Oncology: Physiotherapy’s Role in Cancer Care

Oncology is the medical specialty concerned with the investigation, treatment, and follow-up of cancer. The field covers three main areas:

• Medical oncology: the use of drugs such as chemotherapy, immunotherapy, and hormone therapy

• Radiation oncology: the use of radiotherapy

• Surgical oncology: surgical removal of tumors and other procedures¹

Cancer as a Global Health Challenge

Cancer is the second most common cause of death worldwide. In 2018, it accounted for an estimated 9.6 million deaths, and around one in six deaths globally was caused by cancer². The burden is greatest in low- and middle-income countries, where 70% of cancer-related deaths occur.

Roughly one third of all cancer deaths can be linked to five key lifestyle factors: high body mass index, low intake of fruit and vegetables, physical inactivity, tobacco use, and alcohol².

Physiotherapy in Multidisciplinary Cancer Care

Physiotherapists play an important role across the cancer care continuum – from diagnosis to end-of-life. Their contributions include:

• Assessing and monitoring function, pain, and quality of life

• Promoting physical activity and reducing functional decline

• Supporting relatives and improving coping throughout the disease course³

Without physiotherapy, patients risk reduced quality of life, lower functional capacity, and poorer management of treatment-related side effects³.

How Cancer Develops – Pathophysiology and Cell Changes

Cancer arises when the body’s normal cell growth goes out of control. This is due to genetic alterations that lead to uncontrolled cell division and tumor formation.

A tumor may be:

• Benign (non-malignant): grows locally but does not spread

• Malignant (cancerous): invades surrounding tissues and may spread to other parts of the body via blood or lymph – a process known as metastasis

Genetic changes can occur through:

• Loss or gain of chromosomes during cell division (mitosis)

• DNA sequence mutations

While some changes are inherited, most are caused by external factors.

Known Risk Factors for Cancer

About 90–95% of all cancer cases are linked to environmental and lifestyle factors, while only 5–10% are hereditary⁵.

• Tobacco: The leading cause of cancer worldwide. More than 7 million people die annually from tobacco use, with another 890,000 dying from passive smoking⁶. Reduced smoking has lowered lung cancer mortality in many countries⁷.

• Radiation: Both high and low doses of radiation (e.g. X-rays) increase cancer risk⁸⁹.

• Air pollution: Raises cancer risk and worsens prognosis¹⁰.

• Diet, physical activity, and obesity: Overweight significantly increases the risk of several cancer types¹¹. Regular exercise and a healthy diet can reduce risk – physically active women have up to 40% lower risk of breast cancer¹². Physical activity also improves prognosis after diagnosis¹³.

• Infections: Around 18% of cancer cases in 2002 were infection-related¹⁴.

• Stress: Chronic stress weakens the immune system and contributes to cancer development and progression¹⁵.

Common Cancer Types and Oncological Conditions

Oncology covers a wide range of cancers and related conditions. The most common include:

• Breast cancer

• Lung cancer

• Prostate cancer

• Colorectal cancer

• Leukemias (ALL, AML)

• Lymphomas (Hodgkin, Non-Hodgkin)

• Brain cancer (glioblastoma)

• Bone cancer (osteosarcoma, Ewing’s sarcoma)

• Cancer with metastases, e.g. bone metastases

• Paraneoplastic syndromes

Cancer’s complexity demands precise diagnostics, often through biopsies, imaging, and genetic testing. Many patients face multiple diagnoses or treatment-related complications.

Physiotherapy in Cancer Treatment: Assessment and Intervention

Physiotherapists contribute to oncology through:

• Functional assessment, pain evaluation, and movement analysis

• Management of side effects from radiotherapy and chemotherapy

• Exercise therapy (strength, endurance, mobility)

• Pulmonary physiotherapy for reduced ventilation or secretion build-up

• Lymphedema treatment

• Palliative rehabilitation and end-of-life care

Common Treatment Side Effects Addressed by Physiotherapy

• Fatigue

• Neuropathy

• Muscle atrophy and weakness

• Joint stiffness

• Balance deficits and fall risk

• Cognitive impairment (“chemo brain”)

Outcome Measures and Assessment Tools

To evaluate treatment effects, physiotherapists often use:

• Visual Analogue Scale (VAS) for pain

• Quality of Life Questionnaire (QoL)

• EORTC QLQ-C30: cancer-specific quality of life measure¹⁶

• FACT-G: general functional measure for cancer patients¹⁷

Summary

Oncology is a complex and multidisciplinary field. Physiotherapists are essential in acute treatment, rehabilitation, and palliative care. Physical activity, symptom management, and function-preserving interventions improve prognosis and quality of life – and should be integrated into every stage of the cancer care pathway.

References

1. NCI. Cancer. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/oncology (last accessed 05.07.2025)

2. WHO. Cancer. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer (last accessed 05.07.2025)

3. The Role of Physiotherapy for People with Cancer – CSP Position Statement. The Chartered Society of Physiotherapy, July 2003. Available from: http://www.csp.org.uk/uploads/documents/csp_statement_physioandcancer.pdf (last accessed 05.07.2025)

4. CTCA. What is cancer. Available from: https://www.youtube.com/watch?v=SGaQ0WwZ_0I (last accessed 05.07.2025)

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6. World Health Organization. Tobacco [Internet]. Geneva: World Health Organization; March 2018 [cited 05.07.2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco

7. Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Translational Lung Cancer Research. 2015 Aug;4(4):327.

8. Ron E. Ionizing Radiation and Cancer Risk: Evidence from Epidemiology. Radiation Research. 1998;150(5).

9. Kleinerman RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatric Radiology. 2006 Sep 1;36(2):121–5.

10. Vineis P, Husgafvel-Pursiainen K. Air pollution and cancer: biomarker studies in human populations. Carcinogenesis. 2005;26(11):1846–55. doi:10.1093/carcin/bgi216

11. Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, Fabian CJ, Gucalp A, Hershman DL, Hudson MM, Jones LW. American Society of Clinical Oncology position statement on obesity and cancer. Journal of Clinical Oncology. 2014 Nov 1;32(31):3568.

12. Bianchini F, Kaaks R, Vainio H. Weight control and physical activity in cancer prevention. Obes Rev. 2002;3:5–8.

13. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479–86.

14. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–44.

15. Reiche EMV, Nunes SOV, Morimoto HK. Stress, depression, the immune system, and cancer. The Lancet Oncology. 2004;5(10):617–25. doi:10.1016/s1470-2045(04)01597-9

16. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.

17. Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.