Rehabilitation Oncology

Current Issue Highlights

Efficacy of Photobiomodulation in Mitigating Radiation-Induced Neck Fibrosis in Patients With Head and Neck Cancer: A Phase-IIa Randomized Controlled Trial Study Protocol
October 2026: 44(4):231-240
Background:
Radiation-induced neck fibrosis (RIF-N) significantly impairs function, cosmesis, and quality of life in head and neck cancer (HNC) survivors. Current management options are limited and largely experimental. Photobiomodulation therapy (PBMT), a safe, noninvasive intervention, shows antifibrotic potential in early studies. This randomized controlled trial evaluates its tolerance and efficacy in mitigating RIF-N in patients with HNC.
Methods:
In this phase-IIa, participant-blinded, two-arm parallel-group randomized controlled trial, a minimum of 60 patients will be randomized (1:1) to PBMT + standard care or sham-PBMT + standard care by online software. The PBMT dose, adapted from WALT guidelines, will be delivered using low-level LASER during radiation therapy (RT). Standard care includes supervised exercises during the course of RT, followed by a booklet-guided home exercise program. Feasibility will be qualitatively described based on recruitment, protocol adherence, and retention. Tolerance to PBMT will be determined by evaluating for an increase in erythema, irritation, burning sensation, or pain at the PBMT application site. Efficacy will be determined using (i) fibrosis severity (shear-wave elastography of sternocleidomastoid and Late Effects of Normal Tissues-Subjective, Objective, Management, Analytic Scale); (ii) neck range of motion (goniometry and tape measurements); (iii) quality of life (Functional Assessment of Cancer Therapy-Head & Neck) as primary outcomes. The secondary outcome (radiation dermatitis) will be assessed by CTCAE v5.0. Assessments will be conducted at baseline and 3-, 6-, 9-, and 12-month post-RT, and the efficacy of PBMT will be determined by evaluating group and time interaction.
Discussion:
If found well-tolerated and efficacious, PBMT may offer a feasible, noninvasive strategy to reduce RIF-N in HNC survivors, warranting confirmation in high-quality phase IIb trials.
Cancer Rehabilitation Competencies: A National Delphi Study
October 2026: 44(4):224-230
Background:
Current cancer rehabilitation training and education are fragmented and inconsistent. There are no standardized competencies for entry-level providers in rehabilitation disciplines who treat patients with a diagnosis of cancer. The purpose of this study was to develop consensus regarding cancer rehabilitation competencies for entry-level providers.
Methods:
Delphi methodology was used in a national, web-based survey design. Three surveys (N = 177, 176, 148) were sent to members of rehabilitation professional associations. Survey 1 topics were developed by the American Congress of Rehabilitation and Medicine Cancer Networking Group (ACRM CRNG) based on a literature review and current curricula. Likert-formatted responses from 1 (not important) to 5 (most important) were recorded. Topics receiving a median score of ≥4 from Survey 1 were included in Survey 2. For Survey 2, each participant identified 3 topics important to their discipline for each item. The results were reviewed, and similar responses were grouped together to develop Survey 3. Participants were asked to rank the responses in Survey 3 on the same Likert scale used in Survey 1.
Results:
Survey 1 had 6 topics that did not reach a median score of ≥4, and those topics were excluded from Survey 2. The results of Survey 2 were used to develop Survey 3. Survey 3 noted significant differences between professions in certain topics, especially those related to speech and language therapy, but continued to note the significance of these topics.
Conclusion:
This Delphi study is an important step in providing a framework for the standardization of cancer rehabilitation competencies.
Textured Insoles as a Novel Approach to Address the Negative Symptoms of Chemotherapy-Induced Peripheral Neuropathy and Cancer-Related Myelopathy
October 2026: 44(4):217-223
Background:
Chemotherapy-induced peripheral neuropathy (CIPN) and cancer-related myelopathy often cause pain, numbness, and mobility impairment. While treatments such as medications typically target positive sensory symptoms (eg, burning or tingling), negative symptoms such as numbness and proprioceptive loss remain difficult to manage and significantly affect balance and gait. This study evaluated the feasibility of using textured insoles as a noninvasive approach to improve these symptoms.
Methods:
A prospective feasibility study was conducted with adult patients with cancer experiencing negative sensory symptoms due to CIPN or myelopathy. Participants were provided with textured insoles designed to enhance plantar sensory input and instructed to wear them during daily activities for 1 month. Outcomes were measured pre- and postintervention using the 4-Stage Balance Test, Timed Up and Go test, and patient-reported assessments of balance and mobility.
Results:
Twenty participants were enrolled: 70% reported numbness, 45% gait impairment, 40% balance impairment, and 35% pain. Objective improvements in balance and gait were observed with the use of insoles, with significant Timed Up and Go gains at both initial (P < .001) and follow-up (P = .01) visits, adjusting for additional therapy. Sixteen participants reported improved stability and confidence after 1 month. Adherence was high, and no adverse events occurred.
Conclusion:
Textured insoles are a feasible, well-tolerated supportive intervention for patients with negative sensory symptoms from CIPN or cancer-related myelopathy. By enhancing sensory feedback, insoles may improve balance, mobility, and quality of life. Larger controlled trials are warranted to confirm efficacy and long-term outcomes.
Predicting Adherence to Physical Activity in Individuals With Cancer Using Machine Learning and National Health and Nutrition Examination Survey Data
October 2026: 44(4):207-216
Background:
Physical activity (PA) is a core component of cancer survivorship care, yet adherence to PA guidelines remains low. Correlates of PA adherence reflect a complex interplay of multiple factors, many aligning with domains addressed in physical therapy (PT) but not integrated within a PT-informed analytic framework. Machine learning (ML) approaches may support modeling of complex relationships by accommodating nonlinear interactions. This study aimed to develop and compare ML models to classify PA adherence among adults with cancer using National Health and Nutrition Examination Survey (NHANES) data and a PT-informed feature selection framework.
Methods:
This retrospective cross-sectional study included 1169 adults with a history of cancer from NHANES 2021-2023. From ~400 variables, PT-informed screening, redundancy reduction, and feature engineering yielded 45 features. Logistic regression, random forest, gradient boosting, XGBoost, and support vector machine (SVM) models were developed and compared. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Permutation feature importance was applied to the best-performing model with a reduced-feature sensitivity analysis.
Results:
The SVM demonstrated the strongest performance (AUC = 0.749). Influential variables included self-rated health, sedentary time, educational attainment, difficulty walking or climbing steps, body mass index, gender, number of rooms in the home, systolic blood pressure, income-to-poverty ratio, and anxiety. A reduced SVM using the top 10 variables showed comparable discrimination (AUC = 0.757).
Conclusion:
ML models demonstrated moderate discrimination in classifying PA adherence among adults with cancer. Parsimonious models using clinically accessible variables may support rehabilitation workflows by prompting targeted screening and timely intervention.
Survey of Knowledge, Perceptions, and Adoption of Near-infrared Imaging With Indocyanine Green Findings Among US Lymphedema Therapists
October 2026: 44(4):199-206
Background:
Near-infrared imaging fluorescence using indocyanine green lymphography (NIRF/ICG-L) has emerged as a useful tool in guiding surgical approaches. However, its use in guiding conservative therapy interventions, such as manual lymph drainage (MLD), remains limited. This study aimed to explore the knowledge, perceptions, and adoption of NIRF/ICG-L in the conservative management of lymphedema among US therapists.
Methods:
An anonymous online survey was distributed via email to US lymphedema therapists in late 2024. Descriptive statistics and χ² tests were used to examine knowledge, perceptions, and adoption of ICG-L findings related to conservative therapy interventions.
Results:
Data from 509 actively practicing lymphedema therapists were analyzed. Nearly half (49.7%) reported no knowledge of NIRF/ICG-L, while 30.2% were somewhat familiar and 20.1% were familiar. Therapists working alone were significantly less likely to have heard of NIRF/ICG-L (χ² = 13.97, P < .01). While 33.9% felt NIRF/ICG-L studies would impact MLD practice, 39% were optimistic but needed more information. Adoption of NIRF/ICG-L findings in MLD practice was reported by 23.8% of respondents, with higher rates in urban settings (χ² = 8.53, P <.05) and among Lymphology Association of North America (LANA)-certified therapists (χ² = 16.33, P < .001). Key barriers included limited knowledge (55.8%), limited access to testing (40.7%), time constraints (10.4%), organizational protocols (5.5%), and loyalty to established methods (3.4%).
Conclusion:
There is wide variation in knowledge of NIRF/ICG-L among US lymphedema therapists. Although many recognize its potential benefits, adoption may be limited by knowledge and access barriers. Targeted strategies to enhance education and improve testing access may increase its use in conservative lymphedema management.

Latest Articles

Perioperative Factors Associated With Early Postdischarge Six-Minute Walk Distance After Gastrointestinal Cancer Surgery: An Exploratory Prospective Cohort Study
Rehabilitation Oncology. October 23, 2026
Background:
Recovery after discharge is a key goal of cancer rehabilitation in patients undergoing gastrointestinal cancer surgery; however, perioperative factors associated with early postdischarge 6-minute walk distance (6MWD) remain unclear. This exploratory prospective cohort study aimed to identify perioperative factors associated with 6MWD approximately 1 month after discharge.
Methods:
This exploratory prospective cohort study used convenience sampling and included 27 patients who underwent gastric or colorectal cancer surgery. Assessments were conducted preoperatively, at discharge, and during the early postdischarge period. The primary outcome was the 6MWD measured during the early postdischarge period. Candidate factors included demographic and clinical variables, physical function, cancer-related fatigue, instrumental activities of daily living, and albumin. Accelerometer-derived physical activity variables were examined as secondary exploratory measures. Exploratory multivariable linear regression analyses were performed separately for preoperatively (PRE) and at discharge (DIS) models, and Bayesian linear regression was conducted as a complementary analysis.
Results:
The 6MWD improved after discharge, increasing by 40.4 m from discharge to the early postdischarge assessment, indicating a clinically meaningful recovery. In the DIS model, discharge 6MWD was positively associated with postdischarge 6MWD, whereas age was negatively associated, and postoperative complications showed a negative trend. In the PRE model, preoperative 6MWD was positively associated with postdischarge 6MWD, whereas preoperative mental fatigue was negatively associated. It improved after discharge, increasing by 40.4 m from discharge to the early postdischarge assessment, indicating a clinically meaningful recovery. In the DIS model, discharge 6MWD was positively associated with postdischarge 6MWD, whereas age was negatively associated and postoperative complications showed a negative trend. In the PRE model, preoperative 6MWD was positively associated with postdischarge 6MWD, whereas preoperative mental fatigue was negatively associated.
Conclusions:
Early postdischarge 6MWD was associated with perioperative functional capacity, age, and preoperative mental fatigue. These exploratory findings should be interpreted cautiously and may help refine perioperative assessment and postdischarge support strategies.
MOTIVATE: Feasibility Challenges and Protocol Adaptation Within a Pilot Randomized Rehabilitation Trial for Individuals With Multiple Myeloma
Rehabilitation Oncology. October 23, 2026
Background:
Multiple myeloma (MM) is an incurable cancer of the plasma cells. Although survival has improved, individuals with MM continue to experience treatment-related symptoms and functional decline. Autologous stem cell transplant (SCT) helps participants attain longer disease-free periods but requires a base level of fitness to proceed safely. Prior work by our group has identified substantial patient-reported barriers to exercise in the pre-SCT setting and highlighted a preference for tailored, flexible, and hybrid exercise delivery models to support participation. The aim of this trial protocol is to evaluate the feasibility of a tailored exercise rehabilitation program delivered using a hybrid model that supports virtual, in-person, or combined participation. The trial was originally limited to transplant-eligible individuals before SCT but, due to low recruitment, was amended to include transplant-ineligible and post-SCT individuals.
Methods:
This randomized feasibility trial uses 1:2 allocation to standard care or intervention. A minimum of 30 participants will be recruited and stratified by transplant status. The supervised exercise program is delivered over 8-to-12 weeks using in-person, virtual, or hybrid formats. Feasibility outcomes include recruitment, retention, adherence, and safety. Exploratory efficacy outcomes include physical fitness, patient-reported outcomes, and optional thigh ultrasound measures.
Conclusion:
The trial will inform the feasibility of delivering tailored rehabilitation across diverse MM clinical pathways to inform future research. Importantly, we highlight how real-world recruitment challenges may necessitate adaptive trial design in rehabilitation oncology.
Remote Assessment of Functional Fitness Measures in Survivors of Cancer: A Reliability and Validity Study
Rehabilitation Oncology. October 21, 2026
Background:
Virtual fitness assessments offer unique advantages to overcome the barriers many cancer survivors face in accessing in-person assessments. This study evaluated the reliability and concurrent validity of remotely administered functional fitness measures in cancer survivors.
Methods:
Remote assessments were conducted via Zoom videoconferencing software in participants’ homes. Assessments consisted of four functional fitness measures: right and left one-leg balance test (OLBT), sit-to-stand test (STS), chair sit-and-reach (CSAR), and 2-minute step test (2MST). Participants (n = 31) completed two remote assessments followed by one in-person assessment within a 2-week period. Intrarater reliability and concurrent validity were assessed using intraclass correlation coefficients (ICC) with 95% confidence intervals. Agreement of remote and in-person measures was assessed using the Bland–Altman 95% limits of agreement.
Results:
All ICCs met the threshold for good reliability: OLBT-R (ICC = 0.823, 0.66,0.91); OLBT-L (ICC = 0.874, 0.75,0.94); STS (ICC = 0.87, 0.75,0.94); CSAR (ICC = 0.90, 0.80,0.95); except the 2MST, which showed moderate reliability (ICC = 0.745, 0.53,0.87). ICCs for concurrent validity ranged from moderate for OLBT-R (ICC = 0.687, 0.44,0.83), good for STS (ICC = 0.87, 0.75,0.94), OLBT-L (ICC = 0.86, 0.72,0.92), and excellent for 2MST (ICC = 0.92, 0.84,0.96) and CSAR (ICC = 0.95, 0.90,0.97). However, some measures exhibited uncertainty, with wide confidence intervals and relatively large minimal detectable change values. Bland–Altman tests demonstrated underestimation between averaged means, with slight variability between limits of agreement.
Conclusion:
Remote assessment can be considered a reliable and valid alternative to in-person observations of functional fitness measures for cancer survivors.