Key takeaways:

• An insurance-supported integrative oncology program led to meaningful reductions in several cancer-related symptoms.
• It may serve as a model to deliver guideline-concordant care while overcoming access barriers.

An insurance-supported integrative oncology program may serve as a model for delivery of guideline-concordant symptom management while overcoming barriers to access, according to study findings.

A hybrid clinic that combines insurance-billed services with low-cost self-pay options resulted in meaningful reductions in several cancer-related symptoms, including pain, anxiety, depression and fatigue.

Data derived from Srivastava M, et al. JCO Oncol Pract. 2026;doi:10.1200.OP-26-00274.

A majority of patients treated during the clinic’s first 16 months of operation expressed satisfaction with the program and indicated they would be willing to refer others.

“People with cancer often face severe symptom burdens during active treatment or after treatment, and there is increasing evidence that integrative modalities are very helpful,” Sam Rodgers-Melnick, PhD, MPH, LPMT, MT-BC, research scientist at University Hospitals Connor Whole Health, told Healio. “However, many of these programs rely on out-of-pocket payments or philanthropy. Restrictions related to what procedures you can bill for and how you can bill for them introduce a lot of barriers for people with cancer, so health systems often struggle to find ways to implement these programs into routine care. We went about trying to solve that access problem.”

Increasing access

Prior research has shown integrative oncology approaches such as acupuncture, massage therapy, yoga or mindfulness can help alleviate fatigue, anxiety, pain, nausea and other cancer-related symptoms.

ASCO and National Comprehensive Cancer Network include 10 integrative oncology modalities in symptom management guidelines, and several NCI-designated cancer centers offer integrative oncology programs, according to study background.

However, accessibility and scalability have been limited due to logistical and financial barriers, including inconsistent insurance reimbursement.

University Hospitals Connor Whole Health implemented a hybrid integrative oncology symptom management clinic 3 years ago.

The clinic provides insurance-covered physician consults and massage therapy.

It adopted a self-pay model for group acupuncture visits. Each session cost $36.85, about one-half to one-third of the average individualized treatment cost that Fan and colleagues reported in a 2019 analysis of more than 700 clinics nationwide.

Philanthropic support funds nonbillable clinic services, such as reiki and music therapy.

A paper published in JCO Oncology Practice described implementation of the clinic — led by an integrative oncologist and embedded within the University Hospitals Seidman Cancer Center network — and summarized its impact on patient-reported outcome measures.

The clinic provided 1,924 integrative oncology treatments to 291 patients (mean age, 60.8 years; 73.2% women; 80.8% white) from June 2023 through September 2024. The most common diagnoses included breast cancer (45.5%), genitourinary malignancies (16.7%) and gastrointestinal cancers (13.6%).

Some early challenges had to be overcome.

“There are different rules for different types of insurance and, even if you can bill insurance, sometimes the oncologist has to be in the same clinic space at the same time,” Rodgers-Melnick said. “We found ourselves trying to line up what we know can be a very effective service with the clinician’s schedule and what the patient’s insurance would allow.”

Collaboration with physician champions in oncology who have been willing to work alongside integrative oncology modality specialists helped ensure quality and scalability as clinic demand increased.

“We continue to face challenges with billing for some of these integrative services,” Rodgers-Melnick said. “Even though we have highly trained professionals, including licensed acupuncturists and massage therapists, they sometimes cannot bill directly because they do not have a certain credential. Collaborating with our physician partners has been one way to solve that, but we still have to continue to open reimbursement pathways to make these modalities accessible.”

Scheduling proved particularly challenging with regard to acupuncture treatments. Even though some billing structures could have been feasible, the decision was made to move to the group model, which allowed patients to pay out of pocket at a lower rate than would have been billed for individualized treatment.

‘Profound’ results

Researchers used the PROMIS-29 questionnaire and the 10-point Edmonton Symptom Assessment Scale to calculate single treatment effects among patients with moderate to severe symptom burden at baseline.

Results showed integrative oncology treatments led to significant reductions in nausea (–3.61; 95% CI, –4.43 to –2.78), stress (–2.7; 95% CI, –3.2 to –2.2), depression (–2.54; 95% CI, –3.22 to –1.87), anxiety (–2.28; 95% CI, –2.9 to –1.66), pain (–2.08; 95% CI, –2.51 to –1.66) and fatigue (–1.42; 95% CI, –2.33 to –0.52).

“These improvements are clinically meaningful,” Rodgers-Melnick said. “Thinking about a person who presents with moderate to severe nausea, to see a 3.6-unit reduction on a 0-to-10 scale with a 30- to 45-minute treatment is quite profound.”

Acupuncture accounted for nearly half (48.7%) of all patient encounters. Massage therapy (21.5%), reiki (4.7%) and group medical mind/body visits (3.2%) combined accounted for nearly one-third of encounters.

Weekly clinic volume ranged from 10 to 20 encounters per week shortly after launch to 25 to 35 encounters by early 2024. After the addition of individualized reiki and group acupuncture programs in April 2024, weekly encounters often exceeded 40 and peaked at 57 by the end of the study period.

Sixty-two patients completed an acceptability survey. A majority strongly agreed that they were satisfied with clinic services (87.1%), the services supported effective symptom management (82.3%) and they would refer others to the clinic (85.5%).

“The responses were very positive, and it was very encouraging — despite all of the logistics — that people felt like they were seen in a timely manner and had enough time during their visit,” Rodgers-Melnick said. “Most importantly, a majority of people said the cost of the visit was affordable, which is not always the case for integrative oncology modalities when you have to pay out of pocket.”

A potential ‘roadmap’

The findings suggest the insurance-supported clinic model could be scalable and allow for greater delivery of integrative therapies in routine oncology care, researchers concluded.

“This model helps address one of the biggest challenges in integrative oncology: patient access,” researcher Jacob Wolf, ND, LAc, DipACLM, naturopathic doctor and medical director of acupuncture at University Hospitals Connor Whole Health, told Healio. “By combining insurance-covered services with affordable self-pay options, it provides a more sustainable way to deliver evidence-based supportive care. Future research on outcomes, cost-effectiveness, and health care utilization could help support broader adoption and reimbursement.”

Investigators believe the approach can be replicated at other institutions.

“It can be a roadmap for other cancer centers, but it does require tight coordination between clinical professionals and administrative professionals regarding billing and other logistics,” Rodgers-Melnick said. “It is also essential for the cancer center and integrative medicine center to truly work as a team. There must be a coordinated handoff between the primary cancer clinical team and these integrative services, and they should be co-located when possible so access, transportation and finances are not barriers.”

Efforts are underway to quantify the impact the insurance-supported clinic model had on patient access to integrative oncology modalities, as well as to identify and overcome implementation challenges that may have resulted in “missed opportunities” for delivering integrative oncology care, Rodgers-Melnick said.

“The ultimate goal is to optimize symptom management,” Rodgers-Melnick said. “Sometimes symptoms patients experience go unnoticed — they think they are simply part of treatment or that they will resolve once they are done with chemotherapy. Once they are out of active treatment and are not meeting with their specialist, their symptoms persist.

“I would love to see a model that allows us to measure symptoms and engage in these modalities early,” he added. “If we treat early, we may be able to prevent some of these symptoms. Even if we can’t prevent them, we can help ensure they do not continue to impact a person’s life months or years down the road.”

For more information:

Sam Rodgers-Melnick, PhD, MPH, LPMT, MT-BC, can be reached at samuel.rodgersmelnick@uhhospitals.org.

Jacob Wolf, ND, LAc, DipACLM, can be reached at jacob.wolf@uhhospitals.org.