Exercise has become an increasingly important component of cancer supportive care. Yet having evidence that exercise benefits people with cancer is not the same as having a healthcare system capable of delivering it.
A new 2026 study published in Supportive Care in Cancer, “Barriers to recommendation of integrative oncology modalities in supportive care: a MASCC/SIO survey,” provides an important roadmap for understanding why evidence-based supportive interventions, including exercise, often fail to become routine parts of cancer care.
For organizations developing Exercise Oncology Programs, the message is particularly important: successful programs must be designed not simply around exercise prescription, but around referral, education, financing, accessibility, communication, and integration into the oncology care pathway.
Exercise Is Part of Integrative Oncology
Integrative oncology combines evidence-based complementary approaches with conventional cancer treatment to address patients’ physical, emotional, and spiritual needs. The authors note that exercise, nutrition, and psychosocial support are among the modalities most commonly recommended by oncologists.
That places Exercise Oncology squarely within the larger challenge investigated by this study: How do we move supportive interventions from evidence and recommendation into actual patient care?
Researchers surveyed members of the Multinational Association of Supportive Care in Cancer (MASCC) and Society for Integrative Oncology (SIO). Of 2,714 people invited, 431 responded, with 282 completing the barriers portion of the survey.
The barriers were grouped into four major domains: knowledge, financial, logistical, and individual-level barriers.
The Knowledge Gap Is a Major Problem
More than 80% of respondents agreed that healthcare professionals’ lack of knowledge and experience represented barriers to integrative oncology. More than 75% also identified provider unawareness and perceived lack of patient knowledge as obstacles.
This has direct implications for Exercise Oncology.
It is not enough to employ qualified exercise professionals and expect referrals to appear. Oncologists, surgeons, nurses, advanced practice providers, rehabilitation specialists and other members of the cancer team need to understand who should exercise, why exercise matters, when referral is appropriate, and where patients should be sent.
The authors suggest approaches including continuing medical education, mentorship, standardized educational resources, competency-based curricula, certification programs, communication training and interdisciplinary meetings.
For an Exercise Oncology Program, therefore, provider education should be considered part of the program’s infrastructure, not simply a marketing activity.
The Referral Pathway May Be as Important as the Exercise Prescription
One of the most significant findings concerns logistics. Approximately 80% identified lack of referral pathways as a barrier, while the study also identified problems involving access, scheduling, competing services and the ability to make timely referrals.
This is a crucial organizational lesson.
Telling a patient to “exercise more” is fundamentally different from creating a clinical pathway in which a patient can be assessed, referred, enrolled, evaluated and followed.
The authors recommend dedicated integrative oncology coordinators, standardized referral protocols, integration into existing clinical pathways, electronic-health-record communication, clearly defined multidisciplinary roles, regular case conferences and patient tracking systems.
These recommendations could almost serve as an organizational blueprint for Exercise Oncology.
Cost and Reimbursement Cannot Be Ignored
The financial findings are equally striking. 82% identified lack of insurance coverage as a barrier, 80% identified concerns about out-of-pocket costs, and 88% perceived lack of patient financial support as an obstacle.
This means Exercise Oncology programs need a sustainable business model.
The authors specifically recommend developing models capable of demonstrating cost-effectiveness, exploring reimbursement for evidence-based services and conducting health-economic research.
For Exercise Oncology, measuring only attendance or improvements in fitness may therefore be insufficient. Programs should consider documenting outcomes such as symptom burden, functional capacity, quality of life, healthcare utilization and other measures that could help establish their clinical and economic value.
Perhaps one of the most revealing findings is that more than 80% of respondents agreed that healthcare professionals’ lack of confidence is a barrier to using integrative oncology.
This suggests that simply publishing additional evidence will not automatically change clinical practice.
Exercise Oncology programs need to make referrals easy and credible. Oncologists need confidence that the professionals receiving their patients understand cancer treatments, treatment-related toxicities, safety considerations, functional limitations and communication with the medical team.
Patients likewise need confidence that exercise is being incorporated into their cancer care, not offered as an unrelated wellness service.
What This Means for Building Exercise Oncology Programs
The significance of this publication for CancerFitness.Org extends well beyond integrative oncology. It helps define the organizational architecture necessary to move Exercise Oncology from recommendation to routine cancer care.
An effective Exercise Oncology Program should therefore be built around several interconnected components:
- Educate the oncology team about the evidence supporting exercise and appropriate referral.
- Create a standardized referral pathway rather than relying on informal recommendations.
- Integrate exercise professionals into multidisciplinary cancer care.
- Define professional responsibilities and clinical communication protocols.
- Make referral and documentation compatible with the electronic health record whenever possible.
- Address affordability, reimbursement and financial access from the beginning.
- Educate patients about the safety, purpose and potential benefits of exercise.
- Track clinical, functional and patient-reported outcomes to demonstrate effectiveness and value.
- Develop sustainable business models that allow programs to scale.
- Build trust and confidence among oncologists and patients so that exercise becomes an expected component of supportive care.
The study’s authors ultimately conclude that the obstacles to integrative oncology are interconnected and require strategic, system-level solutions, rather than isolated interventions.
That may be the publication’s most important lesson for Exercise Oncology.
From “Exercise Is Beneficial” to “Exercise Is Built Into Cancer Care”
The scientific case for exercise during and after cancer treatment continues to grow. But evidence alone does not create access.
Infrastructure does.
The next phase of Exercise Oncology must therefore focus not only on what exercise should be prescribed, but also on how patients are identified, referred, assessed, supervised, followed and financially supported within the cancer-care system.
The authors appropriately caution that this was a relatively small, self-selected professional sample, largely from higher-income countries, and that the findings may not generalize to the entire oncology community. Nevertheless, the study provides a valuable framework for organizations attempting to translate supportive-care evidence into everyday practice.
CancerFitness.Org Call to Action
Every cancer program should ask a simple question: What happens after we tell a patient that exercise is important?
If the answer is unclear, the system is incomplete.
CancerFitness.Org advocates moving beyond general advice to organized Exercise Oncology Programs with trained professionals, standardized assessment, defined referral pathways, multidisciplinary communication, patient education, outcome measurement, and sustainable financial models.
The goal should no longer be merely to convince cancer patients to exercise.
The goal should be to build cancer-care systems that make safe, evidence-based exercise accessible as a routine component of treatment and long-term survivorship.
Reference: Barriers to recommendation of integrative oncology modalities in supportive care: a MASCC/SIO survey. Alexandre Chan, Dalia Kagramanov, Reem Nasr, Chioma Asuzu, Ting Bao, Yin Ting Cheung, et al. Supportive Care in Cancer (2026) 34:791 https://doi.org/10.1007/s00520-026-11020-2
