Sociodemographic and clinical characteristics associated with utilization of rehabilitation services in breast cancer survivors.

Abstract

286 Background: Breast cancer treatment is increasingly efficacious, but commonly results in functional morbidity and decreased quality of life for survivors.Rehabilitation services, including physical and occupational therapy, are recommended by clinical practice guidelines to counteract these impairments, yet these supportive services may be underutilized. Little is known about how use of rehabilitation services may vary by patient-level characteristics. Methods: Data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database was used to identify women aged ≥66 years diagnosed with stage 0-III breast cancer between 2011-2016. Rehabilitation services (evaluation/treatment by a physical and/or occupational therapist) delivered in the initial phase of care (0-11 months post-diagnosis) were identified via outpatient or physician visit claims. Descriptive statistics compared rehabilitation usage by patient sociodemographics and clinical characteristics (age, race, dual eligibility status, rural/urban residence, cancer stage, subtype, treatment type). Associations between patient characteristics and rehabilitation services were calculated using modified Poisson models estimating relative risk (RR) and corresponding 95% confidence intervals (CIs). Results: Of 55,539 breast cancer survivors, 33% (n=18,244) had received any type of rehabilitative services. Survivors were a mean age of 75 years (SD 6.7), 88% White, 86% urban-dwelling, 21% Medicare/Medicaid dually enrolled, and 82% had HR+ breast cancer. Clinically, 88% of survivors had received chemotherapy, 69% lumpectomy, and 27% mastectomy. In adjusted models, patients aged >75 vs. ≤75 and dual-eligible beneficiaries vs. those with other insurance were 6% (RR 0.94, 95% CI 0.92-0.96) and 4% (0.96, CI 0.93-0.99) less likely to have received rehabilitative services, respectively. Patients with at least a high school education vs. less than high school, White vs. non-White, or living in a rural vs. urban area were 26% (1.26, CI 1.22-1.30), 6% (1.06, CI 1.02-1.11), and 6% (1.06, CI 1.02-1.10) more likely to have received rehabilitative services, respectively. Patients with invasive vs. in situ cancer and those who received surgical treatment vs. none were 13% (1.13, CI 1.06-1.21) and 15% (1.15, CI 1.02-1.32) more likely to have received rehabilitative services, respectively. Conclusions: Rehabilitation services use differed by patient sociodemographic and clinical characteristics, with the largest differences seen for survivors of differing educational and treatment statuses. Further research is needed on barriers for, access to, and delivery of rehabilitation services, specifically for women with breast cancer who are less educated, older-aged, non-White, or Medicare/Medicaid dual eligible.