Ability to work outcomes for cancer survivors receiving outpatient rehabilitation: An EMR-based analysis of 2,996 cases.

263 Background: Challenges in meeting the physical and mental demands of work are a common source of distress for cancer survivors. Poor ability to work increases the risk of long-term disability, unemployment, loss of health insurance, and financial toxicity. Outpatient rehabilitation interventions — physical, occupational and speech therapy — can address functional impairments that limit work ability, but these services remain underutilized and their effects on work-related outcomes remain understudied. This health services research study examined real-world changes in work ability following outpatient cancer rehabilitation and identified predictors of improvement to help target those most likely to benefit. Methods: Electronic medical record data were analyzed from a national cancer rehabilitation program (2022 to 2024). Included cases had a cancer diagnosis (ICD-coded), attended ≥3 visits, completed pre/post outcomes measures, and reported poor overall ability to work at initial evaluation (≤5/10). Individuals who were retired, unemployed, or aged ≥75 years were excluded. The Work Ability Index was used to assess three domains: overall (0-10), physical (0: very good to 4: very poor), and mental (0: very good to 4: very poor). Mixed-effect models assessed change in physical and mental ability to work while adjusting for covariates. Overall ability to work was categorized as poor (0-5), moderate (6-7), or good-to-excellent (8-10); ordinal regression modeling identified predictors of categorical improvement. Results: The sample (N = 2,996) had a mean age of 57.8 years (SD:11.4) and was predominantly female (79.8%). Most had had breast cancer (59.6%); 7.2% had metastatic or secondary cancer. A mean of 10.5 visits (SD = 4.7) was attended over 10.7 weeks (SD = ±6.6); 84.5% received physical therapy. Significant improvement was observed in physical (EMM = 0.77, SE = 0.02, p < .001) and mental ability to work (EMM = 0.52, SE = 0.02, p < .001). Nearly half improved overall ability to work from poor to moderate-to-excellent (48%). Younger age ( < 45 years, p < .001) and cancer type (p < .001) predicted improvement, but sex (p = .158) and number of visits (p = .079) did not. Greater improvement was observed among individuals with breast, colorectal, head and neck, prostate, neuroendocrine, sarcoma or skin cancers, and among those without metastatic or secondary disease. Conclusions: Outpatient rehabilitation services may significantly enhance cancer survivors’ ability to work, particularly those under 45 years and those with certain cancer types. Further research is warranted to examine effects on broader work outcomes, including absenteeism, presenteeism, and long-term employment.