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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.
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.
Written 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.
Fertility 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.
Rehabilitation. 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.
Exercise. 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.
Return 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.
Uptake 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.
Who 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.
Two 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.
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.
Query for this technology: (TITLE:"Who misses out on recovery care, measured" OR ABSTRACT:"Who misses out on recovery care, measured") 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 Who misses out on recovery care, measured, not a curated reading list.
Shares After treatment in the Nordic countries: rehabilitation written into the pathway, After treatment in low and middle income countries: mostly nothing, What recovery costs in the UK, and what it does not, Financial toxicity and financial navigation and the tags rejuvenation, survivorship, measurement, access.
Shares After treatment in the Nordic countries: rehabilitation written into the pathway, Referral to rehabilitation: the service most people who need it never see, After treatment in the UK: personalised care, and follow-up you lead yourself, Quality of life and the tags rejuvenation, survivorship, measurement, access.
Shares After treatment in the United States: the survivorship care plan, and what the trial found, Who gets told about fertility before treatment, and who does not, What recovery costs in the UK, and what it does not, Financial toxicity and financial navigation and the tags rejuvenation, survivorship, measurement, access.
Shares What recovery costs in the UK, and what it does not, After treatment in the UK: personalised care, and follow-up you lead yourself, How recovery is measured: the questionnaires behind the numbers, Financial toxicity and financial navigation and the tags rejuvenation, survivorship, measurement.
Shares Referral to rehabilitation: the service most people who need it never see, How recovery is measured: the questionnaires behind the numbers, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, measurement.
Shares After treatment in low and middle income countries: mostly nothing, Exercise is the best-evidenced thing on this front, and most survivors are not doing it, Referral to rehabilitation: the service most people who need it never see, How recovery is measured: the questionnaires behind the numbers and the tags rejuvenation, survivorship, measurement.
Shares What recovery costs in the UK, and what it does not, Financial toxicity and financial navigation, Financial toxicity, Quality of life and the tags rejuvenation, survivorship, equity.
Shares After treatment in the United States: the survivorship care plan, and what the trial found, The questionnaires that were never returned, and the people never asked, Quality of life, Fragmented care and guideline gaps and the tags rejuvenation, survivorship, measurement.