Barriers to Occupational and Physical Therapy Utilization for Children With Cancer

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.