and adherence to a freely-provided IO program. Methods: The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0–3 sessions). Results: Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0–4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3–2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02–2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03–1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32–0.83, P = 0.006). Conclusion: Patients’ ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.

Original languageEnglish
JournalJournal of Pain and Symptom Management
StateAccepted/In press - 1 Jan 2024


  • Integrative oncology
  • acupuncture
  • chemotherapy
  • cross-cultural
  • disparities, integrative medicine
  • diversity, equity and inclusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • General Nursing


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