What All Physios Should Know About Cancer Rehab

One of the biggest misconceptions in musculoskeletal practice is that cancer rehabilitation is “specialist physio”. In reality, if you work in private practice, sport, neuro, aged care, or community health, you are already seeing people with cancer, whether you realise it or not.

With 1 in 2 people expected to receive a cancer diagnosis by age 85, physiotherapists are increasingly managing people affected by cancer across every stage of care. Yet many clinicians still feel unsure about exercise prescription, red flags and treatment side effects.

In her Masterclass, Cancer Rehabilitation Essentials: A Practical Guide for Physiotherapists, Germaine Tan breaks down what every physio should know across the continuum of care, from screening and referral pathways to exercise prescription and multidisciplinary management. This blog highlights a few insights that stood out.

If you want an in-depth understanding of the physiotherapist’s role in managing patients with cancer, watch Germaine’s full Masterclass here.

The physio’s role is broader than you might think

Physiotherapists can play a role across the entire cancer continuum:

Prevention: Regular physical activity is associated with reduced risk of 13 different cancer types.

Early detection: Up to 1 in 4 patients with cancer initially present with pain, meaning physios are often a first point of contact. Knowing what to look for matters.

Prehabilitation: In people with colon cancer, structured exercise following treatment reduced recurrence risk by 28% and mortality by 37% in the CHALLENGE trial (1).

Active treatment: Patients may experience pain, reduced range of motion, fatigue, balance deficits, neuropathy, and reduced exercise tolerance during treatment.

Survivorship and palliation: Physios can play a major role in maintaining function, independence, and quality of life long after treatment ends.

Clinically, you you may be helping patients manage a range of different things, such as:

• fatigue and deconditioning
• chemotherapy-induced peripheral neuropathy
• scar tissue and radiation fibrosis
• lymphoedema
• fear of movement and reduced confidence
• balance deficits and falls risk
• cardiovascular complications following treatment

Before diving deeper, it’s important to understand the types of treatments people with cancer may be receiving and how they impact the body. See Germaine explain an overview of common cancer treatments and their impacts in this clip from her Masterclass:

“Not all back pain is benign”

The early identification section of the Masterclass will resonate with many musculoskeletal physios, particularly anyone who has lain awake worrying about whether they missed a red flag.

Germaine outlines several signs and symptoms that should prompt further investigation if someone is presenting to you with pain, including:

• constant, progressive, non-mechanical pain
• unexplained weight loss or persistent fatigue
• failure to improve after 4–6 weeks
• previous history of cancer
• unexplained swelling or masses
• progressive neurological symptoms

Importantly, she also explains how to think about these presentations clinically.

Night pain alone, for example, isn’t necessarily enough to raise concern. It’s the overall pattern, progression, and inconsistency with a typical musculoskeletal presentation that matters.

These conversations can feel challenging, especially when we’re unsure and don’t want to unnecessarily alarm patients. One practical takeaway from the Masterclass is Germaine’s approach to communication. Rather than using alarming language, she recommends calm, clear phrasing such as:

“Your symptoms aren’t behaving how we would expect, and I’d like your GP to investigate further to rule out anything more serious.”

It’s a simple example, but one that might be useful to keep in mind if the situation does arise.

Exercise prescription considerations

Physios understand that exercise is important in cancer care. What’s often less clear is how to prescribe it safely and confidently.

There’s some complexity involved, particularly during active treatment phases where patients may experience:

• severe fatigue
• thrombocytopenia
• neuropathy
• steroid-induced myopathy
• radiation fibrosis
• anxiety and mood changes

Germaine discusses the importance of adapting exercise prescription based on treatment stage, symptoms, and medical considerations, especially for patients with bone metastases or cardiotoxicity risk. This can be daunting for physios who don’t regularly treat patients with cancer, Germaine outlines some key clinical considerations in this snippet from her Masterclass:

There’s also a strong focus on objective assessment and monitoring, including measures such as grip strength, sit-to-stand testing, walking tests, vitals, and functional capacity assessments.

One important point is around exercise intensity. Cancer rehabilitation often requires balancing symptom fluctuation, fatigue, and patient confidence while still delivering a meaningful training stimulus. See Germaine explain how to calculate and prescribe exercise intensity for patients with cancer in this video from her Masterclass:

Wrapping up

Cancer rehabilitation is becoming increasingly relevant across all areas of physiotherapy practice, not just oncology settings.

Whether it’s recognising suspicious presentations, adapting exercise safely during treatment, or helping someone regain function after cancer therapy, all physios need a foundational understanding of how cancer and its treatment can affect the people they see in clinic.

Germaine Tan’s Masterclass does an excellent job of translating cancer rehabilitation into practical, clinically relevant concepts that feel applicable immediately, even for physios with limited oncology experience.

If you want a clearer framework for screening, referral pathways, exercise prescription, and multidisciplinary management in cancer care, watch her full Masterclass here.