Original Article Identifying Factors Associated With Disparities in Access to Integrative Oncology Program Eran Ben-Arye, MD, Ana Maria Lopez, MD MPH, Nihaya Daoud, PhD, Lilach Zoller, MD MBA, Eleanor Walker, MD, Michal Davidescu, PhD, Katerina Shulman, MD, Orit Gressel, MD, Nili Stein, MPH, Shani Brosh, MD, Elad Schiff, MD, and Noah Samuels, MD Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel; Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel; Sidney Kimmel Medical College and Sidney Kimmel Cancer Center (A.M.L.), Thomas Jefferson University, Philadelphia, Pennsylvania, USA; School of Public health, Faculty of Health Sciences (N.D.), Ben-Gurion University of the Negev, Beer Sheba, Israel; Haifa and Western Galilee District (L.Z.), Clalit Health Services, Haifa, Israel; Henry Ford Hospital (E.W.), Detroit, Michigan, USA; The Oncology Service (K.S.), Lin and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel; Department of Community Medicine and Epidemiology (N.S.), Carmel Medical Center, Haifa, Israel; Carmel Medical Center (S.B.), Haifa, Israel; Department of Internal Medicine & Integrative Medicine Service (E.S.), Bnai-Zion, hospital, Haifa, Israel; Center for Integrative Complementary Medicine (N.S.), Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel Abstract Context and Objectives. Cancer centers are increasingly providing complementary medicine as part of an emerging disci- pline termed ‘integrative oncology’ (IO). The present study explored factors associated with disparities in referral and adher- ence to a freely-provided IO program. Methods. The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were iden- tified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adher- ence, 0-3 sessions). Results. Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consul- tation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0-4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3-2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02-2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03-1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32-0.83, P = 0.006). Conclusion. Patients’ ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing. J Pain Symptom Manage 2024;68:10-21. © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. Key Words Integrative oncology, disparities, integrative medicine, chemotherapy, acupuncture, cross-cultural, diversity, equity and inclusion Address correspondence to: Eran Ben-Arye MD, The Oncology Service, Lin Medical Center, 35 Rothschild Street, Haifa 35152, Israel. E-mail: eranben@netvision.net.il Accepted for publication: 14 March 2024. Ó 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. 0885-3924/$ - see front matter https://doi.org/10.1016/j.jpainsymman.2024.03.018 10 Journal of Pain and Symptom Management Vol. 68 No. 1 July 2024