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Physiotherapy, occupational therapy, speech and swallowing therapy and lymphoedema services are the treatments for most of what cancer treatment leaves behind. The measured use of them after cancer treatment is a small fraction of the measured need, and the people delivering them say they were not trained for it.
Cancer rehabilitation is not a single service but a group of them: physiotherapy for strength, balance and lymphoedema, occupational therapy for doing ordinary things again, speech and language therapy after head and neck treatment, dietetics, and rehabilitation medicine to coordinate. Almost every record on this front ends with one of them as the answer, which is why how often people reach them matters.
The size of the gap, in adults. In a survey of 66 cancer survivors, modest to moderate functional deficits were reported in 28 of 70 items covering areas of occupation, performance skills, body functions and psychosocial well-being within the first year after treatment; perceived quality of life in that first year was significantly lower than before diagnosis; reported deficits correlated moderately and negatively with quality of life; and "a very low percentage of participants (4.5%) receiving occupational therapy during the first year posttreatment". That is one small study and should be read as such, but no study in this literature reports high rehabilitation uptake.
The size of the gap, in children. In the Central European survey of 394 parents, 318 physiotherapists and 85 rehabilitation physicians, 63.7 per cent of parents reported their child needed rehabilitation during active treatment and 53.3 per cent received it, an unmet need of 10.4 per cent, rising to 13.3 per cent after treatment finished. Nearly a third of children needed therapy for more than six months during treatment, 29.5 per cent, rising to 47.6 per cent after treatment. The structural barriers the respondents named were informational deficits, insufficient regional infrastructure and professional uncertainty about patient safety.
The workforce finding is the one that explains the rest. In that same survey, "80% of physiotherapists and 74% of rehabilitation physicians rated their graduation-level knowledge as insufficient, a deficit persisting in nearly half of professionals in current practice", while 66 per cent of physiotherapists and 54 per cent of physicians were interested in joining a specialist competence network. The authors read this as "professional reluctance reflects insufficient training rather than lack of motivation", which points at a remediable cause.
Where a system has decided otherwise. The German entitlement described elsewhere in this file funds a three-week structured rehabilitation programme after cancer treatment as a matter of course, and measures its outcome as return to work. That is the clearest existing demonstration that the gap is a commissioning decision rather than an inevitability.
What would need to be measured to know how bad this is. A denominator of people finishing cancer treatment with a functional problem, and a numerator of those seen by a rehabilitation service, by country. Neither exists routinely in any system we could find, which is why every figure in this record comes from a survey rather than from a service dataset.
Rehabilitation need after cancer treatment is high, prolonged and measurable; rehabilitation capacity is commissioned against neither. The gap is sustained by three separable causes, no routine screening for functional problems, no referral pathway attached to the end of treatment, and a workforce that reports it was not trained for this population.
Query for this technology: (TITLE:"Referral to rehabilitation: the service most people who need it never see" OR ABSTRACT:"Referral to rehabilitation: the service most people who need it never see") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Referral to rehabilitation: the service most people who need it never see, not a curated reading list.
Shares Who misses out on recovery care, measured, Fragmented care and guideline gaps, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement, access, equity.
Shares Exercise is the best-evidenced thing on this front, and most survivors are not doing it, After treatment in the UK: personalised care, and follow-up you lead yourself, Who misses out on recovery care, measured, Not enough oncologists, nurses, pathologists, physicists and the tags rejuvenation, survivorship, measurement, access.
Shares Walking, gripping and standing up: the tests that take five minutes, Who misses out on recovery care, measured, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, measurement, access.
Shares Exercise is the best-evidenced thing on this front, and most survivors are not doing it, Walking, gripping and standing up: the tests that take five minutes, The exercise prescription after cancer: the dose the guidelines state, Prehabilitation before cancer surgery and the tags rejuvenation, survivorship, measurement.
Shares After treatment in the Nordic countries: rehabilitation written into the pathway, After treatment in Germany: a rehabilitation entitlement, not a leaflet, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement, access.
Shares After treatment in the UK: personalised care, and follow-up you lead yourself, Who misses out on recovery care, measured, Quality of life, Fragmented care and guideline gaps and the tags rejuvenation, survivorship, access.
Shares After treatment in the UK: personalised care, and follow-up you lead yourself, Compression, decongestive therapy and exercise for lymphoedema, Who misses out on recovery care, measured, Quality of life and the tags rejuvenation, survivorship, measurement, access.
Shares Measuring lymphoedema: tape, bioimpedance and the quality of life scales, Walking, gripping and standing up: the tests that take five minutes, Who misses out on recovery care, measured, Quality of life and the tags rejuvenation, survivorship, measurement.