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Barriers to Occupational and Physical Therapy Utilization for Children With Cancer
Maria C Swartz1,2, Shiming Zhang3, Donna Kelly4
1Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Insights
Referrals and utilization of occupational and physical therapy (OT/PT) for pediatric cancer patients are limited by age, outpatient status, and diagnosis. Strategies are needed to improve access to these crucial rehabilitation services.
Area of Science:
- Pediatric Oncology
- Rehabilitation Medicine
- Health Services Research
Background:
- Occupational and physical therapy (OT/PT) referrals and utilization for pediatric cancer patients are understudied.
- Identifying barriers to OT/PT is crucial for improving care for children with cancer.
Purpose of the Study:
- To investigate factors influencing OT/PT referrals and utilization in pediatric cancer patients.
- To identify barriers to accessing rehabilitation services in this population.
Main Methods:
- Retrospective cohort study of pediatric cancer patients (up to 18.99 years) over 33.5 months.
- Extracted data from electronic medical records including demographics, cancer type, treatment, and OT/PT referral/completion rates.
- Utilized mixed-effect logistic regression models to analyze influencing factors.
Main Results:
- Overall OT/PT referral rates were 55.1% for inpatients and 22.5% for outpatients.
- Completion rates for referred patients were 32.6% (inpatients) and 13.7% (outpatients).
- Older age (18-19 years), outpatient setting, and leukemia diagnosis were associated with lower OT/PT utilization.
Conclusions:
- Key barriers to rehabilitation include older age, outpatient setting, and specific cancer diagnoses like leukemia.
- Further research is needed to develop strategies, such as patient navigation and automated referrals, to enhance OT/PT service utilization.
- Improving access to OT/PT is vital for optimizing functional outcomes in pediatric cancer survivors.
Introduction:
Occupational and physical therapy (OT/PT) referrals and utilization barriers for childhood cancer patients have not been adequately examined. The current study investigated factors influencing referrals to and utilization of OT/PT services among children with cancer at an NIH-designated cancer center.
Methods:
This retrospective cohort study included pediatric cancer patients (up to 18.99 years) presenting to the center over a 33.5-month period. Variables that could influence referrals to OT/PT were extracted from the electronic medical record (EMR) including OT and PT referrals (inpatient and outpatient), OT and PT consult completion, age at diagnosis, cancer type, sex, race/ethnicity, insurance, cancer treatment, comorbidities, and social vulnerability index. Mixed-effect logistic regression models were applied.
Results:
The cohort included 1080 patients (mean age 10.9 years; 55.1% male; 40.7% non-Hispanic White; 52.0% privately insured; 40.8% diagnosed with a non-neural solid tumor). Overall, 55.1% of inpatients and 22.5% of outpatients were referred for OT/PT, and 32.6% (93.6% of referrals) of inpatients and 13.7% (60.9% of referrals) of outpatients completed their OT/PT consults. Patients aged 18 to < 19 years at diagnosis had lower odds of inpatient OT/PT referral, and patients who underwent surgeries involving hardware placement or had conditions affecting mobility and function, pain, or cardiopulmonary diseases had higher odds of inpatient OT/PT referral. Compared with children with leukemia or lymphoma, children with central nervous system tumors had higher odds of outpatient OT/PT referral, and a non-neural solid tumor diagnosis was associated with greater odds of outpatient rehabilitation utilization.
Conclusion:
Barriers to rehabilitation included age ≥ 18 years, outpatient setting, and leukemia diagnosis. More research is needed to identify strategies, such as using patient navigation and automated referrals, to improve utilization of OT/PT services for the pediatric cancer population.
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