{"entity":{"id":"rejuv-access-who-misses-out","kind":"technology","name":"Who misses out on recovery care, measured","aka":[],"tldr":"Every part of recovery care is unevenly distributed, and the pattern repeats: people with less money, less education, more disability, who live further away or whose cancer is less common get less of it. These are measured gaps with sources, not an impression.","summary":"This record collects the measured gaps. Each number is from a named study and the populations differ, so they are reported separately rather than averaged into a single claim.\n\nWritten information at the end of treatment. In the 2010 United States National Health Interview Survey, among 1,185 people with a cancer history, 68 per cent had received any written documentation, 31 per cent had received both a treatment summary and written follow-up advice, and 8 per cent had a treatment summary only. In the 2021 Behavioral Risk Factor Surveillance System module, among 2,271 respondents, 12.1 per cent received nothing, 35.0 per cent received one component and 52.8 per cent received both. Survivors reporting three or more disabilities had lower odds of receiving a full plan than those with none, adjusted odds ratio 0.44 (95% CI 0.22 to 0.88). The 2010 analysis found race to be a strong predictor of receipt, with non-white race associated with increased odds of receiving written documentation in that dataset, which is not the direction many readers will expect and is reported here as the study reported it.\n\nFertility preservation. A systematic review of 25 high-quality United States studies of access among female adolescents and young adults found that \"reported rates of FP discussions ranged from 9% to 75%, referrals or consultations with fertility specialists ranged from 0.9% to 57%, and completion of FP procedures ranged from 0.56% to 70.3%\". Facilitators were \"younger age, private insurance, nulliparity, higher socioeconomic status, certain cancer types, and more recent diagnosis year\"; barriers were \"non-Hispanic Black or Hispanic race/ethnicity, lower income, public insurance, and residence in rural or low-resource areas\". Institutional interventions improved access \"but did not eliminate the underlying disparities\". The width of those ranges is itself the finding: whether a young woman is even told about fertility depends more on where she is treated than on her cancer.\n\nRehabilitation. In a survey of 66 cancer survivors reporting functional deficits in the first year after treatment, only 4.5 per cent received occupational therapy during that year, alongside significantly lower perceived quality of life in the first year of survivorship and moderate negative correlations between reported functional deficits and quality of life. In paediatric oncology in Central Europe, a three-part survey of 394 parents, 318 physiotherapists and 85 rehabilitation physicians found that 63.7 per cent of parents said their child needed rehabilitation during active treatment while 53.3 per cent received it, an unmet need of 10.4 per cent rising to 13.3 per cent after treatment finished, with lymphoma and spinal cord tumour patients having the highest unmet need. Eighty per cent of physiotherapists and 74 per cent of rehabilitation physicians rated their graduation-level knowledge of this area as insufficient.\n\nExercise. In a population-based survey of 606 haematologic cancer survivors in Alberta, \"22% of HCS met the combined exercise guideline, 22% met aerobic-only, 10% met strength-only, and 46% met neither exercise guideline\", and meeting the combined guideline was associated with having completed university.\n\nReturn to work after a universal entitlement. In German Pension Insurance records of completed rehabilitations from 2014 to 2021, 67.2 per cent of people with cancer were in employment two years after oncological rehabilitation, 70.0 per cent of women and 63.4 per cent of men, and people on lower incomes were less likely to return even after adjustment.\n\nUptake in a tax-funded system. The Danish literature records social inequality in uptake of cancer rehabilitation and palliative care repeatedly, despite a tax-funded, needs-based system.\n\nWho is not in the evidence at all. The measurement record on missing data covers this: language, cognitive and sensory impairment, digital access and treatment setting each remove people before a questionnaire is even handed out.\n\nTwo honest limits on this record. First, most of these figures are from the United States, Canada, Germany, Denmark and Australia, because that is where the studies are; the countries with the largest gaps have the least data. Second, we did not find current national United Kingdom figures for receipt of a holistic needs assessment, a treatment summary or a rehabilitation referral by deprivation quintile or ethnicity during this round, and this record does not supply estimates in their place.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Health_equity","links":[{"label":"Hinyard and Wirth, Race is a strong predictor of receipt of a written survivorship care plan: results from the National Health Interview Survey (J Community Health 2017)","url":"https://doi.org/10.1007/s10900-017-0365-0"},{"label":"Sarkar et al., Evaluating differences in receipt of survivorship care plan among cancer survivors with and without disabilities (Support Care Cancer 2024)","url":"https://doi.org/10.1007/s00520-024-08796-6"},{"label":"Algave et al., Fertility preservation access among female adolescents and young adults with cancer: a systematic review (Cancer 2026)","url":"https://doi.org/10.1002/cncr.70486"},{"label":"Hwang et al., Functional deficits and quality of life among cancer survivors: implications for occupational therapy in cancer survivorship care (Am J Occup Ther 2015)","url":"https://doi.org/10.5014/ajot.2015.015974"},{"label":"Jevic et al., Bridging the gap in pediatric cancer rehabilitation care: a multi-perspective survey study (Front Pediatr 2026)","url":"https://doi.org/10.3389/fped.2026.1870844"},{"label":"Vallerand et al., Correlates of meeting the combined and independent aerobic and strength exercise guidelines in hematologic cancer survivors (Int J Behav Nutr Phys Act 2017)","url":"https://doi.org/10.1186/s12966-017-0498-7"},{"label":"Socioeconomic differences in return to work after oncological rehabilitation: an analysis using data from German Pension Insurance (Journal of Health Monitoring 2026), DOI 10.25646/14443","url":"https://doi.org/10.25646/14443"},{"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"}],"tags":["rejuvenation","survivorship","measurement","access","equity"],"related":["rejuv-access-survivorship-care-lmic","rejuv-access-what-it-costs-uk","rejuv-ayac-services"],"cancers":["breast-hr-positive","all-leukemia","dlbcl","cervical","colorectal"],"sections":["rejuvenation","supportive-care"],"technologies":["rejuv-access-rehabilitation-referral","rejuv-access-fertility-preservation","rejuv-access-exercise-programmes","rejuv-mind-access-to-psychological-care","rejuv-measure-missing-data-and-who-is-not-asked","survivorship-care-plan","financial-navigation"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","quality-of-life","aya-oncology","financial-toxicity"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-global-access","b-trial-diversity","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Every element of recovery care on this front is discretionary, requires a referral, and is delivered by a service that is commissioned locally and not counted nationally. Discretionary, referral-gated, locally commissioned and uncounted is the exact profile of a service that distributes by advantage rather than by need.","strengths":["The gaps are measured in national surveys and systematic reviews, not assumed","The pattern is consistent across countries and across different kinds of care","Institutional interventions do measurably improve access even where they do not close the gap"],"limitations":["Most figures come from a handful of high-income countries","Study populations differ, so the numbers cannot be pooled","No current UK national figures by deprivation or ethnicity were found in this round","Several of the studies are small single-centre surveys"]},"route":"/technologies/rejuv-access-who-misses-out/","neighbours":{"technology":[{"id":"rejuv-access-survivorship-care-australia","kind":"technology","name":"After treatment in Australia: a stated model of survivorship care","route":"/technologies/rejuv-access-survivorship-care-australia/"},{"id":"rejuv-access-survivorship-care-lmic","kind":"technology","name":"After treatment in low and middle income countries: mostly nothing","route":"/technologies/rejuv-access-survivorship-care-lmic/"},{"id":"rejuv-access-survivorship-care-nordic","kind":"technology","name":"After treatment in the Nordic countries: rehabilitation written into the pathway","route":"/technologies/rejuv-access-survivorship-care-nordic/"},{"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":"rejuv-access-survivorship-care-us","kind":"technology","name":"After treatment in the United States: the survivorship care plan, and what the trial found","route":"/technologies/rejuv-access-survivorship-care-us/"},{"id":"rejuv-access-exercise-programmes","kind":"technology","name":"Exercise is the best-evidenced thing on this front, and most survivors are not doing it","route":"/technologies/rejuv-access-exercise-programmes/"},{"id":"financial-navigation","kind":"technology","name":"Financial toxicity and financial navigation","route":"/technologies/financial-navigation/"},{"id":"rejuv-mind-access-to-psychological-care","kind":"technology","name":"Getting psychological help after cancer: the stepped-care model, and what is actually commissioned","route":"/technologies/rejuv-mind-access-to-psychological-care/"},{"id":"rejuv-measure-patient-reported-outcomes","kind":"technology","name":"How recovery is measured: the questionnaires behind the numbers","route":"/technologies/rejuv-measure-patient-reported-outcomes/"},{"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":"rejuv-ayac-services","kind":"technology","name":"Services built for teenagers and young adults, and what the national evaluation found","route":"/technologies/rejuv-ayac-services/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-measure-missing-data-and-who-is-not-asked","kind":"technology","name":"The questionnaires that were never returned, and the people never asked","route":"/technologies/rejuv-measure-missing-data-and-who-is-not-asked/"},{"id":"rejuv-access-what-it-costs-uk","kind":"technology","name":"What recovery costs in the UK, and what it does not","route":"/technologies/rejuv-access-what-it-costs-uk/"},{"id":"rejuv-access-fertility-preservation","kind":"technology","name":"Who gets told about fertility before treatment, and who does not","route":"/technologies/rejuv-access-fertility-preservation/"}],"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"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":"aya-oncology","kind":"term","name":"Adolescent and young adult (AYA) oncology","route":"/terms/aya-oncology/"},{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"},{"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-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}]}}