Referral Patterns for Cancer Rehabilitation: Identifying the Who, When, and Why

Background: Individuals with cancer who receive rehabilitation experience improved muscle strength, functional performance, and quality of life. To maximize these benefits, they may need rehabilitation at different points along the cancer care continuum requiring a referral for each occurrence. Little is known about who recommends individuals with cancer to rehabilitation and for what services and reasons. We aimed to describe who is providing cancer rehabilitation, what factors are considered when recommending rehabilitation, and when recommendations are made. Methods: We conducted a 21-question online survey of cancer rehabilitation providers through listservs, social media, email invitations, and word-of-mouth. Results: Most respondents were physical therapists who were older than 44 years, white, and female. Medical oncologists were the most common health care provider to initially refer to rehabilitation. An individual’s level of independence was the most common factor for the initial referral. Cancer rehabilitation providers working in inpatient rehabilitation and outpatient settings made their recommendations for subsequent rehabilitation within their weekly assessment compared to those in acute care who made recommendations within their initial evaluations. Conclusion: Medical and surgical oncologists were reported to be the most common initial referral source for cancer rehabilitation. Impairments experienced by those with cancer appear to be the primary reason for referring. Factors for recommending subsequent rehabilitation varied by setting: patient goals (acute), level of independence (inpatient rehabilitation), and impairments (outpatient). Research is needed to understand when and why patient goals are the primary reason for recommending therapy.