Socioeconomic position, referral and attendance to rehabilitation after a cancer diagnosis: A population-based study in Copenhagen, Denmark 2010–2015

Abstract

Background: Implementation of new cancer services may lead to socioeconomic differences in uptake and despite reports of more unmet needs among patients with low socioeconomic position studies have found that these patients receive less rehabilitation. We aimed to investigate associations between indicators for socioeconomic position and referral as well as attendance to rehabilitation for cancer. Methods: Through the Danish Cancer Registry, we identified all persons diagnosed with cancer in Copenhagen municipality 2010-2015 and obtained information on referral to and visits at the municipal rehabilitation center from municipal records. We linked the population with information on socioeconomic information and vital status through national registries. Associations were analyzed using multivariate Cox regression models. Results: Among 13,059 persons diagnosed with cancer a total of 2523 were referred for rehabilitation within 2.5 years from diagnosis. Compared to persons with short education, men and women with long education and men with medium education had higher adjusted hazard ratios (HR) for being referred to rehabilitation (Long: HR-men, 1.30 (95% CI: 1.06-1.59) and HR-women, 1.33 (95% CI: 1.15-1.53; Medium: HR-men, 1.23 (95% CI: 1.02-1.49)). Both men and women with children living at home had higher HR of referral (HR-men, 1.23 (95% CI: 1.00-1.52) and HR-women, 1.28 (95% CI: 1.11-1.48)). Among patients referred to rehabilitation, 81% attended a visitation consultation. Long education was associated with attendance in both genders while in men, medium education and in women high income, respectively was associated with attendance. Conclusion: Clear socioeconomic differences in referral and attendance to rehabilitation services indicate that socioeconomic inequality exists in patients' transition from cancer treatment into post-treatment care. Systematic needs assessment and clarification of wish for rehabilitation should be a requisite for all cancer patients independent of their socioeconomic position.

Identification of socially vulnerable cancer patients — development of a register-based index (rSVI)

“…The index is based on data from administrative, population-based registries with the future intention to study whether and when during the disease trajectory socially vulnerable patients with advanced cancer use rehabilitation and palliative care services. As these services are regarded as essential aspects of high-quality cancer care [12], and with indications of social inequality in access to these services [13][14][15], more knowledge is needed on how to reach socially vulnerable cancer patients regarding rehabilitation and palliative care [16]. The development of the rSVI is one step in the attempt to ensure optimal cancer treatment for all Danish cancer patients regardless of social position and vulnerability, as described by Danish Research Center for Equality in Cancer (COMPAS) [17].…”

Cancer rehabilitation and palliative care for socially vulnerable patients in Denmark: an exploration of practices and conceptualisations

“…1–3 Despite a tax-funded and needs-based organisation of the Danish health system, and hence largely free access to healthcare for all, social inequality in cancer care has been noted repeatedly in Denmark, 4–10 including in cancer rehabilitation and palliative care. 11–15…”

“…[1][2][3] Despite a tax-funded and needsbased organisation of the Danish health system, and hence largely free access to healthcare for all, social inequality in cancer care has been noted repeatedly in Denmark, [4][5][6][7][8][9][10] including in cancer rehabilitation and palliative care. [11][12][13][14][15] In Denmark, cancer care is governed by a standardised 'cancer package', which includes patients' referral by their general practitioner to hospital for diagnosis, treatment in in-patient and outpatient hospital settings and oncologist's assessment of patient needs and possible referral to community-based rehabilitation and palliative care. 16 Despite this standardised referral pathway embedded in the cancer package, referral to community-based rehabilitation and palliative care is not consistently provided by all hospitals or for all cancer diagnoses.…”

Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer

“…Second, patients living in areas of relative disadvantage, particularly areas at distance from oncology centers, may be substantially sicker before seeing their provider. Alternatively, oncologists' likelihood of intervening for a given level of symptoms may depend on patient factors including socioeconomic status, race, or ethnicity 50–56 . For example, Check et al 55 found both racial and socioeconomic disparities in the use of aprepitant for CINV prevention among women with breast cancer.…”