Cancer care: incidence, hospitalization and medical rehabilitation statistics for Germany from 2003 to 2016

Abstract Background In Germany, inpatient hospital and rehabilitation facilities are two main settings for the delivery of cancer care. Epidemiology and demography are major forces that influence the need for care in these settings. This article examines the extent to which cancer incidence is associated with the use of inpatient and rehabilitative care. Methods Population-based estimates of cancer incidence and survival came from the German Center for Cancer Registry Data. Statistical data on inpatient and rehabilitative care came from the Federal Statistical Office. Analyses included annual numbers and rates of hospitalizations and rehabilitation cases, and joinpoint regression models of these cases in relation to incident case numbers covering the period 2003–2016. To calculate the ratio of rehabilitation cases to incident cases, the number of incident cases was adjusted for 1-year survival. Results The number of incident cancers increased from 2003 to 2016 (women: +9.6%; men: +7.0), whereas the difference in inpatient cases was far smaller (women −0.4%; men +4.5%). In 2016, there were 2.46 inpatient cases per incident case for women and 2.72 for men. This indicator varied: 1.87 for breast cancer (women only) and 3.33 for lung cancer (women and men). The estimated number of 1-year cancer survivors was 180,000 women and 185,900 men in 2016. The number of estimated cases in oncological rehabilitation per 100 1-year survivors among women increased from 59.2 (2003) to 65.2 (2010) and then decreased to 57.2 (2016). There was also an initial increase among men, from 50.8 (2003) to 51.5 (2008) and a subsequent decline to 46.9 (2016). Conclusions Inpatient cases far exceed incident cases, which may reflect multiple hospitalizations for diagnostics and therapy of primary or recurring disease. The time trends of inpatient cases differ greatly from those of incident cases. This could be due to structural changes in the German health care system, such as possible shifts of services from the inpatient to the outpatient care sector. Regarding rehabilitation, the change in the trend of utilization has not been previously reported. Whether the ratio of rehabilitation cases to incidence indicates underuse of rehabilitative services cannot be assessed solely on the basis of the analyzed data.