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Factors influencing utilization of cancer rehabilitation services among older breast cancer survivors in the USA: a qualitative study

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Abstract

Purpose

Many older breast cancer survivors experience long-term disability due to cancer and cancer-related treatments. However, less than 20% of older breast cancer survivors utilize cancer rehabilitation services to address cancer-related disability. Further understanding of survivor experiences may reveal strategies to improve uptake cancer rehabilitation services in the USA.

Methods

Older breast cancer survivors were recruited from university-based registries, previous breast cancer research studies at our institution, community support groups, and geriatric oncology clinics. Participants completed a brief online survey to capture demographic and clinical characteristics. Semi-structured telephone-based interviews were recorded, transcribed, and thematically analyzed. Interviews facilitated conversation about access to rehabilitation and indications for cancer rehabilitation.

Results

Participants (n = 14) were, on average, 71 years old, primarily White, and an average of 36.5 months post-diagnosis. Five participants had formally received rehabilitation for a cancer-related concern. Participants described seven factors that influenced utilization of cancer rehabilitation services: (1) emerging awareness of disability; (2) coping styles; (3) comparison of cancer experience with others; (4) provider interaction; (5) perceptions of cancer diagnosis; (6) social support; and (7) cost of rehabilitation.

Conclusions

Older breast cancer survivors consider multiple factors when determining utilization of cancer rehabilitation services. Development of shared decision-making tools addressing the seven described factors may enhance communication and referral to cancer rehabilitation services. Intervention research should adopt frameworks that enhance healthcare accessibility to improve relevance of intervention content and delivery features for older breast cancer survivors.

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Data availability

The de-identified transcriptions and dataset analyzed in the current study are available upon request to the corresponding author.

Code availability

The coding scheme within NVivo (Version 12) (computer software) is available upon request to the corresponding author.

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Acknowledgements

Research funding was provided in part by the University of Pittsburgh School of Health and Rehabilitation Sciences Research Development Fund and in part by the Dr. Gary Kielhofner Doctoral Research Scholarship in Occupational Therapy funded by the American Occupational Therapy Foundation. Recruitment efforts were supported by the Pittsburgh Pepper Center (P30AG024827), the Geriatric Oncology Research Infrastructure to Improve Clinical Care Grant (R33AG59206), and the Clinical and Translational Science Institute at the University of Pittsburgh (UL1 TR001857).

Funding

This work was supported in part by the University of Pittsburgh School of Health and Rehabilitation Sciences Research Development Fund (PI: Brick; co-author: Eilers) and in part by the Dr. Gary Kielhofner Doctoral Research Scholarship in Occupational Therapy funded by the American Occupational Therapy Foundation (PI: Brick).

Author information

Authors and Affiliations

  1. Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA

    Rachelle Brick, Rachel Eilers, Pamela Toto, Elizabeth Skidmore & Natalie E. Leland

  2. Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA

    Kathleen Doyle Lyons

  3. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Catherine Bender

  4. Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Robert Ferguson

  5. ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA

    Mackenzi Pergolotti

Authors
  1. Rachelle Brick
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  2. Kathleen Doyle Lyons
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  3. Catherine Bender
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  4. Rachel Eilers
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  5. Robert Ferguson
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  6. Mackenzi Pergolotti
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  7. Pamela Toto
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  8. Elizabeth Skidmore
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  9. Natalie E. Leland
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Contributions

Study concepts and design were developed by RB, ES, NL, PT, RF, CB, and MP. Data acquisition was conducted by RB and RE. Quality control of data was completed by RB, RE, and KDL. Data analysis and interpretation were completed by RB, ES, NL, and KDL. Manuscript preparation was completed by RB, ES, NL, and KDL. Manuscript editing and review were completed by all authors.

Corresponding author

Correspondence to Rachelle Brick.

Ethics declarations

Ethics approval

This study was approved by the University of Pittsburgh Institutional Review Board (STUDY20040065) and certifies that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

Informed consent was obtained from each individual participant enrolled in the study.

Consent for publication

Not applicable.

Conflict of interest

Pergolotti receives a salary from ReVital Cancer Rehabilitation, Select Medical.

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Brick, R., Lyons, K.D., Bender, C. et al. Factors influencing utilization of cancer rehabilitation services among older breast cancer survivors in the USA: a qualitative study. Support Care Cancer 30, 2397–2405 (2022). https://doi.org/10.1007/s00520-021-06678-9

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  • DOI: https://doi.org/10.1007/s00520-021-06678-9

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