Cancer patients’ needs for rehabilitation services

Figures & data

Table I. Demographic and medical characteristics, number of needs and unmet needs.

Number of participants	1 325 n (%)
Gender
Male	388 (29)
Female	923 (70)
Missing	14 (1)
Age (Missing = 16) (S.D.) (range)	52 (8.4) (27–64)
Living with a partner
No	310 (23)
Yes	1 006 (76)
Missing	9 (1)
Children < 18 years living at home
No	945 (71)
Yes	380 (29)
Education
Prim/second/high school	702 (53)
University/college	607 (46)
Missing	16 (1)
Employment status
Working/studying	966 (73)
Not working	297 (22)
Missing/other	62 (5)
Changes in employment status due to cancer
No changes	807 (61)
Changes due to cancer	309 (23)
Changes not due to cancer	168 (13)
Missing	41 (3)
Health region
South-east	635 (48)
West	318 (24)
Middle and north	363 (27)
Missing	9 (1)
Months since diagnosis (missing = 27)	29 (16.3) (3–98)
Cancer diagnosis
Breast cancer	544 (41)
Prostate cancer	121 (9)
Melanoma	81 (6)
Non-Hodgkin lymphoma	73 (6)
Colorectal/anal cancer	94 (7)
Gynecological cancer*	140 (11)
Others**	160 (12)
More than one diagnosis	112 (8)
Recurrence
No	1 132 (85)
Yes	177 (14)
Missing	16 (1)
Treatment status at time of survey
After treatment	943 (71)
Current treatment	205 (16)
No statement suits/not sure	165 (12)
Missing	12 (1)
Treatment
Chemotherapy and RAD +/− others***	449 (34)
Chemotherapy without RAD +/− others***	228 (17)
Surgery and RAD or RAD only	168 (13)
Surgery only	351 (26)
Other combinations	129 (10)
Comorbidity
No	676 (51)
Yes	622 (47)
Missing	27 (2)
Self-reported general health
Very good and quite good	936 (71)
Neither good or bad	277 (21)
Quite bad and very bad	103 (7)
Missing	9 (1)
Number of needs (n = 1297)****
0 need	482 (37)
1 need	304 (23)
2 needs	190 (15)
3 needs	126 (10)
4 needs	79 (6)
5 needs	51 (4)
6 needs	35 (3)
7 needs	30 (2)
Unmet needs (n = 1125)*****
0 need/met need	678 (60)
1 unmet need	223 (20)
2 unmet needs	112 (10)
3 unmet needs	43 (4)
4 unmet needs	29 (3)
5 unmet needs	22 (2)
6 unmet needs	9 (1)
7 unmet needs	9 (1)

S.D. – standard deviation.

RAD – Radiotherapy.

*Cervix/corpus and uteri/ovarian cancer.

**Diagnoses n < 50 as lung cancer, testicular cancer, leukemia, tumor in bladder, urethra, nerve system and thyroid.

***Others = surgery, hormone therapy or others.

****Only responders with valid response to the question on need for rehabilitation are included (n = 1 297).

*****Only responders with valid response to the questions on need for rehabilitation and offered and used rehabilitation are included (n = 1 125).

Figure 1. Proportions of cancer patients reporting need for seven rehabilitation services.

Table II. Factors associated with need for each rehabilitation service in multivariate logistic regression analyses.

	Physical therapy (n = 1 161) aOR (95% CI)	Physical training (n = 1 088) aOR (95% CI)	Psychological counseling (n = 1 031) aOR (95% CI)	Consultation with social worker (n = 1 018) aOR (95% CI)	Occupational therapy (n = 1 044) aOR (95% CI)	Support group sessions (n = 1 073) aOR (95% CI)	Admittance to a convalescent home (n = 1 041) aOR (95% CI)
Age			0.95 (0.93–0.96)	0.96 (0.94–0.98)			0.97 (0.95–0.99)
Living with a partner
No		1.0	1.0	1.0	1.0		1.0
Yes		0.61 (0.44–0.85)	0.64 (0.45–0.91)	0.53 (0.36–0.78)	0.48 (0.27–0.86)		0.70 (0.49–1.00)
Children < 18 years living at home
No		1.0
Yes		1.44 (1.05–1.97)
Education
Prim/second/high school		1.0	1.0			1.0	1.0
University/college		1.67 (1.25–2.23)	1.79 (1.30–2.46)			1.46 (1.06–1.99)	1.84 (1.32–2.57)
Employment status
Working/studying			1.0	1.0			1.0
Not working/other			1.76 (1.19–2.58)	1.99 (1.32–3.02)			1.76 (1.19–2.61)
Changes in employment status
No changes	1.0	1.0	1.0	1.0	1.0	1.0	1.0
Changes due to cancer	2.59 (1.82–3.69)	2.91 (2.09–4.06)	3.26 (2.27–4.67)	2.20 (1.48–3.27)	2.81 (1.54–5.13)	1.91 (1.33–2.73)	3.42 (2.38–4.91)
Changes not due to cancer	0.90 (0.58–1.41)	0.66 (0.41–1.07)	1.21 (0.75–1.95)	1.32 (0.75–2.32)	1.49 (0.58–3.85)	1.02 (0.62–1.66)	1.37 (0.84–2.25)
Diagnoses
Breast cancer	1.0	1.0				1.0	1.0
Prostate cancer	0.23 (0.12–0.42)	1.22 (0.67–2.25)				0.29 (0.14–0.59)	1.11 (0.55–2.23)
Melanoma	0.09 (0.03–0.24)	0.33 (0.12–0.94)				0.12 (0.04–0.44)	0.13 (0.03–0.58)
Non-Hodgkin lymphoma	0.25 (0.14–0.47)	1.14 (0.62–2.10)				0.31 (0.15–0.63)	1.02 (0.53–1.94)
Colorectal/anal cancer	0.16 (0.09–0.30)	0.92 (0.52–1.64)				0.22 (0.11–0.47)	0.75 (0.40–1.43)
Gynecological cancer*	0.20 (0.11–0.34)	0.79 (0.45–1.36)				0.30 (0.16–0.56)	0.58 (0.32–1.07)
Others**	0.22 (0.14–0.37)	0.85 (0.52–1.39)				0.17 (0.09–0.33)	0.49 (0.28–0.88)
More than one diagnosis	0.42 (0.24–0.71)	1.50 (0.87–2.58)				0.57 (0.33–1.00)	1.00 (0.56–1.79)
Recurrence
No	1.0
Yes	1.48 (0.96–2.29)
Treatment status at time of survey
After treatment				1.0
Current treatment				1.67 (1.07–2.60)
None statements suits/not sure				1.41 (0.78–2.54)
Treatment
Chemotherapy and RAD +/− others*** and	1.0	1.0	1.0	1.0	1.0	1.0	1.0
Chemotherapy not RAD +/− others***	0.57 (0.37–0.87)	0.95 (0.63–1.44)	0.79 (0.52–1.20)	1.45 (0.95–2.22)	0.70 (0.35–1.37)	1.23 (0.77–1.94)	1.44 (0.91–2.25)
Surgery/RAD or RAD only	0.15 (0.09–0.23)	0.21 (0.13–0.35)	0.35 (0.19–0.63)	0.37 (0.19–0.73)	0.31 (0.10–0.92)	0.49 (0.30–0.80)	0.36 (0.20–0.66)
Surgery only	0.26 (0.17–0.42)	0.26 (0.16–0.42)	0.48 (0.32–0.72)	0.21 (0.12–0.38)	0.28 (0.12–0.66)	0.50 (0.29–0.87)	0.48 (0.28–0.83)
Other combinations	0.23 (0.14–0.38)	0.28 (0.16–0.50)	0.56 (0.31–1.03)	0.32 (0.15–0.69)	0.15 (0.04–0.67)	0.76 (0.43–1.35)	0.49 (0.25–0.95)
Comorbidity
No	1.0	1.0	1.0	1.0			1.0
Yes	1.46 (1.07–1.98)	1.63 (1.21–2.18)	1.89 (1.36–2.63)	1.53 (1.05–2.22)			1.48 (1.06–2.06)
Self-reported general health
Very good and quite good	1.0				1.0	1.0
Neither good or bad	1.61 (1.11–2.31)				3.85 (2.04–7.24)	1.85 (1.26–2.72)
Quite bad and very bad	2.14 (1.19–3.83)				6.62 (3.09–14.18)	2.38 (1.35–4.21)

Adjusted odds ratio (aOR), 95% Confidence Interval (95% CI).

Numbers included in the multivariate analyses vary from 1018 to 1161, depending on missing data of the dependent variable as well as the explanatory variables included in the separate models.

For each of the seven rehabilitation services different variables were included in the final multivariate models (as described in the statistics).

The included variables were for:

Physical therapy: changes in employment status, diagnosis, recurrence, treatment, comorbidity and self-reported general health.

Physical training: living with a partner, children <18 years living at home, education, changes in employment status, diagnosis, treatment and comorbidity.

Psychological counseling: age, living with a partner, education, employment status, changes in employment status, treatment and comorbidity.

Consultation with a social worker: age, living with a partner, employment status, changes in employment status, treatment status at time of survey, treatment and comorbidity.

Occupational therapy: living with a partner, changes in employment status, treatment and self-reported general health.

Support group sessions: education, changes in employment status, diagnosis, treatment and self-reported general health.

Admittance to a convalescent home: age, living with a partner, education, employment status, changes in employment status, diagnosis, treatment and comorbidity.

*Cervix/corpus and uteri/ovarian cancer.

**Diagnoses n < 50 as lung cancer, testicular cancer, leukemia, tumor in bladder, urethra, nerve system and thyroid.

***Others = surgery, hormone therapy or others.

Table III. Factors associated with increasing need for rehabilitation (complex rehabilitation) (range 0–7).

	Simple Linear Regression Analyses			Multivariate Linear Regression Analyses (n = 1 169)
	Regression coefficient (B)	p	95%CI	Regression coefficient (B)	p	95%CI
Sex (male = ref) (n = 1 283)
Female	0.57	< 0.001	0.36–0.79
Age (n = 1281)	−0.03	< 0.001	−0.04 – −0.02	−0.03	< .001	−0.04 – −0.17
Living with a partner (no = ref) (n = 1 288)
Yes	−0.40	0.001	−0.63 – −0.17	−0.33	.003	−0.54 – −0.12
Children < 18 years living with you (no = ref) (n = 1 297)
Yes	0.49	< 0.001	0.27–0.71
Education (prim/second/high school = ref) (n = 1 283)
University/college	0.33	0.001	0.14–0.53	0.45	< .001	0.26–0.63
Employment status (working/studying = ref) (n = 1 238)
Not working/other	0.68	< 0.001	0.44–0.91	0.45	< .001	0.21–0.70
Changes in employment (no changes = ref) (n = 1 257)
Changes due to cancer	1.29	< 0.001	1.06–1.52	0.95	<.001	0.71–1.18
Changes not due to cancer	−0.09	0.55	−0.38–0.20	−0.002	.99	−0.28–0.28
Health region (south-east = reference) (n = 1 288)
West	−0.24	0.06	−0.48–0.01
Middle and north	−0.15	0.20	−0.39–0.08
Months since diagnosis (n = 1 262)	0.002	0.60	−0.01–0.01
Diagnoses (breast cancer = ref) (n = 1 297)
Prostate cancer	−0.99	< 0.001	−1.34 – −0.64	−0.15	.43	−0.52–0.22
Melanoma	−1.56	< 0.001	−1.97 – −1.15	−0.85	< 0.001	−1.31 – −0.40
Non-Hodgkin lymphoma	−0.20	0.35	−0.63 – −0.23	−0.44	.04	−0.86 – −0.03
Colorectal/anal cancer	−0.67	0.001	−1.06 – −0.28	−0.69	< 0.001	−1.08 – −0.31
Gynecological cancer*	−0.70	< 0.001	−1.03 – −0.37	−0.60	.001	−0.95 – −0.24
Other**	−0.69	< 0.001	−0.997 – −0.37	−0.68	< 0.001	−1.00 – −0.36
More than one diagnosis	−0.02	0.92	−0.38–0.34	−0.03	0.86	−0.39–0.32
Recurrence (no = reference) (n = 1 281)
Yes	0.75	< 0.001	0.46–1.03
Treatment status at time of survey (after treatment = ref) (n = 1 285)
During treatment	0.69	< 0.001	0.42–0.97
No statements suits/not sure	−0.18	0.25	−0.48–0.12
Treatment (chemotherapy and RAD +/− others*** = ref) (n = 1 297)
Chemotherapy without RAD +/− others***	−0.22	0.11	−0.49–0.05	0.08	.60	−0.21–0.37
Surgery and RAD or RAD only	−1.34	< 0.001	−1.64 – −1.04	−1.07	< .001	−1.37 – −0.76
Surgery only	−1.57	< 0.001	−1.81 – −1.33	−0.91	< .001	−1.21 – −0.61
Other combinations	−1.15	< 0.001	−1.48 – −0.82	−0.90	< .001	−1.26 – −0.54
Comorbidity (no = reference) (n = 1 273)
Yes	0.37	< 0.001	0.18–0.57	0.29	0.003	0.10–0.48
General health (Very good and quite good = ref) (n = 1 288)
Neither good or bad	0.84	< 0.001	0.61–1.08
Quite bad and very bad	1.46	< 0.001	1.10–1.82

Numbers included varies for each explanatory variable because of missing data.

Only variables that remained statistical significant associated with the dependent variable in the final multivariate analysis (age, living with a partner, education, employment status, changes in employment status, diagnosis, treatment and comorbidity) were included in the table.

*Cervix/corpus and uteri/ovarian cancer.

**Diagnoses n < 50 as lung cancer, testicular cancer, leukemia, tumor in bladder, urethra, nerve system and thyroid.

***Others = surgery, hormone therapy or others.

Figure 2. Rehabilitation services – needed and offered.

Table IV. Factors associated with unmet need for rehabilitation.

	Unmet need (number (%))
	No	Yes	aOR (95%CI)	p
All	676 (60)	449 (40)
Living with a partner*
No	141 (54)	118 (46)	1.0	0.046
Yes	529 (62)	328 (38)	0.73 (0.54–0.99)
Changes employment status*
No changes	467 (66)	240 (34)	1.0	< 0.001
Changes due to cancer	92 (39)	147 (61)	2.57 (1.87–3.54)	< 0.001
Changes not due to cancer	101(67)	50 (33)	1.05 (0.71–1.55)	0.81
Treatment
Chemotherapy and RAD +/− others	179 (50)	179 (50)	1.0	< 0.001
Chemotherapy without RAD +/− others	93 (47)	107 (53)	1.13 (0.79–1.64)	0.50
Surgery and RAD or RAD only	97 (66)	49 (34)	0.53 (0.35–0.81)	0.004
Surgery only	233 (74)	82 (26)	0.38 (0.27–0.54)	< 0.001
Other combinations	74 (70)	32 (30)	0.41 (0.25–0.67)	< 0.001
Comorbidity *
No	395 (66)	204 (34)	1.0
Yes	273 (54)	237 (46)	1.61 (1.23–2.10)	< 0.001

Adjusted odds ratio (aOR), 95% Confidence Interval (95% CI).

Only variables that remained statistical significant associated with the dependent variable in the final multivariate analysis (living with a partner, changes in employment status, treatment and comorbidity) were included in the table.

*Numbers are not equal to 1 125 because of missing data.