Associations of Cancer Rehabilitation During Hospitalization for Cancer Treatment With Survival and Post–Discharge Healthcare Utilization: A Multicenter Retrospective Cohort Study
Toshitaka Morishima, Yoshihiro Kuwabara, Mizuki Shimadzu Kato, Yoko Iwaki, Haruka Kudo, Toshiki Ikawa, Kenji Kishimoto, Kayo Nakata, Isao MiyashiroABSTRACT
Background
Rehabilitation is increasingly recognized as an essential component of oncology care, but there remains limited evidence regarding its broader impact on patient outcomes. This study examined the associations of inpatient cancer rehabilitation with survival and post–discharge healthcare utilization among patients with diverse cancer types.
Methods
We conducted a multicenter retrospective cohort study using cancer registry–linked claims data from designated cancer care hospitals in Osaka Prefecture, Japan. The study cohort comprised adults newly diagnosed with cancer from 2020 to 2022. The exposure was receipt of inpatient cancer rehabilitation during the initial cancer treatment hospitalization. The primary outcome was all–cause mortality within 1 year of diagnosis, and the secondary outcomes were unplanned readmissions and out–of–hours outpatient visits within 28 days of discharge. Multivariable Cox proportional hazards and Fine–Gray subdistribution hazards models were used, adjusting for demographic and clinical factors.
Results
Among 123,955 patients from 69 hospitals, 20,561 (16.6%) underwent inpatient cancer rehabilitation. Rehabilitation was associated with a lower risk of mortality (hazard ratio, 0.83; 95% confidence interval, 0.79–0.87). Lower mortality risks were also observed for the following cancer types: lung, upper gastrointestinal, colorectal, hepato–biliary–pancreatic, breast, and hematologic cancers. Among 115,046 patients included in the post–discharge healthcare utilization analyses, rehabilitation was associated with lower risks of unplanned readmissions (subdistribution hazard ratio, 0.79; 95% confidence interval, 0.73–0.85) and out–of–hours visits (0.92; 0.84–0.999).
Conclusions
Inpatient cancer rehabilitation was associated with lower mortality and reduced post–discharge healthcare utilization. These findings support the further integration of rehabilitation into routine oncology practice.