A systematic review of exercise-based cancer rehabilitation programs worldwide: availability and content

Background: Exercise-based rehabilitation is recommended as best-practice cancer care. However, implementing such programs is challenging. This review evaluated the availability and content of exercise-based cancer rehabilitation programs worldwide. Methods: A systematic review of surveys and/or qualitative studies evaluating the number and/or content of cancer-specific, exercise-based rehabilitation programs was conducted. Electronic databases - MEDLINE, CINAHL, EMBASE, and PEDro - were searched from their inception to October 2023. Data were extracted independently by two reviewers. The quality of evidence was assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Quantitative data were analyzed descriptively; qualitative data reporting implementation challenges and facilitators were analyzed using content analysis. Results: Data from 13 high-income countries (n = 25 studies) identified 2111 exercise-based cancer rehabilitation programs. Most were multidisciplinary programs (88%) for adult cancer survivors, usually for breast, lung and gastrointestinal cancer at any stage of cancer treatment. On average, programs ran twice-weekly up to 8 weeks using a group format, but exercise content was poorly reported. The main facilitators of program implementation were having exercise specialists as part of the cancer care team and strong links between hospitals and the community. Programs with strong evidence also facilitated translation. Key barriers were a lack of resources and skilled staff. Conclusion: Moderate-quality evidence indicates that few exercise-based cancer rehabilitation programs exist globally. However, the availability of cancer rehabilitation is likely greater than reported due to inadequate quality and the scarcity of national reports. Improved reporting of exercise programs could assist in standardizing care.