# The gap between the rehabilitation people need and the rehabilitation they are offered

Source: https://onco.cc/technologies/rejuv-rehab-provision-gap/  
OnCo record `rejuv-rehab-provision-gap` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

This is the measured part. Among 163 women with advanced breast cancer, 92 per cent had at least one physical impairment and 530 impairments were found; 30 per cent of those needing rehabilitation got it. In an Irish cancer centre in 2025, 71 per cent of 660 patients reported at least one specialist rehabilitation need and 36 per cent of those with a need had seen the relevant professional.

## Summary

The gap has been measured several times, in different countries and decades, and the numbers are consistent enough to quote.

The benchmark study is Cheville and colleagues, published in 2008. They took a consecutive sample of 163 community-dwelling women with metastatic breast cancer, assessed each with a physical examination, a six-minute walk test and standard function scales, and had a panel of rehabilitation physicians and therapists decide what each impairment needed. The results: "Ninety-two percent of patients (150 of 163) had at least one physical impairment. Among 530 identified impairments, 484 (92%) required a physical rehabilitation intervention and 469 (88%) required physical therapy (PT) and/or occupational therapy (OT). Only 30% of impairments requiring rehabilitation services and 21% of those requiring PT/OT received treatment." The setting mattered more than the impairment: a problem found while the patient was in hospital had an odds ratio of 87.9 for getting any rehabilitation at all, and 558.8 for getting physiotherapy or occupational therapy, compared with a problem found in clinic. The authors' conclusion names the inequity as well: "Undertreatment was particularly prominent among minority and socioeconomically disadvantaged groups."

The contemporary figure comes from Ireland. A prospective survey of 660 consecutive outpatients at a comprehensive cancer centre in June and July 2025 used the Macmillan Holistic Needs Assessment to capture unmet needs. On average 71 per cent of patients reported at least one specialist allied health professional need and 49 per cent reported at least two. Only 36 per cent of patients with a perceived need reported having seen the relevant professional since diagnosis.

Europe as a whole is no better organised. The INSPIRE project compared official documents and clinical practice in the United Kingdom, France, Denmark, Norway and Italy through a document analysis of 23 documents, 22 stakeholder interviews and a survey of 225 professionals, and found limited integration of rehabilitation into cancer care in both the documents and the practice, present "within limited organisations in secondary healthcare systems, without widespread adoption".

Spain gives the figure for a single profession. In the DAMA cohort of 2,235 women diagnosed with breast cancer in the Barcelona hospital network, among women reporting chronic and acute symptoms "only between 20 and 35% of women visited physiotherapist", and two in three said they had received insufficient information about medical care and rehabilitation.

What the United Kingdom figure is. This is the gap in the gap, and it is worth naming rather than filling with a number from somewhere else. There is no published national audit of how many people in the United Kingdom who need cancer rehabilitation receive it. What exists is a policy layer, including the Macmillan Cancer Support prehabilitation guidance developed with the Royal College of Anaesthetists and the National Institute for Health Research Cancer and Nutrition Collaboration, and single-service evaluations such as Active Together in Sheffield, whose own protocol notes that evidence for multimodal rehabilitation is increasing while "The translation of that evidence into practice is less advanced". A reader asking how likely they are to be offered rehabilitation in an English hospital cannot be given a number from a national source, and should not be given one from anywhere else.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; rehabilitation; evidence:moderate
- Principle: Two things have to be true for a patient to receive rehabilitation: someone has to notice the impairment, and a service has to exist to receive the referral. The published data separate those failures. Cheville's inpatient odds ratios show the noticing problem, because the same impairment in the same patient was treated in hospital and ignored in clinic. The Irish and Spanish figures show the service problem.
- Strengths: Measured repeatedly, in different systems, with consistent results; Separates the referral failure from the service failure; Uses instruments that services already hold
- Limitations: No national audit figure for the United Kingdom; Most studies are single-centre and cross-sectional; Need is self-reported in the newer studies and panel-assessed in the older one, so the figures are not directly comparable

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cancer_survivor
- Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer (JCO 2008): https://doi.org/10.1200/JCO.2007.12.3075
- Unmet cancer rehabilitation needs and access to survivorship services across the cancer continuum (Support Care Cancer 2026): https://doi.org/10.1007/s00520-026-10752-5
- Integration of palliative rehabilitation in cancer care: a multinational mixed method study (BMC Palliat Care 2024): https://doi.org/10.1186/s12904-024-01586-1
- Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort (Breast Cancer Res Treat 2024): https://doi.org/10.1007/s10549-023-07191-9
- Embedding multimodal rehabilitation within routine cancer care in Sheffield: the Active Together service evaluation protocol (J Phys Act Health 2024): https://doi.org/10.1123/jpah.2023-0622

## Connected records

- ideas: [Vocational rehabilitation integrated into cancer care so survivors can return to work](https://onco.cc/ideas/idea-acc-return-to-work-rehabilitation/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cancer rehabilitation: the discipline that puts function back](https://onco.cc/technologies/rejuv-rehab-cancer-rehabilitation/), [Financial toxicity and financial navigation](https://onco.cc/technologies/financial-navigation/), [Prospective surveillance: looking for the problem before it becomes a disability](https://onco.cc/technologies/rejuv-rehab-prospective-surveillance/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Where rehabilitation is commissioned, and who misses out](https://onco.cc/technologies/rejuv-rehab-commissioning-inequity/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Quality of life](https://onco.cc/terms/quality-of-life/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

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