{"entity":{"id":"rejuv-access-survivorship-care-nordic","kind":"technology","name":"After treatment in the Nordic countries: rehabilitation written into the pathway","aka":[],"tldr":"Denmark, Norway and Sweden build rehabilitation and a named contact person into the national cancer pathway rather than leaving them to be requested afterwards. Even in tax-funded systems designed around need, the published work finds that socially disadvantaged people take up less of it.","summary":"The Nordic systems are the closest thing to a natural experiment on this front: tax-funded, universal, organised around national cancer pathways, with rehabilitation written into the pathway rather than bolted on. What they show is that universal design reduces but does not remove inequality of uptake.\n\nDenmark. Cancer rehabilitation and palliative care are organised around needs assessment within national pathway programmes, with much of the delivery devolved to municipalities. The published Danish work on this front is largely about who does not take it up. A narrative review of Danish-language practice development studies with a stakeholder workshop concluded that \"despite a tax-funded, needs-based organisation of the Danish health system, social inequality in cancer rehabilitation and palliative care (PC) has been noted repeatedly\", and that what professionals and the literature favoured was \"approaches which provide additional individualised resources throughout the cancer trajectory for this patient group\" rather than a uniform offer. The same work notes that the terms social inequality and social vulnerability are used interchangeably in the field, which is itself a measurement problem: a service cannot target what it has not defined.\n\nSweden. The Swedish model assigns a named contact nurse to each person with cancer and uses an individual written care plan. The contact nurse role has been studied at national scale in registry-linked cohorts: in a population-based study of 2,614 people who died of oesophageal and gastric cancer in Sweden between 2014 and 2016, assignment of a contact nurse was associated with higher rates of planned outpatient visits and also of unplanned hospital stays and unplanned outpatient visits, compared with those not assigned one. That association runs in both directions and the authors interpret it as reflecting who is assigned a contact nurse as well as what the role does; it is not evidence that the role causes admissions.\n\nNorway. Norway introduced a structured pathway intended to carry people from the end of cancer treatment back into ordinary life, with conversations about needs, late effects and work. We could not reach the Norwegian Directorate of Health page describing it during this round, so this record does not state its contents, its timing or its coverage. That is a named gap rather than an omission.\n\nWhat the Nordic experience supports. First, that building rehabilitation into a pathway rather than offering it on referral changes who receives it. Second, that it does not equalise uptake on its own, which is the finding that most matters for every other country planning a universal offer. Third, that the measurement of social vulnerability has to be defined before a service can act on it.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Healthcare_in_Denmark","links":[{"label":"Nissen et al., Cancer rehabilitation and palliative care for socially vulnerable patients in Denmark: an exploration of practices and conceptualisations (Palliat Care Soc Pract 2022)","url":"https://doi.org/10.1177/26323524221097982"},{"label":"Dalhammar et al., Health care utilization among patients with oesophageal and gastric cancer: the impact of initial treatment strategy and assignment of a contact nurse (BMC Health Serv Res 2021)","url":"https://doi.org/10.1186/s12913-021-07042-7"}],"tags":["rejuvenation","survivorship","measurement","access","nordic"],"related":["rejuv-access-survivorship-care-germany","rejuv-access-survivorship-care-uk"],"cancers":["colorectal","breast-hr-positive","gastric","esophageal"],"sections":["rejuvenation","supportive-care"],"technologies":["survivorship-care-plan","oncology-nursing","rejuv-access-who-misses-out","rejuv-access-rehabilitation-referral","palliative-care"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","quality-of-life"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Embedding rehabilitation needs assessment and a named coordinator inside a national pathway makes the default receipt rather than request, which removes one barrier; it leaves the barriers that operate before the pathway, which is why residual inequality of uptake persists in systems with no financial barrier at all.","strengths":["Rehabilitation and needs assessment are part of the pathway, not an optional referral","A named contact nurse gives every person a route back in","The inequality that remains has been examined rather than assumed away"],"limitations":["Social inequality in uptake persists despite tax funding and needs-based design","Social vulnerability is defined inconsistently, which limits targeting","Delivery devolved to municipalities, so what is available varies locally","We could not verify the Norwegian post-treatment pathway from an official source in this round"]},"route":"/technologies/rejuv-access-survivorship-care-nordic/","neighbours":{"technology":[{"id":"rejuv-access-survivorship-care-germany","kind":"technology","name":"After treatment in Germany: a rehabilitation entitlement, not a leaflet","route":"/technologies/rejuv-access-survivorship-care-germany/"},{"id":"rejuv-access-survivorship-care-uk","kind":"technology","name":"After treatment in the UK: personalised care, and follow-up you lead yourself","route":"/technologies/rejuv-access-survivorship-care-uk/"},{"id":"palliative-care","kind":"technology","name":"Early integrated palliative care","route":"/technologies/palliative-care/"},{"id":"oncology-nursing","kind":"technology","name":"Oncology nursing and nurse-led care","route":"/technologies/oncology-nursing/"},{"id":"rejuv-access-rehabilitation-referral","kind":"technology","name":"Referral to rehabilitation: the service most people who need it never see","route":"/technologies/rejuv-access-rehabilitation-referral/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-access-what-it-costs-elsewhere","kind":"technology","name":"What recovery costs in the rest of the world","route":"/technologies/rejuv-access-what-it-costs-elsewhere/"},{"id":"rejuv-access-who-misses-out","kind":"technology","name":"Who misses out on recovery care, measured","route":"/technologies/rejuv-access-who-misses-out/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}]}}