P2B367: Utilization of Pediatric Integrative Oncology Services at an Academic Pediatric Cancer Center: A Retrospective Review

Background: Children with hematology-oncology diagnoses are at high risk for development of difficult physical and emotional symptoms during treatment either from their disease itself or secondary to therapy. While medical management of symptoms is foundational to the practice of pediatric hematology-oncology (PHO), many patients and families are interested in complementary practices for symptoms management. Integrative medicine (IM) is a discipline that combines conventional and complementary approaches with the goal of supporting whole patient health, but IM is not well integrated into the care of PHO patients. Physicians at St. Jude Children’s Research Hospital (SJCRH) have implemented a novel clinical service providing PIM therapies, like massage and acupoint therapy, to attempt to alleviate patient suffering. The goal of this project is to assess referral trends and patterns of use by aggregating PIM utilization data.

Methods: Retrospective data was collected from electronic medical records of the patients referred to the PIM team from December 2020 through May 2022. Data were analyzed descriptively using counts, means, and medians using SAS v 9.4.

Results: A total of 158 patients received PIM consultation, and 57.4% of patients were simultaneously receiving cure directed therapy. Patients ranged in age (4 months-25 years), were 52.9% female, and majority white (67.7%). When compared to all new patients during the same period, referred patients were no different in terms of gender, ethnicity, or primary language (all NS), but tended to be older (12.9 versus 9.22 years, p< 0.001). All primary PHO services were represented (Leukemia/Solid Tumor/Transplant/Neuro-Oncology/Hematology), while Neuro-Oncology diagnoses were the most common (31.6%). Primary reason for consultation were management of refractory symptoms (49.7%) and parental request for holistic therapy (20.6%). After initial consultation, 30.4% of participants had at least 1 follow up appointment (without services), more than half returned for at least one massage therapy or acupoint visit (N=56.1%, N=50.3% respectively), and the cumulative number of PIM encounters was on average 9.15 visits per patient (range 1-84, median 5.0).

Conclusion: In the short time a dedicated PIM service has been available, approximately 200 patients have been referred for evaluation. Half of these referrals were due to unmet symptom management needs, and the willingness to try complementary therapies. If services are available in the PHO setting, many clinicians are open to referral and families are willing to opt in for care. Future work will focus on patient and family experiences and capture longitudinal patient-reported symptom metrics to further assess clinical utility.