Are there Social Inequalities in the Utilisation of Oncological Rehabilitation by Breast Cancer Patients?

Goal: Using data from a sample of breast cancer patients it was examined whether the utilisation of inpatient rehabilitation after breast cancer surgery within one year of primary therapy is unequally distributed. Furthermore, it was considered which reasons are associated with the omission of rehabilitation. Material and Methods: Subjects were women after primary manifestation of breast cancer (stages: T-1-T-3; N-0-N-2; M-0) aged 25-70 years. The data were collected as part of an ongoing prospective study on the role of social factors in the long-term course of breast cancer. Patients were interviewed immediately after primary surgery and a second time 1 year later. Interviews were performed by specially trained interviewers using semi-structured schedules. 3 gynaecological clinics in Hannover were involved. Logistic regression models were used for performing the main analyses. Results: The data of 238 patients were used; 150 (63.3%) of them went to inpatient rehabilitation. Women with 12/13 years of school education were less likely to go to a rehabilitation clinic than women with lower qualifications; no social gradients in terms of occupational position emerged. A strong predictor for rehabilitation was chemotherapy, and in employed women radiotherapy was associated with lower utilisation. The reasons for not going to rehabilitation appear to be rather personal. They were motivated by patients' avoidance of being faced with cancer, and by the desire to take up the every day life that was interrupted by disease. These reasons are not socially patterned. Conclusion: We found no evidence for social barriers for utilising inpatient rehabilitation, but rather that medical and particularly individual reasons apply.