�---- DelbrUck / Rehabilitacija - letn . VIL supl. 2 (2008) ___________ _ 
GERMAN POL/CY IN REHABILI TATION 
OF CANCER PATIENTS 
Prof. dr. Hermann OelbrUck 
Arbeitsgemeinschaft fur Rehabilitation, Nachsorge und Sozialmedizin (ARNS), Germany 
Summary 
Rehabilitation of cancer patients is a complex discipline 
that involves the interaction of many diverse medica/ 
health care providers in Germany (pension insurance, 
accident insurance, federal employment agency, carri­
ers of social compensationfor health damages, private 
insurance companies, social welfare ... ) More than 80 
o/o of ali inpatient rehabilitation costs are covered by 
the pension funds and almost 80 % of costs far out­
patient rehabilitation are covered by health insurance 
companies. 
Allhough orthopaedic rehabilitation stili constitutes the 
most frequent use of patient rehabilitation in Germany. 
cancer rehabilitation is becoming more and more impor­
tant. Actually 21,3% of all patients treated in rehabilitation 
clinics are cancer patients. Many rehabilitation clinics in 
Germany actually convert into rehabilitation clinics for 
cancer patients. 
Most of thcse cancer patients have breast cancer. malignant 
tumours in the gastrointestinal and in the urologic area. 
Meanwhile there are more than 200 cancer rehabilitation 
hospitals. spread over the whole of Germany. 
DEFINITION AND GOALS 
In Germany we distinguish "medica! after care" from 
"rehabilitative care". The fir st one focuses on i mprov­
i ng survival, the latter focuses on improving ··:quality" of 
survival tirne. 
Table: Cancer Medica/ after care includes 
•
To deteci carly of recidivis (smaller tumour increases the
chances for curing the patients).
•
To do adjuvant treatments (in the hope they would prevent
recurrences)
•
To do additive treatments (in the hope this would stabilize
tumour growth and reduce canccr activity)
•
To treat recurrences (in the hope this would stop cancer
growth) ..
II 
There are some guidelines far the professional qualifica­
tion of the personnel involved in rehabilitation of cancer 
patients. In nearly all European countries outpatient reha­
bilitation measures are given priority, except for Gennany. 
Most of cancer rehabilitation hospitals have specially 
trained personnel and are located in a nice surroundings. 
Outpatient rehabilitation is stili in the process of being 
developed in Germany. 
Germany has guidelines that exclusively concern onco­
logical rehabilitation measures. Psychological, social and 
vocational rehabilitation measures play an important role 
in the rehabilitation process. 
"Rehabilitative care " does not focus on influencing the ill­
ness, but rather on reducing disabilities due to thc tumour 
and therapy. The negative effects of the disease and cor­
responding therapy in physical, psychic. social and voca­
tional areas should be eliminated or at least mitigated by 
rchabilitation. 
Table: Cancer rehabilitative care includes 
•
to deteci impairments and disabilities due to rhe cancer
illness and due to the treatment as well
•
to abolish or at least to reduce impairments and
disabilities due to the cancer illness and due to the
treatment as well
•
to rc-establish impaired functions or at least to compensate
impairments and disabilities duc to the cancer illness and
due to the treatment as well
•
to prevent late impairments and disabilities due to the
cancer illness and due to the treatment as well
Quality of li
f
e and goals of rehabilitation are often con­
founded with those of wellness. Sure. wellness is an impor­
tant part ofr ehabilitation in German, too; but rehabilitation 
is far more. Other people and other European countries 
consider rehabilitation to be mainly a somatic reparation 
discipline. In these countries rehabilitative measures are 
often associated with physical therapy and mainly hydro­
therapy. Physiotherapy. massages, and hydrotherapy are 
important rehabilitative measures in Germany as well but in 
many other cancer patients measures such as psychosocial 
and vocational support may be more important. Rehabili­
tation in Germany is considered to be a multidisciplin ary 

____________ Delbri.ick / Rehabilitacija -letn. VIL supl. 2 (2008) ___________ _ 
effort to be achieved by an holistic approach. This holistic 
approach means the inclusion of physical, psychic, social. 
and vocational measures. These measures are to be con­
sidered equal. 
To have cancer does not automatically mean to have a 
rehabilitative need. Rehabilitation does not require that the 
patient to be free of a tumour. Rehabilitation may be neces­
sary in cured patients and in patients whose disease is not 
responsive to curative treatment as well. Rehabilitation and 
palliation are not mutually exclusive. 
FINANCING 
In most European countries the medica( insurance compa­
nies pay for the costs of medica! rehabilitation. Germany is 
an exception. In Germany pension funds and not medica( 
insurances pay more then 80% for the costs of stationary 
cancer rehabilitation. On the other side pension funds pay 
only about 25% for ambulant rehabilitation. Medica! insur­
ance companies pay for medica! aid supply. 
LEGAL BASIS OF REHABILITATION 
In Germany each cancer patient has the legal right to claim 
medica! rehabilitation. Ever y cancer patient in Germany 
has the right by law to a period of inpatient treatment of 
about 21 - 26 days after completion of acute treatment. 
One in three cancer patients makes use of this opportunity 
for inpatient rehabilitation. In most European countries, 
such as Ger many, ali cancer patients are entitled to a 
legal certificate which makes them eligible for special 
advantages. This certificate must be renewed at least once 
eve ry five years. In Germany you find these rights in the 
Sozialgesetzbi.icher. 
INPATIENT REHABILITATION SERVICE 
OUTPATIENT REHABILITATION SERVICE 
Rehabilitation can be performed in both inpatient and 
outpatient settings. In nearly ali European countries, out­
patient rehabilitation measures are given priority, except 
for Germany. Here almost ali rehabilitation measures 
are predominantly performed within inpatient programs 
in special cancer rehabilitation hospitals. Most of these 
German cancer rehabilitation hospitals are located in a 
nice surrounding. An important note is that these clinics 
simultaneously undertake measures to avoid recurrences 
or worsening of the disease. This includes medica( after 
care and means besides rehabilitative measures prevention, 
recognition and palliative treatment in case of relapses are 
being performed. 
THE PROFESSIONAL QUALIFICATION 
OF THE PERSONNEL INVOLVED IN 
REHABILITATION 
In Germany the initiation, coordination and surveillance of 
rehabilitative measures in cancer patients are mainly directed 
by doctors. The doctors in Germany must hold a diploma of 
medica! oncology and rehabilitative medicine as well. 
Psychologists play a crucial role in the cancer rehabilitation 
team. In Germany there is a special diploma only for psycho 
oncologists. 
Only those rehabilitation hospitals in Germany are allowed 
to rehabilitate cancer patients when they have at least one 
psycho oncologist every 80 patients. 
Physical therapists are very important in some areas. Physical 
therapists in the Netherlands are highly qualified. They have 
an academic diploma which is not the case in Germany. 
Qualified stoma care nurses are extremely important in can­
cer rehabilitation. Their training lasts more then 6 months 
in Germany whereas other countries pay less attention to 
this training. 
REHABILITATION TEAM 
physicians 
exper,enced in rehabilitative medicine 
and oncology as well 
famtly I psychologi
.
st exper
.
1enced 
speech ther ap,st \ 
/ 
in oncol ogy 
' 
'-
\ 
/ 
/ 
phys1otherap1st 
self-help group 
-....___ 
� 
-----
:.---
ergotheraptst 
clergyman +----► Patient ---
/2 
art therap,st 
prosthe tic therap,s t 
� 
I �. social worker 
nutritional theraptst 
/ 
\ 
ostomy theraptst 
vocattonal advtser 
nurse 
QUALITY CONTROL AND OUTCOME 
ASSESSMENT 
Germany has guidelines that exclusively concern oncological 
rehabilitation. However, these guidelines are only applicable 
to inpatient rehabilitation, since outpatient rehabilitation is 
stili in the process of being developed in Germany. 
These guidelines in Germany guarantee a certain quality of 
structures. These guidelines say that the head of a cancer 
rehabilitation hospital should be an oncologist, in particular 
a medica( oncologist; they say, that patients with an ostomy 
should only be rehabilitated in a rehabilitation hospital 
which has a stoma nurse on the team ... 
-

------------ Delbriick / Rehabilitacija - letn. VII, supl. 2 (2008) __________ _ 
References: 
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Rahmenempfehlungen zur ambulanten onkolooischen
b 
Rehabi litation. Frankfurt: Bundesarbeitsgemeinschaft
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Aufl. Miinchen; Baltimore: Urban & Schwarzenbero
1998.
b' 
Id 
3. Delbriick H. Rehabilitation and palliation of cancer
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