Feasibility of Implementing Acupuncture into a Federally Qualified Health Center to Alleviate Multiple Symptoms Among Breast Cancer Survivors Receiving Endocrine therapy

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PROJECT SUMMARY Nearly 94% of breast cancer survivors experience one or more symptoms during or after endocrine therapy. Joint pain, hot flashes, sleep disturbance, fatigue, depression, and anxiety are the most common concurrent symptoms, some of which can persist for 5 to 10 years. These symptoms negatively affect adherence to treatment and compromise people’s functional status, quality of life, and work functioning. Acupuncture is a single therapy with few side effects that holistically addresses multiple symptoms. The effect of acupuncture on multiple symptoms among breast cancer survivors receiving endocrine therapy has not been investigated. Further, implementation-focused acupuncture research focuses on privately insured clinic settings and ignores social determinants of health. There is an urgent need to remove barriers and ensure equal access to this evidence-based treatment among breast cancer survivors with limited access to acupuncture. Federally qualified health centers (FQHC) provide care to people who experience significant barriers to health care access. To date, limited data exist about the use of acupuncture among cancer survivors attending FQHCs. This research study has 2 aims: (1) to test the feasibility and acceptability of implementing acupuncture within an FQHC oncology clinic as a way to manage multiple symptoms (pain, hot flashes, fatigue, sleep disturbance, depression, anxiety) among breast cancer survivors receiving endocrine therapy, and (2) to use a mixed methods approach to identify barriers and facilitators associated with the implementation of acupuncture within an FQHC. The long-term goal is to facilitate the widespread implementation, dissemination, and sustained utilization of acupuncture for symptom management among medically underserved breast cancer survivors receiving endocrine therapy in FQHCs nationwide, and ultimately to promote broader insurance coverage for acupuncture. The proposed research is significant because of its potential to ensure equal access acupuncture, an evidence-based intervention. Results will provide the foundation for a larger multi-site hybrid effectiveness-implementation trial of integrating acupuncture into services provided at FQHCs for breast cancer survivors.