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

项目摘要 近94%的乳腺癌幸存者在内分泌治疗期间或之后经历一种或多种症状。 关节疼痛、潮热、睡眠障碍、疲劳、抑郁和焦虑是最常见的并发症 症状，其中一些可以持续5至10年。这些症状对坚持服用 治疗和损害人们的功能状态，生活质量和工作功能。针灸是一 单一疗法，副作用少，全面解决多种症状。的针刺效应 接受内分泌治疗的乳腺癌幸存者中的多种症状尚未调查。 此外，以实施为重点的针灸研究集中在私人保险诊所设置， 忽视健康的社会决定因素。迫切需要消除障碍， 在获得有限的乳腺癌幸存者中平等获得这种循证治疗 针灸联邦合格的健康中心（CIMHC）为患有严重疾病的人提供护理。 获得医疗保健的障碍。到目前为止，关于针灸在癌症中的应用的数据有限。 幸存者参加了紧急救援中心。本研究有两个目的：（1）测试的可行性和可接受性 在一个联合国癌症中心的肿瘤诊所内实施针灸，作为管理多种症状（疼痛、发热）的一种方法， 闪光，疲劳，睡眠障碍，抑郁，焦虑）的乳腺癌幸存者接受内分泌 治疗，（2）使用混合方法的方法，以确定障碍和促进者与 在一个针灸治疗中心内实施针灸。长期目标是促进 实施，传播，并持续利用针灸的症状管理， 医疗服务不足的乳腺癌幸存者在全国范围内接受内分泌治疗， 最终扩大针灸的保险范围。所提出的研究是有意义的 因为它有可能确保平等获得针灸，这是一种基于证据的干预措施。结果将 为更大规模的多站点混合有效性实施试验提供基础 针灸在乳腺癌康复中心为乳腺癌幸存者提供的服务中发挥作用。

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.