Exercise Counseling and Referral Practices Among Oncology Care Physicians in Latin America: A Multinational Survey Study.

PURPOSE: Exercise improves outcomes for patients with cancer, yet implementation of exercise counseling and referral in oncology care remains inconsistent in Latin America. This study evaluated current practices, barriers, promoters, and provider/practice factors influencing exercise counseling.

METHODS

We conducted a cross-sectional survey in Spanish and Portuguese among oncology physicians in Latin America (December 2024-February 2025). Eligible participants included medical, surgical, radiation oncologists, and palliative care specialists providing direct patient care. A culturally adapted questionnaire assessed practices, barriers, promoters, and demographics. Analyses included descriptive statistics, Chi-square tests, and regression to examine predictors of counseling behaviors.

RESULTS

A total of 454 physicians completed the survey (response rate: 29.5%). Although 62.5% routinely assessed physical activity, only 26.4% did so at every visit. Half regularly recommended exercise (50.7%), and 27.1% never referred patients to exercise programs. Barriers included patient factors (eg, fatigue, side effects, low motivation), provider insecurity/lack of knowledge (65.9%), and cultural norms favoring rest (76.7%). Promoters included prior training, personal exercise experience, and institutional support. Medical oncologists and hospital-based providers were more likely to assess, recommend, and refer (all P < .01). Regression showed prior training strongly predicted counseling behaviors (P < .001), while years in practice was negatively associated.

CONCLUSION

Despite awareness of exercise benefits, counseling and referral remain suboptimal in Latin America. Barriers include structural, knowledge, and cultural factors, while provider training and institutional support improve practices. These findings support the need for targeted educational, system investments, and culturally adapted guidelines to enhance exercise integration in cancer care.