Clinical Oncology Society of Australia position statement on exercise in cancer care

In reply: The Clinical Oncology Society of Australia (COSA) position statement endorses evidenced‐based guidelines and promotes best practice care.1,2,3,4 The statement identifies that recommendations should be tailored to individuals’ abilities, noting that specific exercise adaptations might be needed based on disease and treatment‐related adverse effects, anticipated disease trajectory and health status.1 Patient‐driven goals and preferences are also important considerations. Clearly one size does not fit all, and the mode, intensity, volume, frequency, level of supervision and delivery style of exercise should be tailored to meet the needs of each patient with cancer in the context of the sometimes limited high level evidence available.

COSA emphasises that all members of the multidisciplinary cancer care team have important roles in recommending exercise to their patients. The most important advice is for all patients with cancer to avoid inactivity and be as physically active as current abilities and conditions allow. Not all patients with cancer are able to reach the recommended exercise levels nor should these targets form the primary goal of programs for patients with advanced disease or undergoing difficult treatments. To facilitate the individualised, patient‐centred approach required to safely and effectively integrate exercise in cancer care, COSA encourages referral to exercise specialists. Exercise physiologists and physiotherapists are tertiary‐qualified health professionals with specialist training in exercise for patients. These specialists pragmatically apply the evidence while using clinical judgement and expertise to incorporate the patients’ condition, needs and preferences into a tailored and responsive exercise program. COSA agrees that more research is needed before detailed guidelines can be determined for the appropriate screening, monitoring, programming and behaviour change strategies for the vast array of cancer types, stages and treatment options.5

COSA acknowledges the current level of funding for exercise services through Medicare and private health insurance is suboptimal. However, the presence or lack of public and private subsidies should not dictate best practice care. Data from hundreds of clinical trials synthesised in about 40 meta‐analyses across various cancer types, stages and treatment regimens show the benefits of exercise to the health and wellbeing of patients with cancer. COSA's evidence‐based recommendations are intended to encourage health professionals to discuss exercise with sufficient detail to empower patients’ behaviour change.