The evolving role of physiotherapy in oncology rehabilitation: an evidence-based review addressing scope, efficacy, equity, and educational imperatives.

BACKGROUND

Global cancer prevalence exceeds 50 million survivors, with 60-90 % experiencing debilitating treatment-related impairments severely impacting quality of life. Physiotherapy has transitioned from a reactive adjunct to a proactive cornerstone of cancer care.

PURPOSE: This narrative review examines physiotherapy's expanded scope, evidence-based efficacy, implementation barriers, and equity challenges in oncology rehabilitation, with implications for patient, professional, and interprofessional education.

METHODS

Following SANRA principles and PRISMA-ScR guidance, we systematically searched PubMed, Embase, Cochrane Library, PEDro, Scopus, CINAHL, Web of Science, African Journals Online, and LILACS (January 2015-February 2024). We synthesized peer-reviewed evidence (RCTs, meta-analyses, guidelines) and grey literature, with deliberate prioritization of studies addressing global disparities and educational interventions.

RESULTS

From 2847 records, 38 studies met inclusion criteria. Robust evidence confirms physiotherapy efficacy: supervised exercise reduces cancer-related fatigue by 20-40 % (SMD -0.63), improves functional capacity (+50-80 m in 6-minute walk test), manages lymphedema (29-32 % volume reduction), and enhances quality of life. Prehabilitation reduces surgical complications by 50 % and hospital stays by ≈3.2 days. Telerehabilitation achieves outcomes comparable to in-person care (89-91 % adherence). Critical barriers include fragmented care pathways (<30 % of centers), workforce knowledge gaps (68 % of therapists report insufficient training), reimbursement issues, and profound disparities affecting older adults (>75 years), metastatic patients, and underserved populations-especially in low-resource settings.

CONCLUSION

Physiotherapy is vital for mitigating cancer's functional burden. Translating efficacy into equitable practice requires policy reform, specialized physiotherapy education, integration into interprofessional oncology curricula, patient education, digital health solutions, and research focused on underrepresented groups.