Abstract
Background:
Nocturia is multifactorial condition, but most treatments only target urine production or storage in isolation. Acupuncture has been shown to decrease nocturia, but its mechanisms remain unclear. This study explores the preliminary effects of acupuncture on urine production and storage to inform future mechanistic hypotheses.
Methods:
We conducted a secondary analysis of 3-day frequency volume charts from a clinical trial in which prostate cancer survivors with nocturia were randomized to receive acupuncture or usual care (waitlist control [WLC]). Within-group posttreatment changes and between-group differences were compared by paired and two-sample t-tests in the total sample and in subgroups stratified by the presence of nocturnal polyuria at baseline.
Results:
In the total sample (N = 35), acupuncture reduced nocturia episodes (−1.1 vs −0.4, P = .016) and increased mean urine volume per nighttime void (+30.3 mL vs −0.6 mL, P = .047) relative to the WLC group. In the subgroup with nocturnal polyuria, acupuncture reduced nocturia episodes (−1.1, P = .0057) and reduced the ratio of nocturnal urine volume to total urine volume (−10.7%, P = .02); nocturia episodes also decreased in the WLC group (−0.4, P = .018), but there was no significant change in the ratio of nocturnal urine volume to total urine volume.
Conclusions:
Among prostate cancer survivors with nocturia, acupuncture demonstrated joint effects on urine production and storage. Acupuncture also reduced nocturia across different types of underlying urinary dysfunction, including nocturnal polyuria. If confirmed, these preliminary findings could inform a novel treatment approach uniquely suited for the multifactorial etiology of nocturia.
Key Words: acupuncture, integrative medicine, nocturia, lower urinary tract symptoms, prostate cancer
Introduction
Nocturia is one of the most common and distressing symptoms affecting prostate cancer survivors, but its complex nature makes it particularly challenging to treat.1 In this population, nocturia often stems from factors both unrelated and related to prostate cancer treatments. Owing to their older age, prostate cancer survivors are at increased risk for disruptions in urine production resulting in nocturnal polyuria.2,3 Age-related changes in circadian rhythms have been shown to impair mechanisms of fluid balance through dysregulated secretion of antidiuretic hormone and atrial natriuretic peptides.4 Furthermore, the older age of prostate cancer survivors increases the comorbidity of cardiovascular, hormonal, or nephrological conditions, which may contribute to both urine overproduction and impaired urine storage.5 Urine storage issues may also occur secondary to prostate cancer treatment itself because urodynamic studies in this population have demonstrated de novo detrusor overactivity and reduced bladder compliance after prostatectomy or radiation therapy.6,7 Thus, nocturia in prostate cancer survivors is often driven by a combination of nighttime urine overproduction and dysfunctional urine storage.
This multifactorial etiology presents unique treatment challenges. Prostate cancer survivorship guidelines highlight nocturia as an unmet care need and note that the quality of evidence for current treatments remains low.8 Existing treatments primarily target either urine production or storage in isolation but not jointly, which could explain their mixed findings in clinical trials.9 In particular, nocturia driven by dysfunctional urine production, such as nocturnal polyuria, has few treatment options. Desmopressin, an antidiuretic medication, is the only nocturia treatment that directly targets nighttime urine production. However, most studies of desmopressin have excluded prostate cancer survivors, and the notable side effect of hyponatremia carries significant risks, especially in older adults.10 Other treatments for nocturia, such as antimuscarinics, alpha blockers, and beta-3 agonists, primarily target urine storage.9 Like desmopressin, studies of these drugs often exclude prostate cancer survivors. Antimuscarinics and alpha blockers also have a side effect profile, such as anticholinergic effects and hypotension, which may pose greater risk to older adults, and beta-3 agonists may be costly and inaccessible for patients.11-13 Polypharmacy is a growing concern among older cancer survivors, highlighting a need to develop and test nonpharmacologic interventions for nocturia in the prostate cancer survivorship population.14
Acupuncture is a nonpharmacological modality derived from traditional Chinese medicine; it involves the manual or electrical stimulation of thin, sterile, disposable needles inserted into the body surface.15 In our recent pilot randomized clinical trial (RCT) of prostate cancer survivors with nocturia, acupuncture was associated with a greater reduction in patient-reported nocturia episodes, compared with usual care in a waitlist control (WLC) group.16 The benefits were comparable with or superior to those of common medications for nocturia and were associated with fewer side effects.17 However, it remains unclear whether the effects of acupuncture may be related to urine production, urine storage, or both. Using data from frequency volume charts (FVCs), a secondary outcome of the parent RCT, this study aims to characterize urinary dysfunction co-occurring with nocturia and explore the preliminary effects of acupuncture on urine production and storage to inform future mechanistic hypotheses.
Materials and Methods
Study Design, Settings, and Participants
We performed an exploratory analysis of FVC outcomes from a pilot RCT, the protocol and primary findings of which are described in detail elsewhere.16 The trial enrolled N = 60 survivors of prostate cancer treated with radical prostatectomy and/or radiation therapy with no evidence of disease who reported 2 or more episodes of nocturia every night for the past month. Participants with evidence of moderate to severe sleep apnea or other untreated primary sleep disorders were excluded from the study. Eligible participants were randomized then 2:1 to an acupuncture group or a WLC group.
Interventions
The acupuncture group received 10 weekly treatments. The following acupuncture points were used for nocturia: BL23, BL28, BL31, BL33, BL35, BL40, KI3, KI7, SP6, kidney-auricular, and bladder-auricular. Electrical stimulation was applied bilaterally from BL23 to BL33 or BL52 at 2 to 10 Hz for 20 to 30 minutes. This treatment approach was designed to modulate the autonomic nervous system, which plays a key role in regulating urine production and storage.18 The WLC group received usual care for nocturia while being placed on a waiting list for acupuncture, which was offered to participants in this group after the conclusion of the study period. All participants were instructed to refrain from starting new interventions or changing their current regimen for nocturia during the study period.
Data Collection and Outcomes
Participants completed FVCs at baseline and week 10 (the end of the treatment period). A three-day duration has been shown to be more reliable than shorter durations and comparable in reliability with longer durations (reliability coefficient > 0.8).19 Participants recorded their fluid intake, volume and time of each void, and wake and sleep times to distinguish nighttime and daytime voids. Nighttime voids included all voids after sleeping and before the final awakening.
FVC data were used to calculate number of nighttime and daytime voids; the mean urine volumes per nighttime void, per daytime void, and per void over 24 hours; the 24-hour, daytime, and nighttime urine volume (NUV) (excluding first morning void); and the maximum voided volume. NUV was then divided by 24-hour voided volume (24HVV) to determine the presence of nocturnal polyuria, which was defined as NUV/24HVV > 33%.20
Statistical Analyses
We restricted analyses to study participants who completed FVCs at both timepoints (baseline and week 10) and had 2 or more nocturia episodes recorded by FVC at baseline. The cutoff of 2 nocturia episodes was set to prevent floor effect because 2 or more episodes has been defined as clinically significant.21 We evaluated the change in FVC metrics from baseline to week 10 (end of treatment) by paired t-tests. We also compared mean changes between the acupuncture group and the WLC group by two-sample t-tests of means. We then repeated these analyses within 2 subgroups, those with and without nocturnal polyuria at baseline.
Results
Among N = 60 participants in the parent RCT, 54 (90%) completed at least 1 FVC, and 43 (71.7%) completed both FVCs. Among the 43 with complete FVC data, 35 recorded 2 or more nocturia episodes at baseline and were included in the analyses. Table 1 summarizes baseline characteristics. In the study sample (N = 35), 22 (62.9%) participants had undergone radical prostatectomy, 19 (54.3%) had received external beam radiation therapy, 7 (20.0%) had received brachytherapy, and 8 (22.9%) had received androgen deprivation therapy. Nocturnal polyuria was present in 20 (57.1%) study participants at baseline.
Table 1.
Baseline Characteristics
| Total (n = 35) | Acupuncture (n = 21) | Waitlist Control (n = 14) | |
| Age, mean, y (SD) | 71.8 (6.9) | 72.4 (7.6) | 70.9 (5.9) |
| Race, n (%) | |||
| White | 30 (85.7) | 18 (85.7) | 12 (85.7) |
| Black | 4 (11.4) | 2 (9.5) | 2 (14.3) |
| Asian | 1 (2.9) | 1 (4.8) | 0 (0) |
| Prostate cancer TNM stage group, n (%) | |||
| I | 5 (14.3) | 2 (9.5) | 3 (21.4) |
| II(a-c) | 19 (54.3) | 13 (61.9) | 6 (42.9) |
| III(a-c) | 10 (28.6) | 5 (23.8) | 5 (35.7) |
| IV(a-b) | 1 (2.9) | 1 (4.8) | 0 (0) |
| Prostate cancer treatment history, n (%) | |||
| Radical prostatectomy | 22 (62.9) | 12 (57.1) | 10 (71.4) |
| External beam radiation therapy | 19 (54.3) | 12 (57.1) | 7 (50.0) |
| Brachytherapy | 7 (20.0) | 4 (19.0) | 3 (21.4) |
| Androgen deprivation therapy | 8 (22.9) | 4 (19.0) | 4 (28.6) |
| Years since treatment completed, mean (SD) | 7.9 (5.8) | 8.0 (5.7) | 7.7 (6.0) |
| Years since onset of nocturia, mean (SD) | 6.6 (4.8) | 7.6 (5.5) | 5.3 (3.3) |
| Comorbid medical conditions, n (%) | |||
| Diabetes mellitus | 3 (8.6) | 0 (0) | 3 (21.4) |
| Hypertension | 19 (54.3) | 11 (52.4) | 8 (57.1) |
| Coronary artery disease | 9 (25.7) | 5 (23.8) | 4 (28.6) |
| Bladder outlet obstruction | 2 (5.7) | 2 (9.5) | 0 (0) |
| Spinal cord injury | 1 (2.9) | 0 (0) | 1 (7.1) |
| Taking medications for urinary or sexual dysfunction, n (%) | 18 (51.4) | 9 (42.9) | 9 (64.3) |
| Alpha-1 adrenergic antagonists | 8 (22.9) | 4 (19.0) | 4 (28.6) |
| 5-alpha reductase inhibitors | 2 (5.7) | 2 (9.5) | 0 (0) |
| Phosphodiesterase-5 inhibitors | 10 (28.6) | 5 (23.8) | 5 (35.7) |
| Beta-3 adrenergic agonists | 2 (5.7) | 1 (4.8) | 1 (7.1) |
| Anticholinergics | 1 (2.9) | 1 (4.8) | 0 (0) |
| Taking diuretic medications, n (%) | 6 (17.1) | 1 (4.8) | 5 (35.7) |
| FVC metrics | |||
| Nocturia episodes, mean (SD) | 3.2 (0.9) | 3.1 (1.0) | 3.2 (0.7) |
| Daytime frequency, mean (SD) | 8.4 (3.0) | 8.5 (3.4) | 8.4 (2.6) |
| Urine volume per nighttime void, cc, mean (SD) | 230.8 (121.3) | 220.7 (149.9) | 245.8 (59.3) |
| Urine volume per daytime void, cc, mean (SD) | 163.6 (60.7) | 158.9 (67.0) | 170.6 (51.4) |
| Average void volume per 24 hours, cc, mean (SD) | 185.0 (74.4) | 179.6 (88.0) | 193.2 (49.3) |
| Maximum voided volume, cc, mean (SD) | 395.0 (180.3) | 387.2 (211.1) | 406.8 (127.4) |
| NUV/24HVV, %, mean (SD) | 34.8 (10.6) | 33.4 (11.1) | 36.8 (10.0) |
| Presence of nocturnal polyuria, n (%) | 20 (57.1) | 10 (47.6) | 10 (71.4) |
24HVV, 24-hour voided volume; FVC, frequency volume chart; NUV, nighttime urine volume; TNM, tumor, node, and metastasis.
FVC Outcomes in the Total Sample
The acupuncture group had a significant reduction in nocturia episodes (−1.1, P = .0002, Table 2). The WLC group also had a significant reduction in nocturia episodes (−0.4, P = .013). The between-group difference was significant (P = .016).
Table 2.
Mean Change in FVC Outcomes, Baseline to End of Treatmenta
| Acupuncture (n = 21) | P valueb | Waitlist Control (n = 14) | P value | Between-Group P value | |
| Nocturia episodes, mean (SD) | −1.1 (1.0) | .0002 | −0.4 (0.6) | .013 | 0.016 |
| Daytime episodes, mean (SD) | −1.7 (2.7) | .026 | −0.3 (1.8) | .55 | 0.19 |
| Change in mean urine volume per nighttime void, ml, mean (SD) | 30.3 (68.6) | .036 | −0.6 (29.2) | .92 | 0.047 |
| Change in mean urine volume per daytime void, cc, mean (SD) | 8.1 (35.4) | .41 | 4.0 (35.4) | .78 | 0.64 |
| Change in mean urine volume per 24-hours, cc, mean (SD) | 7.6 (29.1) | .20 | 3.0 (28.1) | .98 | 0.50 |
| Maximum voided volume, cc, mean (SD) | −18.8 (140.1) | .54 | −36.5 (70.7) | .068 | 0.46 |
| NUV/24HVV, %, mean (SD)c | −3.8 (13.2) | .060 | −2.6 (9.4) | .14 | 0.95 |
FVC, frequency volume chart; 24HVV, 24-hour voided volume; NUV, nighttime urine volume.
Bold-italic entries represent statistical signficance P < 0.05.
Among participants with complete FVC data and ≥ 2 episodes of nocturia at baseline.
P values were derived from paired t-tests.
Calculated by dividing NUV by total 24-h voided volume, averaged over 3 d.
The acupuncture group also had significant reduction in daytime episodes (−1.7, P = .026), whereas the WLC group did not (−0.3, P = .55); however, the between-group difference was not significant (P = .19).
The acupuncture group had a significant increase in mean urine volume per nighttime void (30.3 cc, P = .036), whereas the WLC group did not (−0.6, P = .92). The between-group difference was significant (P = .047).
Neither the acupuncture group nor the WLC had a significant decrease in the NUV/24HVV ratio, and there was no significant between-group difference (P = .95).
FVC Outcomes in the Subgroup With Nocturnal Polyuria
Restricting to those with nocturnal polyuria at baseline, the acupuncture group had a significant reduction in nocturia episodes (−1.1, P = .0057, Table 3). The WLC group also had a significant reduction in nocturia (−0.4, P = .018). The between-group difference was not significant (P = .079).
Table 3.
Mean Change in Frequency Volume Chart Outcomes Among Those With Baseline Nocturnal Polyuria, Baseline to End of Treatment
| Acupuncture (n = 10) | Pre-post P value in ACU | WL Control (n = 10) | Pre-post P value in WL | Acu vs WL P value | |
| Nocturia episodes, mean (SD) | −1.1 (1.0) | 0.0057 | −0.4 (0.5) | 0.018 | 0.079 |
| Daytime episodes, mean (SD) | −0.6 (1.2) | 0.064 | 0.03 (1.5) | 0.88 | 0.47 |
| Change in mean urine volume per nighttime void, ml, mean (SD) | 4.2 (72.5) | 0.51 | 0.2 (26.4) | 0.96 | 0.60 |
| Change in mean urine volume per daytime void, cc, mean (SD) | 19.0 (36.1) | 0.20 | 3.5 (28.1) | 0.65 | 0.32 |
| Change in mean urine volume per 24-hours, cc, mean (SD) | 7.1 (32.5) | 0.51 | 1.0 (22.4) | 0.96 | 0.60 |
| Maximum voided volume, cc, mean (SD) | −22.5 (109.4) | 0.80 | −41.2 (70.0) | 0.074 | 0.29 |
| NUV/24HVV, %, mean (SD) | −10.7 (11.6) | 0.022 | −4.2 (7.2) | 0.083 | 0.18 |
24HVV, 24-hour voided volume; NUV, nighttime urine volume; WL, waitlist.
Bold-italic entries represent statistical signficance P < 0.05.
The acupuncture group also had a significant decrease in NUV/24HVV (−10.7%, P = .022), whereas the WLC group did not (−4.2%, P = .08). However, the between-group difference was not significant (P = .18).
There were no significant within-group changes or between-group differences in daytime episodes or mean urine volume per nighttime void.
FVC Outcomes in the Subgroup Without Nocturnal Polyuria
Among those without nocturnal polyuria at baseline, the acupuncture group had a significant reduction in nocturia episodes (−1.1, P = .011, Table 4), whereas the WLC group did not (−0.4, P = .45). However, the between-group difference was not significant (P = .15).
Table 4.
Mean Change in Frequency Volume Chart Outcomes Among Those Without Baseline Nocturnal Polyuria, Baseline to End of Treatment
| Acupuncture (n = 11) | Pre-post P value in ACU | WL Control (n = 4) | Pre-post P value in WL | Acu vs WL P value | |
| Nocturia episodes, mean (SD) | −1.1 (1.1) | 0.011 | −0.4 (0.9) | 0.45 | 0.15 |
| Daytime episodes, mean (SD) | −2.6 (3.4) | 0.016 | −1.2 (2.5) | 0.27 | 0.56 |
| Change in mean urine volume per nighttime void, ml, mean (SD) | 54.0 (58.0) | 0.0099 | −2.7 (39.8) | 0.72 | 0.068 |
| Change in mean urine volume per daytime void, cc, mean (SD) | −1.8 (33.2) | 0.93 | 5.1 (55.3) | 1.00 | 0.90 |
| Change in mean urine volume per 24-hours, cc, mean (SD) | 7.9 (27.4) | 0.13 | 7.9 (43.3) | 0.72 | 0.60 |
| Maximum voided volume, cc, mean (SD) | −15.5 (168.7) | 0.53 | −24.8 (82.1) | 0.46 | 0.90 |
| NUV/24HVV, %, mean (SD) | 2.5 (11.8) | 0.82 | 1.2 (14.1) | 1.00 | 0.70 |
24HVV, 24-hour voided volume; NUV, nighttime urine volume; WL, waitlist.
Bold-italic entries represent statistical signficance P < 0.05.
The acupuncture group also had a significant reduction in daytime episodes (−2.6, P = .016), whereas the WLC group did not (−1.2, P = .27). However, the between-group difference was not significant (P = .56).
The acupuncture group also had a significant increase in mean urine volume per nighttime void (54.0 cc, P = .0099), whereas the WLC group did not (−2.7 cc, P = .72). However, the between-group difference was not significant (P = .068).
There were no significant within-group changes or between-group differences in the NUV/24HVV ratio.
Discussion
Among prostate cancer survivors with nocturia, underlying issues with urine production and storage were common, reflecting the multifactorial nature of this difficult-to-treat condition.9 In this exploratory analysis, acupuncture was associated with a greater reduction in nocturia episodes as recorded in objective FVCs compared with usual care in the WLC group, which reinforces the primary findings from the parent trial.16 Our preliminary findings also suggest that acupuncture may jointly target urine production and storage, which contrasts with existing treatment options and highlights a potential therapeutic advancement in the management of nocturia.9
This study contributes to the emerging research on the effects of acupuncture on urinary storage function. As prostate cancer treatments are known to compromise urine storage function, characterizing the effects of acupuncture on storage metrics is important to understanding its potential utility in this population.6,7 Our findings suggest that urine storage function improved in the acupuncture group, as evidenced by the reduction in daytime voids and the increase in nighttime average voided volume in both the total sample and the subgroup without nocturnal polyuria. Existing literature supports the potential benefits of acupuncture for storage symptoms in the general population. In one meta-analysis of studies comparing acupuncture with common treatments for overactive bladder (OAB), the benefit on OAB subscore, frequency, and incontinence was equivalent between acupuncture and medications (ie, solifenacin, tolterodine, and tamsulosin). The meta-analysis also demonstrated that acupuncture had a synergistic effect, with acupuncture plus medications being favorable to medications alone for OAB subscore, frequency, and incontinence.22 This aligns with preliminary findings from our study because approximately one-third of participants in the acupuncture group were taking medications for urinary dysfunction at baseline. The addition of acupuncture to their usual care regimen seems to have provided some additional benefit for nocturia, as reported in the literature. Although few studies include the prostate cancer survivorship population, in one recent RCT, acupuncture with electrical stimulation of lumbosacral points was associated with a significant reduction in postprostatectomy urinary incontinence.23 This study by Niu et al evaluated early urinary incontinence in the 4- to 6-week postoperative period through an assessment of pad use. By focusing on longer-term storage symptoms and evaluating other urine storage metrics from FVCs, our study builds on these findings of acupuncture improving storage function.
The treatment of nocturia during prostate cancer survivorship is complicated by the elevated risk of comorbid conditions contributing to nocturnal polyuria.4 Acupuncture appears effective in reducing nocturia, even in prostate cancer survivors with underlying nocturnal polyuria. This subtype of nocturia has historically been difficult to treat, and options have typically been limited to desmopressin if medication is used.10 Our study found that acupuncture not only reduced nocturia episodes in prostate cancer survivors with nocturnal polyuria but also reduced the proportion of nighttime to total 24-hour urine volume, a novel finding previously undocumented in the literature. If confirmed, these findings have potential to expand treatment options beyond desmopressin for prostate cancer survivors whose nocturia is primarily driven by nocturnal polyuria.
The biological plausibility of these observed dual effects of acupuncture is supported by the growing evidence of its modulation of the autonomic nervous system,18 which plays key roles in both urine production (eg, regulating antidiuretic hormone) and urine storage (ie, sympathetic/parasympathetic inputs to the bladder).24 Figure depicts the core acupuncture points used in our study and their potential interplay with the autonomic nervous system. Our acupuncture intervention specifically targeted lumbosacral nerves that innervate the bladder, urinary tract, and pelvic floor.25 This treatment approach is consistent with other large acupuncture trials focused on urinary dysfunction.22,23,26 Taken together, these findings highlight the potential importance of lumbosacral neuroanatomy in the treatment of nocturia and may help inform the development of interventions focused on neuromodulation.
Figure.
Neuroanatomical schematic of acupuncture points used for nocturia. This diagram is intended for conceptual and illustrative purposes only. It does not reflect exact anatomical renderings. Blue circles reflect key acupuncture points used in the parent study protocol.
Integrative therapies such as acupuncture have a growing evidence base and have gained popularity among U.S. adults in recent years.27 From 2012 to 2022, the number of adults who had used acupuncture in the previous 12 months increased from 3.5 million to 7.3 million.28 For prostate cancer survivors, acupuncture is among the top reasons for seeking integrative oncology services.29 However, several key patient-level, provider-level, and system-level factors may affect patients' willingness to use or seek acupuncture, such as cost, limited provider availability, and lack of insurance coverage.30 Understanding the effects of acupuncture on urine production and storage is a timely imperative which may improve shared decision-making and tailoring of patient care for prostate cancer survivors with urinary symptoms, a current unmet care need.8 Medications to modulate urine storage or urine production have also been associated with more adverse side effects compared with acupuncture.22 Thus, acupuncture may represent a safe and versatile therapy or adjunct for the management of nocturia, particularly among prostate cancer survivors who may already be at risk of polypharmacy.14
Given that this study is a secondary analysis, the findings should be interpreted as exploratory and are intended to be hypothesis-generating to inform future studies in this population. Not every participant completed both FVCs, although completion rates (> 70%) were better than those documented in other research.19 In addition, there is potential imbalance in baseline characteristics between the 2 groups, which is expected in a small sample size. Some of these factors may or may not affect nocturia outcomes (ie, cancer treatment history, comorbid conditions, and medications), and larger randomized trials are needed to mitigate any potential imbalance between treatment groups. Furthermore, owing to the small sample size, some findings did not meet the threshold of statistical significance. Therefore, these preliminary findings should be confirmed in larger trials that are adequately powered for these FVC metrics. Since the parent trial was an intervention trial, rather than an epidemiological study focused on disease characterization, we broadly characterized etiologies of nocturia as storage or production because these categories are often used clinically to inform the overarching treatment approach.9 More detailed characterization of underlying urinary issues (eg, postprostatectomy or postradiation bladder dysfunction) could be helpful in future studies. Finally, it is unknown how these objective FVC findings translate to patients' perceptions of their urinary symptoms; future studies should evaluate patient-reported outcomes in combination with objective metrics.
To our knowledge, this is the first study to suggest the potential joint effects of acupuncture on urine production and storage in prostate cancer survivors with nocturia. Acupuncture also demonstrated promising effects on nocturia in survivors with different types of underlying urinary dysfunction, including nocturnal polyuria. If confirmed, these preliminary findings could inform a novel treatment approach uniquely suited for the multifactorial etiology of nocturia.
FUNDING
This work was supported in part by the Chanel Endowment to Fund Survivorship Research, an NCI K08 Award (5K08CA266927) and an NCI Core Grant (P30CA008748).
CONFLICT OF INTEREST DISCLOSURES
The authors have no conflicts of interest to disclose.
ETHICS STATEMENT
This study received ethical approval from the Institutional Review Board at Memorial Sloan Kettering Cancer Center (approval #22-270) on October 19, 2023.
DATA AVAILABILITY STATEMENT
The data sets generated during and/or analyzed during this study are available from the corresponding author on reasonable request.
AUTHOR CONTRIBUTIONS
Conceptualization: Booher, Laudone, Liou. Data curation: Booher, Mao, Laudone, Liou. Formal analysis: Booher, Liou. Funding acquisition: Liou. Investigation: Liou. Methodology: Booher, Sandhu, Ajay, Carlsson, Liou. Supervision: Liou. Writing—original draft: Booher, Mao, Liou. Writing—review & editing: Booher, Sandhu, Ajay, Carlsson, Laudone, Morris, Liou.
Contributor Information
Allison G. Booher, Email: allison.g.booher.med@dartmouth.edu.
Jake Mao, Email: jakemao@hunterschools.org.
Jaspreet Sandhu, Email: sandhuj@mskcc.org.
Divya Ajay, Email: ajayd@mskcc.org.
Sigrid V. Carlsson, Email: sigrid.carlsson@dkfz-heidelberg.de.
Vincent Laudone, Email: laudonev@mskcc.org.
Michael J. Morris, Email: morrism@mskcc.org.
Kevin T. Liou, Email: liouk@mskcc.org.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data sets generated during and/or analyzed during this study are available from the corresponding author on reasonable request.