Factors Associated with Completion and Improvement Following Integrative Oncology Acutherapy in a Racially-Diverse Population

Factors Associated with Completion and Improvement Following Integrative Oncology Acutherapy in a Racially-Diverse Population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated with Completion and Improvement Following Integrative Oncology Acutherapy in a Racially-Diverse Population María Grosso Zelaya, Edouard H. Nicaise, Blaise Hartsoe, Margarite Melikian, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4572312/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Acutherapy 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 acutherapy regimen in a racially diverse cohort of cancer patients, along with determining the usefulness of functioning and well-being questionnaires in evaluating acupuncture outcomes. Methods We prospectively enrolled 432 patients who completed at least one acutherapy visit from the Integrative Oncology 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. Results There were 432 patients included: 153 (35.1%) attended 8 or more sessions. Multivariable logistic regression showed that non-white race (OR 0.63; p = 0.047) and active treatment status (OR 0.54; p = 0.005) were associated with decreased adherence to the recommended acutherapy regimen. No differences in rate of posttreatment improvement were observed across race or cancer status. Non-white patients had greater moderate/severe scores in the domains of physical functioning (baseline: 54.2% vs. 32.4%; p = 0.019 | posttreatment: 50.0% vs. 18.1%; p < .001) and pain interference (baseline: 34.3% vs. 62.5%; p = 0.005 | posttreatment: 60.4% vs. 27.6%; p = 0.001). Additional analyses suggest obesity and delay in treatment cadence were factors associated with any improvement of PROMIS-29 domains after regimen completion. Conclusions Race and active cancer treatment were notable barriers to completing a recommended acutherapy 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 acutherapy among cancer patients. acupuncture integrative oncology race patient-reported outcomes Figures Figure 1 Figure 2 Background Integrative therapies, such as acupuncture, have been increasingly incorporated at National Cancer Institute (NCI)-designated cancer centers to combat disease- and treatment-related adverse effects. 1 The NCI has developed recommendations for future research in the clinical use of acupuncture as a support therapy due to its moderate effectiveness in managing manifold symptoms across malignancies. 1 Acupuncture has been shown to alleviate concurrent and chronic side effects, such as pain and nausea, in active treatment and survivorship patients alike. 2,3 However, there has yet to be a consensus on the recommended frequency or duration of an acupuncture regimen in such a population. In a randomized trial from Ben-Arye et al, cancer patients with chemotherapy-induced peripheral neuropathy who completed at least 6 weekly appointments reported significant posttreatment improvement. 4 Notably, two other clinical trials have suggested that regimens extending past 8 weeks demonstrate the greatest benefit at follow-up for insomnia and pain in survivorship patients. 5,6 Thus, meeting a 6-to-8 acupuncture session minimum, preferably weekly, is critical to observe significant change in patient-reported outcomes following treatment. External barriers can significantly hinder patients’ treatment adherence and may interfere with treatment delivery. Multiple studies have highlighted how financial burden and limited insurance coverage, particularly among patients from lower-income communities, reduce nationwide accessibility to acupuncture in patients seeking adjunctive care. 7 A collaborative study conducted at private and public cancer sites showed there is decreased availability and utilization of integrative therapies in neighborhoods that are underserved with a greater proportion of residents of color. 8 This pattern is often a byproduct of socio-demographic factors such as race, educational achievement, and household income, which limits knowledge and access to integrative care in oncology settings. In addition, non-white patients with fewer years of education report more perceived barriers to acupuncture use. 9 Lack of insurance coverage for integrative therapies and exorbitant treatment-related costs may thus introduce obstacles for cancer patients seeking acupuncture as adjunctive care. Although accessibility varies from patient to patient, established research supports the relationship between acupuncture and relief of cancer-related symptoms. Study findings suggest a decrease in symptom severity after a recommended 6–8 week regimen for domains not limited to peripheral neuropathy, insomnia, and musculoskeletal pain; 4–6 sampled participants included active and survivorship patients who were diagnosed with prostate or gynecological cancer and hematological malignancies. In a randomized controlled trial by Molassiotis et al, breast cancer patients who had completed chemotherapy demonstrated improvements in mood and physical-social functioning following a 6-week acupuncture regimen. 10 Patients in the control group received standard care without integrative therapies and noted improvement in patient-reported outcomes at a lesser rate than the intervention group. Breast cancer survivors also report chronic pain reduction and general wellness maintenance to minimize potential recurrence. 11 These symptoms contribute to overall quality of life, emphasizing the importance of facilitating access to acupuncture and related therapies for patient populations across malignancies, and treatment status. This study, featuring a large and racially diverse cohort seen at an NCI-designated cancer center, primarily investigates factors impacting patients’ ability to complete a recommended acupuncture regimen. In addition, this study will help to validate the utilization of the PROMIS-29 in a heterogenous cancer cohort receiving acutherapy and characterize differences in domain symptomatology according to race and cancer treatment status. Methods Patient Inclusion Characteristics The Integrative Oncology Service treated established patients in the Winship Cancer Institute at Emory University from May 2022 to January 2024. Patients who attended at least 1 group acutherapy session were prospectively enrolled and included in this study. Baseline information, including patient sex, race, age, body mass index (BMI, kg/m 2 ), Eastern Cooperative Oncology Group performance status (ECOG), cancer type, and cancer status (active treatment vs. survivorship) were documented. General questions regarding most bothersome symptomatology were asked at intake, which was later categorized by number of symptoms. Acupuncture Regimen Structure Patients were referred by their oncology health care professional and screened for eligibility criteria, including cancer diagnosis and being at least 18 years of age. Acupuncture visits were scheduled at one-week intervals, and each session had a duration of 30 minutes. Treatments were performed in a small group setting by a licensed acupuncturist. Patients were able to list up to 3 symptoms to be targeted by acupuncture. Acupuncture points were selected for each patient using established institutional protocols, designed to target specific acupuncture points according to the most common self-reported symptoms ( Supplemental Table 1 ). There were no acupuncture-related adverse events reported. PROMIS-29 Assessment The PROMIS-29© v2.0 questionnaire (Patient-Reported Outcomes Measurement Information System) was administered to patients at intake and follow-up. The PROMIS is a National Institutes of Health initiative developed to measure self-reported assessments of functioning and well-being. 12 This measures pain intensity using a 0–10 numeric scale and seven physical and mental health domains: physical function, anxiety, depression, fatigue, sleep, social functioning, and pain interference. These domains have been tested, validated, and further calibrated in tens of thousands of patients, particularly among patients with cancer, to generate standardized scores associated with responses. 13–19 Patients were then categorized into Normal, Mild, Moderate, or Severe domain symptomatology according to established cutoffs. 20,21 Patients with any missing or incomplete information were excluded from this study. Objectives and Statistical Analyses Primary objective of the study was to assess factors associated with completion of recommended acutherapy cadence. The threshold for meeting regimen completion was defined as at least 8 visits. Categorical variables were reported as total numbers with percentages, while continuous variables were reported as median values with interquartile range (IQR). Patients were first dichotomized according to the visit threshold, and variable comparisons between groups were analyzed using Chi-square test for categorical and Ranksum test for continuous variables. Univariable and multivariable logistic regression models were then constructed to examine factors associated with completion of 8 or more acutherapy sessions. Models were adjusted for sex, age (years), race, BMI, number of self-reported symptoms, cancer status, ECOG, and baseline scores in the PROMIS-29 domains. The inclusion of baseline PROMIS-29 categorization was to adjust for potential disease or symptom severity. Results were reported with odds ratios (OR) and 95% confidence intervals (CI). Statistical significance was indicated by p-value < 0.05. The secondary objectives were to evaluate differences in pre-to-post-treatment PROMIS-29 scores according to race and cancer status. Patients who did not complete 8 or more visits were excluded from these subgroup analyses. Among this cohort, the number of visits per week was calculated since there was variation in the maximum number of sessions attended ( 8 – 12 ). Patients were stated to have delayed treatment if the time to attend 8 visits surpassed 70 days or 110 days for 12 visits, which approximates at least 3 visits over 4 weeks. Chi-square test for categorical and Ranksum test for continuous variables was used to test for differences according to race and cancer status. Furthermore, PROMIS-29 domain classification change was recorded from baseline to most recent acutherapy session for patients with mild, moderate, or severe symptomatology. Patients were labeled as improved if post-acutherapy domain classification changed from moderate/severe to mild/normal or from mild to normal. Stable referred to no change in domain classification, and worsened referred to development of moderate/severe symptomatology. Changes in classification were compared using Chi-square test according to race and cancer status. Finally, logistic regression models were constructed to evaluate factors associated with any domain improvement among patients with a documented mild-to-severe level of symptoms. Variables adjusted for included age (years), race, sex, BMI, ECOG, acutherapy delay, and cancer status. All statistical analyses were performed using Stata/SE v15.1 (StataCorp LLC; College Station, TX). Results Factors Influencing Acutherapy Regimen Completion There were 432 patients included: 153 (35.1%) met the 8-visit threshold. The most represented primary cancer sites were breast (216; 50.0%), head and neck (65; 15.1%), multiple myeloma (23; 5.3%), and colorectal (21; 4.9%), with no other site representing greater than 3% of the total cohort. There were 133 Black-identifying patients (30.8%), 16 Asian (3.7%), and 4 American Indian or Native Hawiian (0.9%). Table 1 demonstrates the baseline features according to recommended visit completion. There was no difference in age (59 vs. 58 years; p = 0.664), sex (female: 76.3% vs. 77.1%; p = 0.846), BMI (obesity, > 30kg/m 2 : 27.6% vs. 28.2%; p = 0.898), symptom burden (≥ 2: 76.3% vs. 69.6%; p = 0.140), or ECOG (≥ 1: 36.2% vs. 37.5%; p = 0.787) between ≥ 8 visits vs. <8 visit groups, respectively. In the 8 or more visit group, there was a significantly lower proportion of non-white patients (28.9% vs. 38.9%; p = 0.038) and patients undergoing active treatment (46.7% vs. 59.6%; p = 0.010). No differences were observed in PROMIS-29 domain scoring between the groups. The most commonly rated domain was Pain Interference with 21.1–23.2% reporting mild symptomatology and 42.8–45.4% reporting moderate-to-severe symptomatology. Median pain intensity was 4 (IQR 2–7) across both groups. Table 1 Baseline Features According to Completion of Recommended Acutherapy Cadence Covariate ≥ 8 Visits (n = 152) < 8 Visits (n = 280) p-value Sex Male 36 (23.7) 64 (22.9) 0.846 Female 116 (76.3) 216 (77.1) Age (years) 59 (50–68) 58 (49–67) 0.664 Race White 108 (71.1) 171 (61.1) 0.038 Non-White 44 (28.9) 109 (38.9) Obesity (BMI > 30kg/m2) 42 (27.6) 79 (28.2) 0.898 2 or More Symptoms 116 (76.3) 195 (69.6) 0.140 Cancer Status Active Treatment 71 (46.7) 167 (59.6) 0.010 Survivor 81 (53.3) 113 (40.4) ECOG 0 97 (63.8) 175 (62.5) 0.787 1+ 55 (36.2) 105 (37.5) Total Moderate/Severe Domains 2 (0–4) 2 (0–4) 0.352 ≥ 1 Moderate/Severe Domain 104 (68.4) 202 (72.1) 0.416 Physical Functioning Normal 70 (46.1) 107 (38.1) 0.274 Mild 25 (16.4) 56 (19.9) Moderate/Severe 57 (37.5) 117 (41.8) Anxiety Normal 66 (43.4) 117 (41.8) 0.686 Mild 41 (27.0) 69 (24.6) Moderate/Severe 45 (29.6) 94 (33.6) Depression Normal 104 (69.3) 173 (62.0) 0.258 Mild 24 (16.0) 49 (17.6) Moderate/Severe 22 (14.7) 57 (20.4) Fatigue Normal 60 (39.5) 116 (41.4) 0.902 Mild 31 (20.4) 53 (18.9) Moderate/Severe 61 (40.1) 111 (39.6) Sleep Normal 86 (56.6) 158 (56.4) 0.600 Mild 31 (20.4) 48 (17.1) Moderate/Severe 35 (23.0) 74 (26.4) Social Functioning Normal 79 (52.0) 137 (48.9) 0.759 Mild 36 (23.7) 75 (26.8) Moderate/Severe 37 (24.3) 68 (24.3) Pain Interference Normal 55 (36.2) 88 (31.4) 0.598 Mild 32 (21.1) 65 (23.2) Moderate/Severe 65 (42.8) 127 (45.4) Pain Intensity (0–10) 4 ( 2 – 7 ) 4 ( 2 – 7 ) 0.342 Values represented as n (%). *Median (interquartile range). Abbreviations: body mass index (BMI); Eastern Cooperative Oncology Group (ECOG). Table 2 reports the results from univariable and multivariable logistic regression analyses examining factors potentially associated with meeting recommended acutherapy cadence. On univariable analysis, both non-white race (OR 0.64, 95% CI 0.42–0.98; p = 0.039) and active treatment (OR 0.59, 95% CI 0.40–0.88; p = 0.010) were associated with decreased likelihood of completing 8 or more visits. When adjusting for the listed factors in the multivariable analysis, race and cancer status remained significant predictors of recommended acutherapy visit completion. Patients of non-white race (OR 0.63, 95% CI 0.40–0.99); p = 0.047) were 37% less likely to complete all 8 visits, while patients undergoing active treatment (OR 0.55, 95% CI 0.36–0.84; p = 0.005) were 45% less likely. Table 2 Logistic regression models to examine factors associated with meeting recommended acutherapy cadence Univariable Multivariable Covariate OR (95% CI) p-value OR (95% CI) p-value Male Sex 1.05 (0.66–1.67) 0.846 1.05 (0.64–1.72) 0.855 Age (years, continuous) 1.01 (0.99–1.02) 0.495 1.01 (0.99–1.02) 0.486 Non-White 0.64 (0.42–0.98) 0.039 0.63 (0.40–0.99) 0.047 Obesity (BMI > 30 kg/m2) 0.97 (0.63–1.51) 0.898 1.11 (0.69–1.79) 0.666 2 or more symptoms 1.40 (0.89–2.21) 0.141 1.49 (0.92–2.41) 0.107 Active Treatment 0.59 (0.40–0.88) 0.010 0.55 (0.36–0.84) 0.005 ECOG 1+ 0.95 (0.63–1.42) 0.787 0.95 (0.61–1.50) 0.830 Physical Functioning* 0.84 (0.56–1.25) 0.386 0.86 (0.48–1.52) 0.595 Anxiety* 0.85 (0.55–1.30) 0.443 1.08 (0.63–1.83) 0.781 Depression* 0.67 (0.39–1.15) 0.144 0.58 (0.30–1.13) 0.111 Fatigue* 1.02 (0.68–1.53) 0.921 1.22 (0.72–2.06) 0.457 Sleep* 0.83 (0.52–1.32) 0.437 0.79 (0.47–1.32) 0.367 Social Functioning* 1.00 (0.63–1.59) 0.990 1.36 (0.73–2.52) 0.328 Pain Interference* 0.89 (0.60–1.33) 0.577 0.96 (0.55–1.71) 0.900 429 total observations included. *Moderate-to-severe symptomatology on PROMIS-29 Changes in PROMIS-29 According to Race In the group meeting the 8 visit threshold, there were 48 (31.4%) non-white and 105 (68.6) white patients. Of the non-white population, 41 (28.8%) were Black, 6 were Asian (3.9%), and 1 Native Hawaiian (0.7%). Table 3 represents baseline demographic and PROMIS-29 differences according to race. Non-white patients had higher BMI (28.0 vs. 25.4 kg/m 2 ; p = 0.031), worse ECOG (≥ 1: 56.3% vs. 34.3%; p = 0.010), and greater burden of PROMIS-29 domains reaching moderate-to-severe classification (Total #: 3 vs. 1; p = 0.005 | any presence: 83.3% vs. 65.7%; p = 0.025) than white patients. There were no other differences in age, sex, number of self-reported symptoms, cancer status, or delayed acutherapy. The median number of visits per week was 0.71–0.73 between groups (p = 0.339). At the time of most recent acutherapy session, non-white patients demonstrated greater burden in moderate-to-severe symptomatology (Total #: 2 vs. 0; p < .001 | any presence: 77.1% vs. 46.7%; p < .001), although there was no statistically significant difference in domain improvement between groups with 63.8% of white patients reporting at least 1 moderate-to-severe domain improvement versus 45.0% in non-white patients (p = 0.057). Table 3 Demographics and PROMIS-29 Features According to Race Covariate White Population (n = 105) Non-White (n = 48) p-value Age (years) 60 (52–68) 57 (50–64) 0.365 Sex Male 21 (20.0) 13 (27.1) 0.328 Female 84 (80.0) 35 (72.9) BMI (kg/m2) 25.4 (22.8–28.5) 28.0 (22.7–34.9) 0.031 Number of SXS 2 ( 2 – 3 ) 2 ( 1 – 3 ) 0.746 Cancer Status Active Treatment 52 (49.5) 20 (41.7) 0.366 Survivor 53 (50.5) 28 (58.3) ECOG 0 69 (65.7) 21 (43.8) 0.010 1+ 36 (34.3) 27 (56.3) Visits per Week 0.71 (0.55–0.89) 0.73 (0.57-1.00) 0.339 Delayed Treatment 60 (57.1) 27 (56.3) 0.340 # of Baseline Moderate/Severe Domains 1 (0–3) 3 ( 1 – 4 ) 0.005 Any Baseline Moderate/Severe Domain 69 (65.7) 40 (83.3) 0.025 # of Post-acutherapy Moderate/Severe Domains 0 (0–2) 2 ( 1 – 4 ) < .001 Any Post-acutherapy Moderate/Severe Domains 49 (46.7) 37 (77.1) < .001 # of Moderate/Severe Domains Improved 0 (-1-0) 0 (-2-0) 0.498 Any Moderate/Severe Domain Improvement 44 (63.8) 18 (45.0) 0.057 Abbreviations: body mass index (BMI, kg/m2); symptoms (SXS); Eastern Cooperative Oncology Group (ECOG). Supplemental Table 2 indicates the PROMIS-29 classification at the time of the very first to the most recent acutherapy session by race. There was a significantly higher rate of baseline moderate/severe impairment in physical functioning (54.2% vs. 32.4%; p = 0.019) and pain interference (62.5% vs. 34.3%; p = 0.005) among non-white patients. This trend was again seen on the post-therapy questionnaire with greater moderate/severe impairment in physical function (50.0% vs. 18.1%; p < .001), pain interference (60.4% vs. 27.6%; p = 0.001), along with social function (33.3% vs. 11.4%; p = 0.004). This is consistent with the findings in Fig. 1 , which show a lower proportion of improvement in physical function (20.6% vs. 50.0%; p = 0.018) and social function (28.6% vs. 57.5%; p = 0.035) for non-white patients versus white patients. Changes in PROMIS-29 According to Cancer Status There were 72 (47.1%) active treatment and 81 (52.9%) survivorship patients meeting recommended visit threshold. Table 4 shows all the baseline features for these groups. There were no differences in age, sex, BMI, self-reported symptoms, race, or ECOG. The median number of visits per week was 0.69–0.73 across groups (p = 0.405). The survivorship group had a slightly higher proportion of patients with any baseline moderate/severe domain symptomatology (74.1% vs. 68.1%), however, this was not statistically significant (p = 0.412). Furthermore, there was no difference in the rate of any domain improvement between these groups (55.0% vs. 59.2%; p = 0.661). Table 4 Demographics and PROMIS-29 features according to cancer status Covariate Active Treatment (n = 72) Survivorship (n = 81) p-value Age (years) 59 (50–67) 58 (52–68) 0.892 Sex Male 16 (22.2) 18 (22.2) 1.000 Female 56 (77.8) 63 (77.8) BMI (kg/m2) 25.8 (22.5–28.7) 26.4 (23.0-31.3) 0.220 Number of SXS 2 ( 2 – 3 ) 2 ( 2 – 3 ) 0.922 Race White 52 (72.2) 53 (65.4) 0.366 Non-White 20 (27.8) 28 (34.6) ECOG 0 37 (51.4) 53 (65.4) 0.078 1+ 35 (48.6) 28 (34.6) Visits per Week 0.69 (0.56–0.89) 0.73 (0.56-1.00) 0.405 Delayed Treatment 43 (59.7) 44 (54.3) 0.501 # of Baseline Moderate/Severe Domains 1 (0–4) 2 (0–3) 0.886 Any Baseline Moderate/Severe Domain 49 (68.1) 60 (74.1) 0.412 # of Post-acutherapy Moderate/Severe Domains 1 (0–3) 1 (0–2) 0.822 Any Post-acutherapy Moderate/Severe Domains 36 (50.0) 50 (61.7) 0.144 # of Moderate/Severe Domains Improved 0 (-1-0) 0 (-1-0) 0.889 Any Moderate/Severe Domain Improvement 29 (59.2) 33 (55.0) 0.661 Abbreviations: body mass index (BMI, kg/m2); symptoms (SXS); Eastern Cooperative Oncology Group (ECOG). Supplemental Table 3 indicates the PROMIS-29 classification from the baseline to the post-treatment session by cancer status. There were no differences in domain categorization, with moderate-to-severe pain interference at baseline (40.7% vs. 45.8%; p = 0.773) and post-therapy (37.0% vs. 28.9%; p = 0.846) representing the most common problem between survivorship and active treatment patients. In Fig. 2 there were no differences in PROMIS-29 domain changes according to cancer status. It should be noted, that although being the most common moderate/severe problem, pain interference improvement occurred in 31.4–34.7% of patients. Greatest rates of improvement were seen with anxiety (54.8–58.7%) and depression (52.6–72.0%). Factors Influencing PROMIS-29 Improvement Post-Acutherapy Table 5 reports the results from univariable and multivariable logistic regression analyses examining factors potentially associated with improvement in any PROMIS-29 domain post-acutherapy. On univariable analysis, obesity (BMI > 30kg/m 2 ) decreased likelihood of improvement following a recommended session regimen (OR 0.47, 95% CI 0.22–0.99; p = 0.048). Upon adjusting for listed factors, patients with obesity (OR 0.44, 95% CI 0.20–0.99; p = 0.046) and delay in treatment sessions (OR 0.43, 95% CI 0.20–0.92; p = 0.029) were significantly less likely in demonstrating improvement on PROMIS-29. Table 5 Logistic regression models to examine factors associated with any PROMIS-29 domain improvement Univariable Multivariable Covariate OR (95% CI) p-value OR (95% CI) p-value Male Sex 1.38 (0.59–3.23) 0.453 1.28 (0.51–3.22) 0.607 Age (years, continuous) 0.98 (0.96–1.01) 0.281 0.98 (0.94–1.01) 0.120 Non-White 0.76 (0.37–1.56) 0.461 0.90 (0.41–1.96) 0.790 Obesity (BMI > 30 kg/m2) 0.47 (0.22–0.99) 0.048 0.44 (0.20–0.99) 0.046 Delayed Acutherapy 0.51 (0.26–1.03) 0.060 0.43 (0.20–0.92) 0.029 Active Treatment 1.67 (0.84–3.31) 0.142 1.87 (0.89–3.91) 0.099 ECOG 1+ 0.73 (0.37–1.45) 0.374 0.61 (0.29–1.30) 0.199 136 total observations included Discussion The present paper investigated factors that are associated with the completion of a recommended acupuncture regimen at an NCI-designated cancer center. Non-white race was an important barrier that decreased the likelihood of regimen completion, along with undergoing active cancer treatment. Among those that attended at least 8 sessions, non-white patients were found to have greater baseline and post-therapy burden of moderate-to-severe impairment in physical functioning and pain interference. Notably, patients with obesity and weekly delay in sessions were less likely to report any domain improvement as measured on PROMIS-29. Barriers to Acutherapy Regimen Completion One-third of patients successfully met the recommended acutherapy regimen, while non-white and active cancer treatment patients were less likely to attain this goal. This may exacerbate existing social and health inequities that hinder patients of color disproportionately, including reduced access to integrative therapies and high cost of treatment without partial insurance coverage. 7–9,11 Future studies need to explore the specific factors that may contribute to our observed racial disparity. Preferably, this would entail qualitative research interviewing patients, informal caregivers, and healthcare providers regarding their attitudes toward integrative regimens. In addition, the patient health-belief model and expectations from acupuncture should be explored, and whether racial and cultural factors contribute to the perception of complementary medicine. Active treatment patients have a greater number of appointments and costs due to ongoing treatment, which may reduce availability in scheduling for acupuncture and affordability amid standard care. They also report higher levels of disease and treatment-related symptoms such as fatigue and pain. 22 This potentially heightens mobility issues and limits how many acupuncture visits patients can attend. Identifying these barriers is useful to understand how to aid patients in meeting the necessary regimen cadence and optimizing their benefit from acutherapy. Differences in PROMIS-29 Domains Following Acutherapy Overall, the study’s findings emphasize the effectiveness of acupuncture as a treatment modality for patients with cancer and highly varied symptomatology. Across each PROMIS-29 domain, approximately 90% reported stability or improvement of symptoms. There is a trend of improvement posttreatment across race and cancer status when following the recommended regimen. The present cohort included a fairly diverse sample not limited to sociodemographic factors but cancer diagnosis and status as well. These results support prior literature on the general benefit of acupuncture as adjunct integrative care for cancer populations. 1–3 However, it is important to note that baseline and follow-up scores of several PROMIS-29 domains were significantly higher for non-white patients. These were pain interference, physical function, and social participation. Existing determinants of health could explain why racial minorities report higher initial symptom burden and severity. Research shows a greater prevalence of poor disease outcomes for non-white groups, particularly Black and Hispanic individuals, across multiple malignancies. 23,24 Increased problems with chronic pain and general pain management are specifically reported in Black cancer patients. 25 Similarly, non-white patients have less favorable outcomes in domains of physical and social functioning from diagnosis through survivorship. 26 They report higher levels of distress, emotional fatigue, and weakness at baseline and follow-up. This may elucidate why patients in the current study had higher scores in associated PROMIS-29 domains before and after receiving acupuncture. PROMIS-29 Domain Improvements Following Acutherapy While acupuncture is effective in managing cancer-related symptoms, significant disparities exist. Findings indicate that race and cancer status are factors that negatively impact patients' successful completion of the recommended regimen. However, analysis of prospectively collected PROMIS-29 data at baseline and follow-up showed no difference in patient-reported outcomes across groups. What were significant factors in lowering the probability of improvement were obesity and weekly delays in treatment. In a study from Cao et al examining the impact of acupuncture on insulin sensitivity among patients with polycystic ovarian syndrome, those with lean body mass experienced a greater response than those classified as overweight or obese. 27 This may suggest excess body mass represents a physical barrier to acupuncture needles. However, there is an extensive meta-analysis supporting acupuncture as an efficacious adjunct in reducing BMI and waist circumference. 28 Although it should be noted, those studies included patients undergoing 3–12 week adjunct regimens targeted for diabetes treatment and weight loss in contrast to our cohort. The average rate of acupuncture visits per week was approximately 0.7, which failed to meet our goal of 0.75 visits per week. Notably, patients who fell below this threshold were less likely to experience improvement in any PROMIS-29 domain following completion of the acutherapy regimen. In a meta-analysis of 23 randomized controlled trials from Chen et al evaluating appropriate acupuncture schedules in treating chronic pain, at least 2 sessions or more per week resulted in significant high pain relief during follow-up. Although their patient populations were far more heterogeneous, pain interference was the most commonly affected domain among our cancer patients, which supports such a regimen for our patients. This is an important barrier to focus on and to consider whether implementing a more frequent schedule of at least 1.0 visits per week is feasible and would result in even greater improvement. Limitations and Strengths Findings from the present study must be set in the context of several limitations. Approximately 70% of enrolled patients were diagnosed with either breast, head and neck, colorectal cancer, or multiple myeloma. This suggests that results may not be generalizable across other malignancies or to any specific site. Researching cohorts that are diverse across malignancies would be helpful to understand how underrepresented cancer types benefit from a recommended acutherapy regimen. Established literature does not mention the use of the PROMIS-29 questionnaire to evaluate the effectiveness of an acutherapy regimen in an oncology setting. While this instrument includes several domains of functioning and well-being, it does not encapsulate the breadth of cancer-related symptomatology that patients report during their initial intake. Some common symptoms such as fatigue, mood, and pain strongly overlap with PROMIS-29 domains. However, this measure does not account for other prevalent symptoms like nausea or peripheral neuropathy, which may disproportionately affect patients depending on cancer type. 4,5 This study supports the utilization of the PROMIS-29 questionnaire to gauge self-reported assessment of functioning and well-being following an acutherapy regimen. Supplemental studies could include other measures, besides the PROMIS-29 questionnaire, that target malignancy- or treatment-specific symptoms in more detail. Furthermore, notable benefits included the prospective data collection along with a racially diverse patient population (~ 30% self-identifying as non-white). Given that patients of color report greater barriers to healthcare access in general, examining racial differences helped identify the existing needs and limitations of the present community when establishing and completing cancer treatment. 8,9 Oncology teams could include patient identifiers throughout the referral screening process to facilitate scheduling racial minorities for acupuncture visits and other integrative care. In addition, socioeconomic status is a known factor influencing the health status, mortality and morbidity of a population. Calculating socioeconomic status using specific markers such as zip code, employment, and income would be a more direct measure in future studies rather than relying on race as a proxy. Notably, Black patients represented the majority of our non-white population, to which we further recommend multi-site research studies to include greater representation of other minority populations and their perceptions with integrative oncology regimens. Conclusions Race and active cancer treatment were notable barriers to completion of a recommended acutherapy regimen. In addition, despite improvements in well-being and functioning domains following acutherapy, non-white cancer patients face greater burdens in pain, physical functioning, and social participation both before and after treatment. Care should be taken to address these disparities while ensuring appropriate schedule adherence to an acutherapy regimen to maximize benefit among cancer patients seeking complementary treatment. Declarations Ethics approval and consent to participate Emory University IRB approval via STUDY00005177 Consent for publication All relevant information was deidentified and no individual patient health information is present within this publication. Availability of data and materials Individual participant data that underlie the results reported in this article, after deidentification can be made available upon reasonable request by investigators who provide a methodologically sound proposal following publication. Proposals should be directed to the corresponding author. To gain access, data requestors will need to sign a data access agreement. Competing interests The authors have no competing interests to report. Funding There is no formal funding for this research. This is an adjunctive supportive care service for established patients at Winship Cancer Institute that is provided as a courtesy free of charge and funded via Shared Essential Services. Authors’ contributions All authors were responsible for the conception and design of the project. Authors MGZ, BH, MM, AC, DP, and AB participated in the initial data collection. Author DP was responsible for database management and data curation. Author EHN was responsible for primary data analysis. Authors MGZ, EHN, and AB were responsible for initial interpretation of results and preparation of tables, figures and early manuscript. Author EBA participated in the final editing of the manuscript. All authors participated in editing and revising the final manuscript for publication. Author VAM was responsible for the senior leadership and securing funding. Acknowledgments There are no further acknowledgments. References Zia FZ, Olaku O, Bao T et al. The National Cancer Institute’s Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps. J Natl Cancer Inst Monogr. 2017;2017(52). 10.1093/jncimonographs/lgx005 . Birch S, Lee MS, Alraek T, Kim TH. Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review. Integr Med Res. 2019;8(3):160–6. de Valois B, Young T, Zollman C, et al. Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion). Support Care Cancer. 2024;32(4):229. Ben-Arye E, Hausner D, Samuels N, et al. Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer. 2022;128(20):3641–52. Garland SN, Xie SX, DuHamel K, et al. Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. J Natl Cancer Inst. 2019;111(12):1323–31. Mao JJ, Liou KT, Baser RE, et al. Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial. JAMA Oncol. 2021;7(5):720–7. Veleber S, Cohen MR, Weitzman M, et al. 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. 2024;23:15347354241226640. Desai K, Liou K, Liang K, Seluzicki C, Mao JJ. Availability of Integrative Medicine Therapies at National Cancer Institute-Designated Comprehensive Cancer Centers and Community Hospitals. J Altern Complement Med. 2021;27(11):1011–3. Mao JJ, Tan T, Li SQ, Meghani SH, Glanz K, Bruner D. Attitudes and barriers towards participation in an acupuncture trial among breast cancer patients: a survey study. BMC Complement Altern Med. 2014;14:7. Molassiotis A, Bardy J, Finnegan-John J, et al. Acupuncture for Cancer-Related Fatigue in Patients With Breast Cancer: A Pragmatic Randomized Controlled Trial. J Clin Orthod. 2012;30(36):4470–6. Mao JJ, Palmer CS, Healy KE, Desai K, Amsterdam J. Complementary and alternative medicine use among cancer survivors: a population-based study. J Cancer Surviv. 2011;5(1):8–17. Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS®-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27(7):1885–91. Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63(11):1179–94. Rose M, Bjorner JB, Gandek B, Bruce B, Fries JF, Ware JE Jr.. The PROMIS Physical Function item bank was calibrated to a standardized metric and shown to improve measurement efficiency. J Clin Epidemiol. 2014;67(5):516–26. Lai JS, Cella D, Choi S, et al. How item banks and their application can influence measurement practice in rehabilitation medicine: a PROMIS fatigue item bank example. Arch Phys Med Rehabil. 2011;92(10 Suppl):S20–7. Amtmann D, Cook KF, Jensen MP, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173–82. Pilkonis PA, Choi SW, Reise SP, et al. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment. 2011;18(3):263–83. Hahn EA, DeWalt DA, Bode RK, et al. New English and Spanish social health measures will facilitate evaluating health determinants. Health Psychol. 2014;33(5):490–9. Buysse DJ, Yu L, Moul DE, et al. Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments. Sleep. 2010;33(6):781–92. Cella D, Choi S, Garcia S, et al. Setting standards for severity of common symptoms in oncology using the PROMIS item banks and expert judgment. Qual Life Res. 2014;23(10):2651–61. Rothrock NE, Cook KF, O’Connor M, Cella D, Smith AW, Yount SE. Establishing clinically-relevant terms and severity thresholds for Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures of physical function, cognitive function, and sleep disturbance in people with cancer using standard setting. Qual Life Res. 2019;28(12):3355–62. Bouffard KJ, Koyyalagunta L, Abdi S, Hernandez M, Novy DM. Differences in pain, symptom burden, and opioid use among cancer pain patients with active versus non-active disease. J Clin Orthod. 2013;31(15suppl):e20568–20568. Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7(2):525–35. Yoon SL, Scarton L, Duckworth L, et al. Pain, symptom distress, and pain barriers by age among patients with cancer receiving hospice care: Comparison of baseline data. J Geriatr Oncol. 2021;12(7):1068–75. Bonds Johnson K, Bai J, Waldrop D, et al. Barriers to Pain Management: Incongruence in Black Cancer Caregiving Dyads. J Pain Symptom Manage. 2022;63(5):711–20. Madison AA, Peng J, Shrout MR, et al. Distress Trajectories in Black and White Breast Cancer Survivors: From Diagnosis to Survivorship. Psychoneuroendocrinology. 2021;131:105288. Cao J, Nie G, Dai Z, Shan D, Wei Z. Comparative effects of acupuncture and metformin on insulin sensitivity in overweight/obese and lean women with polycystic ovary syndrome and insulin resistance: a post hoc analysis of a randomized trial. Front Med. 2023;10:1232127. Wang Y, Xu GN, Wan RH, et al. Acupuncture in treating obesity combined with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled clinical trials. Complement Ther Clin Pract. 2022;49:101658. Additional Declarations No competing interests reported. Supplementary Files AdditionalMaterialssupplementaltables.docx SUPPTABLE1PreandPostPROMISCategoriesbyrace.xlsx SUPPTABLE2PreandPostPROMISCategoriesbycancerstatus.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Jul, 2024 Editor assigned by journal 04 Jul, 2024 Submission checks completed at journal 04 Jul, 2024 First submitted to journal 12 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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In a randomized trial from Ben-Arye et al, cancer patients with chemotherapy-induced peripheral neuropathy who completed at least 6 weekly appointments reported significant posttreatment improvement.\u003csup\u003e4\u003c/sup\u003e Notably, two other clinical trials have suggested that regimens extending past 8 weeks demonstrate the greatest benefit at follow-up for insomnia and pain in survivorship patients.\u003csup\u003e5,6\u003c/sup\u003e Thus, meeting a 6-to-8 acupuncture session minimum, preferably weekly, is critical to observe significant change in patient-reported outcomes following treatment.\u003c/p\u003e \u003cp\u003eExternal barriers can significantly hinder patients\u0026rsquo; treatment adherence and may interfere with treatment delivery. Multiple studies have highlighted how financial burden and limited insurance coverage, particularly among patients from lower-income communities, reduce nationwide accessibility to acupuncture in patients seeking adjunctive care.\u003csup\u003e7\u003c/sup\u003e A collaborative study conducted at private and public cancer sites showed there is decreased availability and utilization of integrative therapies in neighborhoods that are underserved with a greater proportion of residents of color.\u003csup\u003e8\u003c/sup\u003e This pattern is often a byproduct of socio-demographic factors such as race, educational achievement, and household income, which limits knowledge and access to integrative care in oncology settings. In addition, non-white patients with fewer years of education report more perceived barriers to acupuncture use.\u003csup\u003e9\u003c/sup\u003e Lack of insurance coverage for integrative therapies and exorbitant treatment-related costs may thus introduce obstacles for cancer patients seeking acupuncture as adjunctive care.\u003c/p\u003e \u003cp\u003eAlthough accessibility varies from patient to patient, established research supports the relationship between acupuncture and relief of cancer-related symptoms. Study findings suggest a decrease in symptom severity after a recommended 6\u0026ndash;8 week regimen for domains not limited to peripheral neuropathy, insomnia, and musculoskeletal pain;\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e sampled participants included active and survivorship patients who were diagnosed with prostate or gynecological cancer and hematological malignancies. In a randomized controlled trial by Molassiotis et al, breast cancer patients who had completed chemotherapy demonstrated improvements in mood and physical-social functioning following a 6-week acupuncture regimen.\u003csup\u003e10\u003c/sup\u003e Patients in the control group received standard care without integrative therapies and noted improvement in patient-reported outcomes at a lesser rate than the intervention group. Breast cancer survivors also report chronic pain reduction and general wellness maintenance to minimize potential recurrence.\u003csup\u003e11\u003c/sup\u003e These symptoms contribute to overall quality of life, emphasizing the importance of facilitating access to acupuncture and related therapies for patient populations across malignancies, and treatment status.\u003c/p\u003e \u003cp\u003eThis study, featuring a large and racially diverse cohort seen at an NCI-designated cancer center, primarily investigates factors impacting patients\u0026rsquo; ability to complete a recommended acupuncture regimen. In addition, this study will help to validate the utilization of the PROMIS-29 in a heterogenous cancer cohort receiving acutherapy and characterize differences in domain symptomatology according to race and cancer treatment status.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Inclusion Characteristics\u003c/h2\u003e \u003cp\u003eThe Integrative Oncology Service treated established patients in the Winship Cancer Institute at Emory University from May 2022 to January 2024. Patients who attended at least 1 group acutherapy session were prospectively enrolled and included in this study. Baseline information, including patient sex, race, age, body mass index (BMI, kg/m\u003csup\u003e2\u003c/sup\u003e), Eastern Cooperative Oncology Group performance status (ECOG), cancer type, and cancer status (active treatment vs. survivorship) were documented. General questions regarding most bothersome symptomatology were asked at intake, which was later categorized by number of symptoms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAcupuncture Regimen Structure\u003c/h2\u003e \u003cp\u003ePatients were referred by their oncology health care professional and screened for eligibility criteria, including cancer diagnosis and being at least 18 years of age. Acupuncture visits were scheduled at one-week intervals, and each session had a duration of 30 minutes. Treatments were performed in a small group setting by a licensed acupuncturist. Patients were able to list up to 3 symptoms to be targeted by acupuncture. Acupuncture points were selected for each patient using established institutional protocols, designed to target specific acupuncture points according to the most common self-reported symptoms (\u003cb\u003eSupplemental Table\u0026nbsp;1\u003c/b\u003e). There were no acupuncture-related adverse events reported.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePROMIS-29 Assessment\u003c/h2\u003e \u003cp\u003eThe PROMIS-29\u0026copy; v2.0 questionnaire (Patient-Reported Outcomes Measurement Information System) was administered to patients at intake and follow-up. The PROMIS is a National Institutes of Health initiative developed to measure self-reported assessments of functioning and well-being.\u003csup\u003e12\u003c/sup\u003e This measures pain intensity using a 0\u0026ndash;10 numeric scale and seven physical and mental health domains: physical function, anxiety, depression, fatigue, sleep, social functioning, and pain interference. These domains have been tested, validated, and further calibrated in tens of thousands of patients, particularly among patients with cancer, to generate standardized scores associated with responses.\u003csup\u003e13\u0026ndash;19\u003c/sup\u003e Patients were then categorized into Normal, Mild, Moderate, or Severe domain symptomatology according to established cutoffs.\u003csup\u003e20,21\u003c/sup\u003e Patients with any missing or incomplete information were excluded from this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eObjectives and Statistical Analyses\u003c/h2\u003e \u003cp\u003ePrimary objective of the study was to assess factors associated with completion of recommended acutherapy cadence. The threshold for meeting regimen completion was defined as at least 8 visits. Categorical variables were reported as total numbers with percentages, while continuous variables were reported as median values with interquartile range (IQR). Patients were first dichotomized according to the visit threshold, and variable comparisons between groups were analyzed using Chi-square test for categorical and Ranksum test for continuous variables. Univariable and multivariable logistic regression models were then constructed to examine factors associated with completion of 8 or more acutherapy sessions. Models were adjusted for sex, age (years), race, BMI, number of self-reported symptoms, cancer status, ECOG, and baseline scores in the PROMIS-29 domains. The inclusion of baseline PROMIS-29 categorization was to adjust for potential disease or symptom severity. Results were reported with odds ratios (OR) and 95% confidence intervals (CI). Statistical significance was indicated by p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe secondary objectives were to evaluate differences in pre-to-post-treatment PROMIS-29 scores according to race and cancer status. Patients who did not complete 8 or more visits were excluded from these subgroup analyses. Among this cohort, the number of visits per week was calculated since there was variation in the maximum number of sessions attended (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Patients were stated to have delayed treatment if the time to attend 8 visits surpassed 70 days or 110 days for 12 visits, which approximates at least 3 visits over 4 weeks. Chi-square test for categorical and Ranksum test for continuous variables was used to test for differences according to race and cancer status.\u003c/p\u003e \u003cp\u003eFurthermore, PROMIS-29 domain classification change was recorded from baseline to most recent acutherapy session for patients with mild, moderate, or severe symptomatology. Patients were labeled as improved if post-acutherapy domain classification changed from moderate/severe to mild/normal or from mild to normal. Stable referred to no change in domain classification, and worsened referred to development of moderate/severe symptomatology. Changes in classification were compared using Chi-square test according to race and cancer status. Finally, logistic regression models were constructed to evaluate factors associated with any domain improvement among patients with a documented mild-to-severe level of symptoms. Variables adjusted for included age (years), race, sex, BMI, ECOG, acutherapy delay, and cancer status. All statistical analyses were performed using Stata/SE v15.1 (StataCorp LLC; College Station, TX).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Acutherapy Regimen Completion\u003c/h2\u003e \u003cp\u003eThere were 432 patients included: 153 (35.1%) met the 8-visit threshold. The most represented primary cancer sites were breast (216; 50.0%), head and neck (65; 15.1%), multiple myeloma (23; 5.3%), and colorectal (21; 4.9%), with no other site representing greater than 3% of the total cohort. There were 133 Black-identifying patients (30.8%), 16 Asian (3.7%), and 4 American Indian or Native Hawiian (0.9%). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates the baseline features according to recommended visit completion. There was no difference in age (59 vs. 58 years; p\u0026thinsp;=\u0026thinsp;0.664), sex (female: 76.3% vs. 77.1%; p\u0026thinsp;=\u0026thinsp;0.846), BMI (obesity, \u0026gt;\u0026thinsp;30kg/m\u003csup\u003e2\u003c/sup\u003e: 27.6% vs. 28.2%; p\u0026thinsp;=\u0026thinsp;0.898), symptom burden (\u0026ge;\u0026thinsp;2: 76.3% vs. 69.6%; p\u0026thinsp;=\u0026thinsp;0.140), or ECOG (\u0026ge;\u0026thinsp;1: 36.2% vs. 37.5%; p\u0026thinsp;=\u0026thinsp;0.787) between \u0026ge;\u0026thinsp;8 visits vs. \u0026lt;8 visit groups, respectively. In the 8 or more visit group, there was a significantly lower proportion of non-white patients (28.9% vs. 38.9%; p\u0026thinsp;=\u0026thinsp;0.038) and patients undergoing active treatment (46.7% vs. 59.6%; p\u0026thinsp;=\u0026thinsp;0.010). No differences were observed in PROMIS-29 domain scoring between the groups. The most commonly rated domain was Pain Interference with 21.1\u0026ndash;23.2% reporting mild symptomatology and 42.8\u0026ndash;45.4% reporting moderate-to-severe symptomatology. Median pain intensity was 4 (IQR 2\u0026ndash;7) across both groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Features According to Completion of Recommended Acutherapy Cadence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8 Visits (n\u0026thinsp;=\u0026thinsp;152)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8 Visits (n\u0026thinsp;=\u0026thinsp;280)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216 (77.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (50\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (49\u0026ndash;67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (38.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eObesity (BMI\u0026thinsp;\u0026gt;\u0026thinsp;30kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 or More Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195 (69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCancer Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvivor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (40.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eECOG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;1 Moderate/Severe Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical Functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (19.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (41.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (33.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173 (62.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (20.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFatigue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (39.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (17.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (26.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (52.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (26.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (24.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain Interference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (23.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (45.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain Intensity (0\u0026ndash;10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eValues represented as n (%). *Median (interquartile range). Abbreviations: body mass index (BMI); Eastern Cooperative Oncology Group (ECOG).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reports the results from univariable and multivariable logistic regression analyses examining factors potentially associated with meeting recommended acutherapy cadence. On univariable analysis, both non-white race (OR 0.64, 95% CI 0.42\u0026ndash;0.98; p\u0026thinsp;=\u0026thinsp;0.039) and active treatment (OR 0.59, 95% CI 0.40\u0026ndash;0.88; p\u0026thinsp;=\u0026thinsp;0.010) were associated with decreased likelihood of completing 8 or more visits. When adjusting for the listed factors in the multivariable analysis, race and cancer status remained significant predictors of recommended acutherapy visit completion. Patients of non-white race (OR 0.63, 95% CI 0.40\u0026ndash;0.99); p\u0026thinsp;=\u0026thinsp;0.047) were 37% less likely to complete all 8 visits, while patients undergoing active treatment (OR 0.55, 95% CI 0.36\u0026ndash;0.84; p\u0026thinsp;=\u0026thinsp;0.005) were 45% less likely.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression models to examine factors associated with meeting recommended acutherapy cadence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale Sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05 (0.66\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.05 (0.64\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years, continuous)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.99\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01 (0.99\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-White\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.64 (0.42\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63 (0.40\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eObesity (BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.97 (0.63\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.11 (0.69\u0026ndash;1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 or more symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.40 (0.89\u0026ndash;2.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.49 (0.92\u0026ndash;2.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActive Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59 (0.40\u0026ndash;0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55 (0.36\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eECOG 1+\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.63\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95 (0.61\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical Functioning*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.56\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86 (0.48\u0026ndash;1.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.55\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08 (0.63\u0026ndash;1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67 (0.39\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58 (0.30\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFatigue*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.68\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.22 (0.72\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83 (0.52\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 (0.47\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Functioning*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.63\u0026ndash;1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.36 (0.73\u0026ndash;2.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain Interference*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89 (0.60\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.96 (0.55\u0026ndash;1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e429 total observations included. *Moderate-to-severe symptomatology on PROMIS-29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eChanges in PROMIS-29 According to Race\u003c/h2\u003e \u003cp\u003eIn the group meeting the 8 visit threshold, there were 48 (31.4%) non-white and 105 (68.6) white patients. Of the non-white population, 41 (28.8%) were Black, 6 were Asian (3.9%), and 1 Native Hawaiian (0.7%). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e represents baseline demographic and PROMIS-29 differences according to race. Non-white patients had higher BMI (28.0 vs. 25.4 kg/m\u003csup\u003e2\u003c/sup\u003e; p\u0026thinsp;=\u0026thinsp;0.031), worse ECOG (\u0026ge;\u0026thinsp;1: 56.3% vs. 34.3%; p\u0026thinsp;=\u0026thinsp;0.010), and greater burden of PROMIS-29 domains reaching moderate-to-severe classification (Total #: 3 vs. 1; p\u0026thinsp;=\u0026thinsp;0.005 | any presence: 83.3% vs. 65.7%; p\u0026thinsp;=\u0026thinsp;0.025) than white patients. There were no other differences in age, sex, number of self-reported symptoms, cancer status, or delayed acutherapy. The median number of visits per week was 0.71\u0026ndash;0.73 between groups (p\u0026thinsp;=\u0026thinsp;0.339). At the time of most recent acutherapy session, non-white patients demonstrated greater burden in moderate-to-severe symptomatology (Total #: 2 vs. 0; p\u0026thinsp;\u0026lt;\u0026thinsp;.001 | any presence: 77.1% vs. 46.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), although there was no statistically significant difference in domain improvement between groups with 63.8% of white patients reporting at least 1 moderate-to-severe domain improvement versus 45.0% in non-white patients (p\u0026thinsp;=\u0026thinsp;0.057).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and PROMIS-29 Features According to Race\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite Population (n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-White (n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (52\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (50\u0026ndash;64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (72.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.4 (22.8\u0026ndash;28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0 (22.7\u0026ndash;34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of SXS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCancer Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvivor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (58.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eECOG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (56.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVisits per Week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71 (0.55\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73 (0.57-1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e# of Baseline Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Baseline Moderate/Severe Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e# of Post-acutherapy Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Post-acutherapy Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e# of Moderate/Severe Domains Improved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (-1-0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (-2-0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Moderate/Severe Domain Improvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: body mass index (BMI, kg/m2); symptoms (SXS); Eastern Cooperative Oncology Group (ECOG).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSupplemental Table\u0026nbsp;2\u003c/b\u003e indicates the PROMIS-29 classification at the time of the very first to the most recent acutherapy session by race. There was a significantly higher rate of baseline moderate/severe impairment in physical functioning (54.2% vs. 32.4%; p\u0026thinsp;=\u0026thinsp;0.019) and pain interference (62.5% vs. 34.3%; p\u0026thinsp;=\u0026thinsp;0.005) among non-white patients. This trend was again seen on the post-therapy questionnaire with greater moderate/severe impairment in physical function (50.0% vs. 18.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), pain interference (60.4% vs. 27.6%; p\u0026thinsp;=\u0026thinsp;0.001), along with social function (33.3% vs. 11.4%; p\u0026thinsp;=\u0026thinsp;0.004). This is consistent with the findings in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which show a lower proportion of improvement in physical function (20.6% vs. 50.0%; p\u0026thinsp;=\u0026thinsp;0.018) and social function (28.6% vs. 57.5%; p\u0026thinsp;=\u0026thinsp;0.035) for non-white patients versus white patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eChanges in PROMIS-29 According to Cancer Status\u003c/h2\u003e \u003cp\u003eThere were 72 (47.1%) active treatment and 81 (52.9%) survivorship patients meeting recommended visit threshold. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows all the baseline features for these groups. There were no differences in age, sex, BMI, self-reported symptoms, race, or ECOG. The median number of visits per week was 0.69\u0026ndash;0.73 across groups (p\u0026thinsp;=\u0026thinsp;0.405). The survivorship group had a slightly higher proportion of patients with any baseline moderate/severe domain symptomatology (74.1% vs. 68.1%), however, this was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.412). Furthermore, there was no difference in the rate of any domain improvement between these groups (55.0% vs. 59.2%; p\u0026thinsp;=\u0026thinsp;0.661).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and PROMIS-29 features according to cancer status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive Treatment (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvivorship (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (50\u0026ndash;67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (52\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.8 (22.5\u0026ndash;28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.4 (23.0-31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of SXS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eECOG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVisits per Week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.69 (0.56\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73 (0.56-1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e# of Baseline Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Baseline Moderate/Severe Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (68.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e# of Post-acutherapy Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Post-acutherapy Moderate/Severe Domains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e# of Moderate/Severe Domains Improved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (-1-0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (-1-0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Moderate/Severe Domain Improvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: body mass index (BMI, kg/m2); symptoms (SXS); Eastern Cooperative Oncology Group (ECOG).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSupplemental Table\u0026nbsp;3\u003c/b\u003e indicates the PROMIS-29 classification from the baseline to the post-treatment session by cancer status. There were no differences in domain categorization, with moderate-to-severe pain interference at baseline (40.7% vs. 45.8%; p\u0026thinsp;=\u0026thinsp;0.773) and post-therapy (37.0% vs. 28.9%; p\u0026thinsp;=\u0026thinsp;0.846) representing the most common problem between survivorship and active treatment patients. In Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e there were no differences in PROMIS-29 domain changes according to cancer status. It should be noted, that although being the most common moderate/severe problem, pain interference improvement occurred in 31.4\u0026ndash;34.7% of patients. Greatest rates of improvement were seen with anxiety (54.8\u0026ndash;58.7%) and depression (52.6\u0026ndash;72.0%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing PROMIS-29 Improvement Post-Acutherapy\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e reports the results from univariable and multivariable logistic regression analyses examining factors potentially associated with improvement in any PROMIS-29 domain post-acutherapy. On univariable analysis, obesity (BMI\u0026thinsp;\u0026gt;\u0026thinsp;30kg/m\u003csup\u003e2\u003c/sup\u003e) decreased likelihood of improvement following a recommended session regimen (OR 0.47, 95% CI 0.22\u0026ndash;0.99; p\u0026thinsp;=\u0026thinsp;0.048). Upon adjusting for listed factors, patients with obesity (OR 0.44, 95% CI 0.20\u0026ndash;0.99; p\u0026thinsp;=\u0026thinsp;0.046) and delay in treatment sessions (OR 0.43, 95% CI 0.20\u0026ndash;0.92; p\u0026thinsp;=\u0026thinsp;0.029) were significantly less likely in demonstrating improvement on PROMIS-29.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression models to examine factors associated with any PROMIS-29 domain improvement\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale Sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.38 (0.59\u0026ndash;3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.28 (0.51\u0026ndash;3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years, continuous)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.96\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98 (0.94\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76 (0.37\u0026ndash;1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90 (0.41\u0026ndash;1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity (BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.47 (0.22\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44 (0.20\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed Acutherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.51 (0.26\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43 (0.20\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.67 (0.84\u0026ndash;3.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.87 (0.89\u0026ndash;3.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECOG 1+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73 (0.37\u0026ndash;1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61 (0.29\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e136 total observations included\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present paper investigated factors that are associated with the completion of a recommended acupuncture regimen at an NCI-designated cancer center. Non-white race was an important barrier that decreased the likelihood of regimen completion, along with undergoing active cancer treatment. Among those that attended at least 8 sessions, non-white patients were found to have greater baseline and post-therapy burden of moderate-to-severe impairment in physical functioning and pain interference. Notably, patients with obesity and weekly delay in sessions were less likely to report any domain improvement as measured on PROMIS-29.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBarriers to Acutherapy Regimen Completion\u003c/h2\u003e \u003cp\u003eOne-third of patients successfully met the recommended acutherapy regimen, while non-white and active cancer treatment patients were less likely to attain this goal. This may exacerbate existing social and health inequities that hinder patients of color disproportionately, including reduced access to integrative therapies and high cost of treatment without partial insurance coverage.\u003csup\u003e7\u0026ndash;9,11\u003c/sup\u003e Future studies need to explore the specific factors that may contribute to our observed racial disparity. Preferably, this would entail qualitative research interviewing patients, informal caregivers, and healthcare providers regarding their attitudes toward integrative regimens. In addition, the patient health-belief model and expectations from acupuncture should be explored, and whether racial and cultural factors contribute to the perception of complementary medicine. Active treatment patients have a greater number of appointments and costs due to ongoing treatment, which may reduce availability in scheduling for acupuncture and affordability amid standard care. They also report higher levels of disease and treatment-related symptoms such as fatigue and pain.\u003csup\u003e22\u003c/sup\u003e This potentially heightens mobility issues and limits how many acupuncture visits patients can attend. Identifying these barriers is useful to understand how to aid patients in meeting the necessary regimen cadence and optimizing their benefit from acutherapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDifferences in PROMIS-29 Domains Following Acutherapy\u003c/h2\u003e \u003cp\u003eOverall, the study\u0026rsquo;s findings emphasize the effectiveness of acupuncture as a treatment modality for patients with cancer and highly varied symptomatology. Across each PROMIS-29 domain, approximately 90% reported stability or improvement of symptoms. There is a trend of improvement posttreatment across race and cancer status when following the recommended regimen. The present cohort included a fairly diverse sample not limited to sociodemographic factors but cancer diagnosis and status as well. These results support prior literature on the general benefit of acupuncture as adjunct integrative care for cancer populations.\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, it is important to note that baseline and follow-up scores of several PROMIS-29 domains were significantly higher for non-white patients. These were pain interference, physical function, and social participation. Existing determinants of health could explain why racial minorities report higher initial symptom burden and severity. Research shows a greater prevalence of poor disease outcomes for non-white groups, particularly Black and Hispanic individuals, across multiple malignancies.\u003csup\u003e23,24\u003c/sup\u003e Increased problems with chronic pain and general pain management are specifically reported in Black cancer patients.\u003csup\u003e25\u003c/sup\u003e Similarly, non-white patients have less favorable outcomes in domains of physical and social functioning from diagnosis through survivorship.\u003csup\u003e26\u003c/sup\u003e They report higher levels of distress, emotional fatigue, and weakness at baseline and follow-up. This may elucidate why patients in the current study had higher scores in associated PROMIS-29 domains before and after receiving acupuncture.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePROMIS-29 Domain Improvements Following Acutherapy\u003c/h2\u003e \u003cp\u003eWhile acupuncture is effective in managing cancer-related symptoms, significant disparities exist. Findings indicate that race and cancer status are factors that negatively impact patients' successful completion of the recommended regimen. However, analysis of prospectively collected PROMIS-29 data at baseline and follow-up showed no difference in patient-reported outcomes across groups. What were significant factors in lowering the probability of improvement were obesity and weekly delays in treatment. In a study from Cao et al examining the impact of acupuncture on insulin sensitivity among patients with polycystic ovarian syndrome, those with lean body mass experienced a greater response than those classified as overweight or obese.\u003csup\u003e27\u003c/sup\u003e This may suggest excess body mass represents a physical barrier to acupuncture needles. However, there is an extensive meta-analysis supporting acupuncture as an efficacious adjunct in reducing BMI and waist circumference.\u003csup\u003e28\u003c/sup\u003e Although it should be noted, those studies included patients undergoing 3\u0026ndash;12 week adjunct regimens targeted for diabetes treatment and weight loss in contrast to our cohort.\u003c/p\u003e \u003cp\u003eThe average rate of acupuncture visits per week was approximately 0.7, which failed to meet our goal of 0.75 visits per week. Notably, patients who fell below this threshold were less likely to experience improvement in any PROMIS-29 domain following completion of the acutherapy regimen. In a meta-analysis of 23 randomized controlled trials from Chen et al evaluating appropriate acupuncture schedules in treating chronic pain, at least 2 sessions or more per week resulted in significant high pain relief during follow-up. Although their patient populations were far more heterogeneous, pain interference was the most commonly affected domain among our cancer patients, which supports such a regimen for our patients. This is an important barrier to focus on and to consider whether implementing a more frequent schedule of at least 1.0 visits per week is feasible and would result in even greater improvement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Strengths\u003c/h2\u003e \u003cp\u003eFindings from the present study must be set in the context of several limitations. Approximately 70% of enrolled patients were diagnosed with either breast, head and neck, colorectal cancer, or multiple myeloma. This suggests that results may not be generalizable across other malignancies or to any specific site. Researching cohorts that are diverse across malignancies would be helpful to understand how underrepresented cancer types benefit from a recommended acutherapy regimen.\u003c/p\u003e \u003cp\u003eEstablished literature does not mention the use of the PROMIS-29 questionnaire to evaluate the effectiveness of an acutherapy regimen in an oncology setting. While this instrument includes several domains of functioning and well-being, it does not encapsulate the breadth of cancer-related symptomatology that patients report during their initial intake. Some common symptoms such as fatigue, mood, and pain strongly overlap with PROMIS-29 domains. However, this measure does not account for other prevalent symptoms like nausea or peripheral neuropathy, which may disproportionately affect patients depending on cancer type.\u003csup\u003e4,5\u003c/sup\u003e This study supports the utilization of the PROMIS-29 questionnaire to gauge self-reported assessment of functioning and well-being following an acutherapy regimen. Supplemental studies could include other measures, besides the PROMIS-29 questionnaire, that target malignancy- or treatment-specific symptoms in more detail.\u003c/p\u003e \u003cp\u003eFurthermore, notable benefits included the prospective data collection along with a racially diverse patient population (~\u0026thinsp;30% self-identifying as non-white). Given that patients of color report greater barriers to healthcare access in general, examining racial differences helped identify the existing needs and limitations of the present community when establishing and completing cancer treatment.\u003csup\u003e8,9\u003c/sup\u003e Oncology teams could include patient identifiers throughout the referral screening process to facilitate scheduling racial minorities for acupuncture visits and other integrative care. In addition, socioeconomic status is a known factor influencing the health status, mortality and morbidity of a population. Calculating socioeconomic status using specific markers such as zip code, employment, and income would be a more direct measure in future studies rather than relying on race as a proxy. Notably, Black patients represented the majority of our non-white population, to which we further recommend multi-site research studies to include greater representation of other minority populations and their perceptions with integrative oncology regimens.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eRace and active cancer treatment were notable barriers to completion of a recommended acutherapy regimen. In addition, despite improvements in well-being and functioning domains following acutherapy, non-white cancer patients face greater burdens in pain, physical functioning, and social participation both before and after treatment. Care should be taken to address these disparities while ensuring appropriate schedule adherence to an acutherapy regimen to maximize benefit among cancer patients seeking complementary treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEmory University IRB approval via STUDY00005177\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eAll relevant information was deidentified and no individual patient health information is present within this publication.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eIndividual participant data that underlie the results reported in this article, after deidentification can be made available upon reasonable request by investigators who provide a methodologically sound proposal following publication. Proposals should be directed to the corresponding author. To gain access, data requestors will need to sign a data access agreement.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no competing interests to report.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThere is no formal funding for this research.\u003c/p\u003e\n\u003cp\u003eThis is an adjunctive supportive care service for established patients at Winship Cancer Institute that is provided as a courtesy free of charge and funded via Shared Essential Services.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eAll authors were responsible for the conception and design of the project. Authors MGZ, BH, MM, AC, DP, and AB participated in the initial data collection. Author DP was responsible for database management and data curation. Author EHN was responsible for primary data analysis. Authors MGZ, EHN, and AB were responsible for initial interpretation of results and preparation of tables, figures and early manuscript. Author EBA participated in the final editing of the manuscript. All authors participated in editing and revising the final manuscript for publication. Author VAM was responsible for the senior leadership and securing funding.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThere are no further acknowledgments.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZia FZ, Olaku O, Bao T et al. The National Cancer Institute\u0026rsquo;s Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps. J Natl Cancer Inst Monogr. 2017;2017(52). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jncimonographs/lgx005\u003c/span\u003e\u003cspan address=\"10.1093/jncimonographs/lgx005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBirch S, Lee MS, Alraek T, Kim TH. Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review. Integr Med Res. 2019;8(3):160\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Valois B, Young T, Zollman C, et al. Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion). Support Care Cancer. 2024;32(4):229.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBen-Arye E, Hausner D, Samuels N, et al. Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer. 2022;128(20):3641\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarland SN, Xie SX, DuHamel K, et al. Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. J Natl Cancer Inst. 2019;111(12):1323\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao JJ, Liou KT, Baser RE, et al. Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial. JAMA Oncol. 2021;7(5):720\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeleber S, Cohen MR, Weitzman M, et al. 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. 2024;23:15347354241226640.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesai K, Liou K, Liang K, Seluzicki C, Mao JJ. Availability of Integrative Medicine Therapies at National Cancer Institute-Designated Comprehensive Cancer Centers and Community Hospitals. J Altern Complement Med. 2021;27(11):1011\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao JJ, Tan T, Li SQ, Meghani SH, Glanz K, Bruner D. Attitudes and barriers towards participation in an acupuncture trial among breast cancer patients: a survey study. BMC Complement Altern Med. 2014;14:7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolassiotis A, Bardy J, Finnegan-John J, et al. Acupuncture for Cancer-Related Fatigue in Patients With Breast Cancer: A Pragmatic Randomized Controlled Trial. J Clin Orthod. 2012;30(36):4470\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao JJ, Palmer CS, Healy KE, Desai K, Amsterdam J. Complementary and alternative medicine use among cancer survivors: a population-based study. J Cancer Surviv. 2011;5(1):8\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHays RD, Spritzer KL, Schalet BD, Cella D. PROMIS\u0026reg;-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27(7):1885\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005\u0026ndash;2008. J Clin Epidemiol. 2010;63(11):1179\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRose M, Bjorner JB, Gandek B, Bruce B, Fries JF, Ware JE Jr.. The PROMIS Physical Function item bank was calibrated to a standardized metric and shown to improve measurement efficiency. J Clin Epidemiol. 2014;67(5):516\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai JS, Cella D, Choi S, et al. How item banks and their application can influence measurement practice in rehabilitation medicine: a PROMIS fatigue item bank example. Arch Phys Med Rehabil. 2011;92(10 Suppl):S20\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmtmann D, Cook KF, Jensen MP, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePilkonis PA, Choi SW, Reise SP, et al. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS\u0026reg;): depression, anxiety, and anger. Assessment. 2011;18(3):263\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHahn EA, DeWalt DA, Bode RK, et al. New English and Spanish social health measures will facilitate evaluating health determinants. Health Psychol. 2014;33(5):490\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuysse DJ, Yu L, Moul DE, et al. Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments. Sleep. 2010;33(6):781\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCella D, Choi S, Garcia S, et al. Setting standards for severity of common symptoms in oncology using the PROMIS item banks and expert judgment. Qual Life Res. 2014;23(10):2651\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRothrock NE, Cook KF, O\u0026rsquo;Connor M, Cella D, Smith AW, Yount SE. Establishing clinically-relevant terms and severity thresholds for Patient-Reported Outcomes Measurement Information System\u0026reg; (PROMIS\u0026reg;) measures of physical function, cognitive function, and sleep disturbance in people with cancer using standard setting. Qual Life Res. 2019;28(12):3355\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouffard KJ, Koyyalagunta L, Abdi S, Hernandez M, Novy DM. Differences in pain, symptom burden, and opioid use among cancer pain patients with active versus non-active disease. J Clin Orthod. 2013;31(15suppl):e20568\u0026ndash;20568.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7(2):525\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoon SL, Scarton L, Duckworth L, et al. Pain, symptom distress, and pain barriers by age among patients with cancer receiving hospice care: Comparison of baseline data. J Geriatr Oncol. 2021;12(7):1068\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonds Johnson K, Bai J, Waldrop D, et al. Barriers to Pain Management: Incongruence in Black Cancer Caregiving Dyads. J Pain Symptom Manage. 2022;63(5):711\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadison AA, Peng J, Shrout MR, et al. Distress Trajectories in Black and White Breast Cancer Survivors: From Diagnosis to Survivorship. Psychoneuroendocrinology. 2021;131:105288.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCao J, Nie G, Dai Z, Shan D, Wei Z. Comparative effects of acupuncture and metformin on insulin sensitivity in overweight/obese and lean women with polycystic ovary syndrome and insulin resistance: a post hoc analysis of a randomized trial. Front Med. 2023;10:1232127.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Xu GN, Wan RH, et al. Acupuncture in treating obesity combined with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled clinical trials. Complement Ther Clin Pract. 2022;49:101658.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"acupuncture, integrative, oncology, race, patient-reported outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4572312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4572312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcutherapy 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 acutherapy regimen in a racially diverse cohort of cancer patients, along with determining the usefulness of functioning and well-being questionnaires in evaluating acupuncture outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe prospectively enrolled 432 patients who completed at least one acutherapy visit from the Integrative Oncology 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were 432 patients included: 153 (35.1%) attended 8 or more sessions. Multivariable logistic regression showed that non-white race (OR 0.63; p\u0026thinsp;=\u0026thinsp;0.047) and active treatment status (OR 0.54; p\u0026thinsp;=\u0026thinsp;0.005) were associated with decreased adherence to the recommended acutherapy regimen. No differences in rate of posttreatment improvement were observed across race or cancer status. Non-white patients had greater moderate/severe scores in the domains of physical functioning (baseline: 54.2% vs. 32.4%; p\u0026thinsp;=\u0026thinsp;0.019 | posttreatment: 50.0% vs. 18.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and pain interference (baseline: 34.3% vs. 62.5%; p\u0026thinsp;=\u0026thinsp;0.005 | posttreatment: 60.4% vs. 27.6%; p\u0026thinsp;=\u0026thinsp;0.001). Additional analyses suggest obesity and delay in treatment cadence were factors associated with any improvement of PROMIS-29 domains after regimen completion.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eRace and active cancer treatment were notable barriers to completing a recommended acutherapy 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 acutherapy among cancer patients.\u003c/p\u003e","manuscriptTitle":"Factors Associated with Completion and Improvement Following Integrative Oncology Acutherapy in a Racially-Diverse Population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 18:23:24","doi":"10.21203/rs.3.rs-4572312/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-05T09:54:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-04T12:05:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-04T12:05:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2024-06-12T19:59:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e73c3f54-a341-4d1a-bca6-350fd44a8019","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T20:23:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-29 18:23:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4572312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4572312","identity":"rs-4572312","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}