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Published on: October 31, 2025
Patient-initiated rehabilitation after radiotherapy: gender and sociodemographic differences despite standardized
Angela Besserer1, Sally Mutiara2, Julia Boschan3
1Department of Radiation Oncology, Ernst Von Bergmann Hospital Potsdam, Potsdam, Germany. angela.besserer@klinikumevb.de.
Purpose:
Oncological rehabilitation improves quality of life and convalescence after cancer therapy yet is not uniformly accessed. While physician referral patterns and structural access barriers are studied, data on patient decision-making under standardized conditions are lacking. This single-center study examines gender and sociodemographic differences in patient-initiated rehabilitation under standardized conditions to eliminate physician selection bias and make patient-side decision processes visible.
Methods:
From January 2024 to December 2025, all patients treated at a radiation oncology department in Brandenburg, Germany received standardized written information about rehabilitation options and uniform support from social services. Patients who initiated rehabilitation were compared with the total cohort regarding gender, age, residence, insurance status, and diagnosis to identify sociodemographic factors in decision-making.
Results:
Overall rehabilitation uptake was 17.8% (484/2,727). Females accessed rehabilitation 2.6 times more frequently than males (25.1% vs. 9.6%, p < 0.001). Patients ≤ 65 years had twice the uptake of older patients (25.8% vs. 12.3%, OR = 2.48, 95% CI: 2.03-3.03, p < 0.001). Rural residents showed higher uptake than urban residents (32.0% vs. 15.2%, OR = 2.63, 95% CI: 2.08-3.33, p < 0.001). Statutory health insurance patients had higher uptake than privately insured patients (18.7% vs. 10.4%, OR = 1.98, 95% CI: 1.36-2.90, p < 0.001). Rehabilitation uptake varied substantially by tumor entity, with breast cancer showing the highest rates (43.9%). Curative treatment intent strongly predicted uptake (OR = 13.73, 95% CI: 8.87-21.27, p < 0.001).
Conclusion:
Even with standardized information and administrative support, significant gender-specific and sociodemographic differences persist. Barriers extend beyond information deficits to include patient-specific factors requiring targeted interventions to achieve equitable rehabilitation access.