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Oncology/palliative careJun 28, 2021

Most physiotherapists who went into the cancer field in Australia felt under-prepared, survey shows

Most physiotherapists who work in the cancer field in Australia feel they were poorly prepared to enter the speciality. That is the conclusion of a paper written by a team led by physiotherapist Amy Dennett, from the Eastern Health and School of Allied Health, Human Services and Sport at La Trobe University in Victoria.

The authors express concern over the lack of knowledge about how undergraduates are currently being prepared in Australia and beyond, despite the growing need for rehabilitation among cancer survivors. 'The extent of curriculum devoted to cancer care among Australian physiotherapy training programmes is not currently known, and no national framework exists to advocate for minimum content. The breadth and depth able to be devoted to cancer care in university settings may be limited, as described in other countries.'

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The paper, titled 'Perceptions and work-readiness of Australian physiotherapists in cancer care: a national evaluation', is available as a pre-proof publication at the journal Physiotherapy.

It sheds light on a poorly researched topic, the authors suggest: ‘To date, no studies have evaluated physiotherapists’ perceptions of their role in cancer care [in] relation to the breadth of interventions they can deliver.’

More than 100 physiotherapists took part

Dr Dennett and her colleagues invited clinical physiotherapists at 119 Australian hospitals and 35 rehabilitation programmes to take part in a survey in 2019.

They received responses from 128 physiotherapists and found that three in four of them (77 per cent) said their preparation to work in oncology had been inadequate. 

The respondents’ experience in physiotherapy varied widely (from four to 19 years, with eight as a median) while the time they had spent in oncology spanned six months to five years (a median of two years).

Perhaps unsurprisingly, those who were still in their first year in the field felt less confident than those with more years under their belts.

In general, however, the respondents felt their confidence and knowledge was relatively high when working with people with early-stage cancers, but the levels were lower in areas such as prescribing exercise for patients with cardiotoxicity.

Their knowledge about the precautions and contraindications associated with hormone and targeted therapies was also relatively low.

Exercise and physical activity rated highly

Australian physiotherapists feel underprepared to work in cancer care, but report good confidence and knowledge. Professional development opportunities appear indicated [Amy Dennett et al.]

Very high ‘importance ratings’ (Likert scores 4 or 5) were reported for exercise (91 per cent) and physical activity (95 per cent).

‘Learning needs were identified for medical management, treatment side-effects/precautions and management of cancer-related pain and fatigue,’ the paper states.

In conclusion, the authors note: ‘Australian physiotherapists feel underprepared to work in cancer care, but report good confidence and knowledge. Professional development opportunities appear indicated.’

Rehabilitation gulf

More people are being diagnosed with cancer and the number of survivors is also increasing. Many survivors report that having cancer and its treatment leads to both and long-term adverse effects. The problems they experience shows there is a ‘crucial, growing need for cancer rehabilitation services’ – yet ‘access remains extremely poor’, the paper suggests.

Survivors commonly report

  • fatigue
  • physical limitations
  • depression and anxiety
  • pain
  • peripheral neuropathy
  • joint movement restrictions
  • lymphoedema
  • bladder and bowel dysfunction
  • immobility
  • falls


What is the physiotherapist’s role?

Physiotherapists are 'integral to the delivery of rehabilitation across the cancer continuum: from pre-diagnosis through treatment and to end of life', the paper states. They might provide education relating to physical activity behaviour change to minimise risks from cancer or, post-diagnosis, offer activities such as aerobic and resistance training, therapeutic exercise, respiratory training and manual therapy.

'These interventions improve a broad range of outcomes in cancer survivors such as quality of life, physical function, fatigue, lymphedema and incontinence.’

Opportunity knocks

‘The growing demand for specialist oncology physiotherapy services means there are opportunities for physiotherapists to develop knowledge and skills in cancer care,’ the paper notes.

Countries including Australia, USA, Chile, Denmark and the Netherlands have dedicated oncology professional groups and are creating career pathways for clinicians wanting to advance cancer-specific skills.

Most respondents said they would prefer to undertake professional development activities through their professional bodies. But opportunities to ‘upskill’ in cancer physiotherapy in the country have been hampered by a lack of cancer-specific post-graduate training options and dedicated career pathways, the authors note.

Such opportunities have only recently become available in some countries. For example, in 2019 the American Physical Therapy Association and Australian Physiotherapy Association introduced specialist schemes for physiotherapists working in cancer care, they add.

To see a pre-proof copy of 'erceptions and work-readiness of Australian physiotherapists in cancer care: a national evaluation' visit: https://doi.org/10.1016/j.physio.2021.06.003

Author: Ian A McMillan
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