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The use and timing of rehabilitation and palliative care to cancer patients, and the influence of social vulnerability – a population-based study
  1. Jens-Jakob Kjer Møller1,
  2. Karen la Cour2,
  3. Marc Sampedro Pilegaard3,4,
  4. Susanne Oksbjerg Dalton5,6,
  5. Pernille Bidstrup7,8,
  6. Sören Möller9,10 and
  7. Lene Jarlbaek1
  1. 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  2. 2 Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
  3. 3 DEFACTUM, Central Region Denmark, Aarhus, Denmark
  4. 4 Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
  5. 5 Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
  6. 6 Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
  7. 7 Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
  8. 8 Department of Psychology, University of Copenhagen, Copenhagen, Denmark
  9. 9 Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  10. 10 Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
  1. Correspondence to Jens-Jakob Kjer Møller, REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Syddanmark, Denmark; jens-jakob.kjer.moller{at}


Objectives To identify and investigate different cohorts of cancer patients’ use of physical rehabilitation and specialised palliative care (SPC) services, focusing on patients with incurable cancer and the impact of social vulnerability.

Methods The sample originated from patients diagnosed during 2013–2018 and alive 1 January 2015. Use of physical rehabilitation and/or SPC units were identified from contacts registered in population-based administrative databases. Competing-risks regression models were applied to investigate disparities with regard to social vulnerability, disease duration, gender and age.

Results A total of 101 268 patients with cancer were included and 60 125 survived longer than 3 years after their diagnosis. Among the 41 143 patients, who died from cancer, 66%, survived less than 1 year, 23% survived from 1 to 2 years and 11% survived from 2 to 3 years. Contacts regarding physical rehabilitation services appeared in the entire cancer trajectory, whereas contacts regarding SPC showed a steep increase as time drew closer to death. The largest disparity was related to disease duration. Socially vulnerable patients had less contact with SPC, while a larger proportion of the socially vulnerable cancer survivors used rehabilitation, compared with the non-vulnerable patients.

Conclusions This study provides a previously unseen detailed overview of the use of physical rehabilitation and/or SPC among patients with incurable cancer. The services appeared to overlap at a group level in the cancer trajectory, emphasising the importance of awareness with regard to coordination and combination of the services. Disparities between socially vulnerable or non-vulnerable patients were identified.

  • Cancer
  • Rehabilitation
  • Hospice care
  • Terminal care
  • Supportive care

Data availability statement

No data are available.

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  • Contributors All authors contributed to the study conception and design. Material preparation, data management and analysis were performed by J-JKM. The first draft of the manuscript was written by J-JKM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. J-JKM is responsible for the overall content as the guarantor.

  • Funding This study was supported by the Danish Cancer Society (R223-A13094-18-S68) through the Danish Research Center for Equality in Cancer (COMPAS), a faculty scholarship from the Faculty of Health Sciences on University of Southern Denmark, and REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.