Utilization of rehabilitation services in patients with head and neck cancer in the United States: A SEER-Medicare analysis

Head Neck. 2019 Sep;41(9):3299-3308. doi: 10.1002/hed.25844. Epub 2019 Jun 25.


Background: Head and neck cancer (HNC) and its treatment lead to functional impairments. Rehabilitation by speech-language pathology (SLP) and occupational/physical therapy (OT/PT) can decrease morbidity.

Methods: The Surveillance, Epidemiology and End Results-Medicare data for patients with HNC diagnosed between 2002 and 2011 was utilized to evaluate posttreatment rehabilitation.

Results: In 16 194 patients, the overall utilization rate was 20.7% for SLP and 26.2% for OT/PT services. Treatment modality was significantly associated rehabilitation utilization. Compared to patients treated with primary surgery, those treated with primary radiotherapy had significantly lower odds of OT/PT utilization. Patients treated with surgery plus adjuvant treatment and primary concurrent chemoradiation had higher odds of SLP utilization compared to patients treated with surgery alone.

Conclusions: Rehabilitation services appeared to be underutilized by patients with HNC in the United States and vary with treatment modality. There is a need to improve integration of rehabilitation services into the HNC care continuum.

Summary: Rehabilitation services are underutilized by patients with HNC during posttreatment surveillance in the United States. Treatment modality significantly impacts rehabilitation utilization patterns.

Keywords: head and neck cancer; occupational therapy; physical and rehabilitation medicine; rehabilitation research; speech-language pathology; survivorship.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy*
  • Health Services Accessibility*
  • Humans
  • Language Therapy*
  • Male
  • Patient Acceptance of Health Care*
  • Physical Therapy Modalities*
  • SEER Program
  • Speech Therapy*
  • United States