Healthcare utilization and costs associated with structured oncological training therapy: a retrospective analysis in cancer patients

Abstract Exercise is an essential component of supportive cancer care, improving physical function and quality of life. In Germany, oncological training therapy (OTT) provides a structured way to incorporate exercise into routine oncology care. This retrospective study examined the healthcare utilization of OTT, focusing on differences in healthcare utilization among active participants (T), interested non-participants (I), and a control group (C). Clinical and billing data from a health insurance company were analyzed. The control cohort was selected using predefined demographic, oncological, and regional criteria. The interested group included patients who enrolled but did not participate. The final study population comprised 289 patients: 39 OTT participants, 94 interested non-participants, and 156 controls. A total of 152 patients initially registered for OTT between 2015 and 2019. Outcomes covered inpatient treatment days, outpatient visits and one-year survival. Between-group comparisons were performed using Kruskal–Wallis tests with Dunn’s post hoc tests for continuous or ordinal outcomes and chi-square tests for categorical variables. Of the 152 registered patients, 58 (38.1%) attended at least one session, and 39 (67.2%) attended at least 12 of the 24 scheduled sessions. The training group had significantly more outpatient visits than the control group during the second observation period (t2; median: 13 vs. 7 visits; p = 0.0005), accompanied by higher outpatient costs (median: €639.29 vs. €267.89; p = 0.0006). The interested non-participant group had the highest comorbidity burden and significantly higher inpatient costs than the training group during the first observation period (t1; median: €5666.89 vs. €0; p < 0.0001). Although estimated one-year survival was numerically higher in the training group (94.9%) than in the control group (85.8%), no statistically significant difference in overall survival was observed (log-rank p = 0.945). This real-world analysis showed that participation in OTT was associated with higher outpatient healthcare utilization and costs, while no reduction in inpatient utilization was observed. Further prospective studies are needed to determine whether these utilization patterns translate into a clinical benefit.