Cancer Rehabilitation Reaches Fewer Than One in Ten Patients in Regional Victoria

Only 5.8 percent of cancer patients in South West Victoria attended a formal oncology rehabilitation program during 2023, despite every cancer service in the region offering or being linked to one, according to a retrospective study published in Supportive Care in Cancer. The finding exposes a stark gap between national guidelines that call for exercise to be embedded as routine cancer care and the reality of what regional patients actually receive. Of the small number who did attend, just 61.5 percent completed their program, meaning that fewer than four in every hundred patients treated for cancer in the region finished a structured rehabilitation pathway in the study year.

The research team, led by Alicia Boyd of St John of God Warrnambool Hospital with colleagues from the Integrated Clinical Oncology Network and the Barwon South Western Regional Integrated Cancer Service, analysed electronic medical records at all five health services providing cancer treatment across South West Victoria. The region is served by three public services in Hamilton, Portland and Warrnambool, one private hospital, and a private radiotherapy provider whose patients are invited into the public program in Warrnambool. After screening 1,658 patient records and excluding those who did not meet the criteria, including people whose only diagnosis was surgically treated skin cancer, the researchers assembled a cohort of 898 adults who received cancer treatment during 2023.

The statistical picture that emerged was one of profound underuse. Across 21 cancer diagnosis categories, only 12 were represented among rehabilitation attendees at all. Breast and bowel cancers, the two most common diagnoses among attendees, still saw only 6 percent and 9 percent of their respective patient groups participate. Prostate, bladder and head and neck cancer patients were particularly unlikely to attend. Age and gender showed no statistically significant association with attendance, suggesting the barriers operate at the level of the health system and the treatment pathway rather than the demography of the patient population.

Treatment modality proved to be the strongest predictor of engagement. Patients receiving chemotherapy or immunotherapy, alone or in combination with other treatments, accounted for more than 90 percent of the rehabilitation cohort, compared with 52.5 percent of non-attendees. By contrast, patients whose treatment consisted solely of surgery or radiotherapy attended at a rate of roughly 1 percent. The researchers also found a positive correlation between the number of treatment types a patient received and the likelihood of attending rehabilitation, with attendance rising as treatment complexity increased. Median treatment duration was dramatically longer among attendees, at 148 days compared with 43 days for non-attendees, a difference that was highly statistically significant.

Completion told a more nuanced story. Patients who had undergone multiple treatment modalities were more likely to start rehabilitation but less likely to finish it, with completion rates of 70 percent among those treated with a single modality versus 50 percent among those treated with several. The authors suggest a difficult paradox: the same cumulative treatment burden, side effects and competing appointments that increase a patient’s need for rehabilitation also erode their capacity to sustain attendance. Completers attended sessions over a median of 86 days, compared with just 19 days for non-completers, indicating that sustained engagement over time, rather than brief exposure, characterised successful program completion.

Timing emerged as another critical variable. Most patients, 76.9 percent, began rehabilitation while still receiving active cancer treatment, and only four patients started before treatment began, a strikingly low figure given growing international interest in prehabilitation, the practice of building physical reserve before therapy starts. Interestingly, patients who commenced rehabilitation later in their treatment course were significantly more likely to complete their program, beginning on average 91 days after starting treatment compared with 33.5 days for non-completers. The authors caution, however, that this should not be read as evidence that delayed rehabilitation is superior; national guidelines emphasise benefit across the entire cancer continuum, and early intervention may deliver important gains even when formal completion is not achieved.

The findings land against a backdrop of well-documented rural health inequity. People living in regional and rural Australia experience poorer cancer outcomes and are more likely to die from the disease than their metropolitan counterparts. Previous work cited in the study found that rural cancer survivors carry a high burden of modifiable risk factors, are more likely to be physically inactive, and often travel more than 100 kilometres to access health services. Roughly two-thirds of rural Australian cancer survivors fail to meet recommended physical activity levels. What this new study adds is evidence that engagement in structured, service-based rehabilitation may be even lower than participation in exercise more broadly, implying that barriers extend well beyond the availability of programs.

That availability was never the problem is perhaps the study’s most consequential message. All five cancer services in the region provided or were linked to rehabilitation, including the Cancer Wellness and Exercise Program supported by Cancer Council Victoria, which delivers weekly group exercise and education over eight weeks, and a personalised multidisciplinary program at the private hospital. Yet uptake remained minimal. The authors argue that referral pathways, clinician awareness, patient education about the benefits of rehabilitation, travel burden and competing treatment demands are all plausible levers, and that providing a service alone is insufficient to guarantee engagement. They call for assessment of current referral practices across tumour streams, suggesting that the pathways working well within chemotherapy and immunotherapy services could be replicated for surgical and radiotherapy patients.

The study also surfaced an unexpected cross-border phenomenon: 195 patients who received treatment within the participating services were excluded because they lived outside the region, many in neighbouring South Australia. This raises broader questions about how regional health networks serve populations that straddle state boundaries, and whether patients in border communities face additional obstacles to accessing coordinated cancer care. The authors suggest this pattern warrants investigation across regional Australia to determine whether it is a local quirk or a systemic feature of how cancer services are organised outside metropolitan centres.

Methodologically, the study has clear strengths and acknowledged limits. It is, to the authors’ knowledge, the first to quantify rehabilitation participation and completion across an entire regional cancer network, spanning both public and private sectors and minimising selection bias by including every provider in the region. But the retrospective design, the single calendar year of data, and differences in electronic medical record systems across sites, which required manual cross-checking and may have introduced misclassification, all constrain the analysis. The small number of attendees limited subgroup comparisons, and the study captured only health service-based rehabilitation, not independent exercise or community programs. Even so, the baseline it establishes is sobering: in a region where rehabilitation is available at every cancer service, fewer than six in a hundred patients walked through its door, and the authors argue that telehealth and hybrid models, already proven in other areas of rural health care, deserve urgent evaluation as a route to closing the gap.

Subject of Research: Participation in oncology rehabilitation among cancer patients in regional South West Victoria, Australia

Article Title: Participation in oncology rehabilitation in regional South West Victoria, Australia: a retrospective study

Article References: Boyd, A., Jansen, F., Hawkins, M., & Davis-Lameloise, N. (2026). Participation in oncology rehabilitation in regional South West Victoria, Australia: a retrospective study. Supportive Care in Cancer, 34(11), Article 1093. https://doi.org/10.1007/s00520-026-11319-0

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11319-0

Keywords: oncology rehabilitation, cancer survivorship, regional health, exercise oncology, rural Australia, health equity, retrospective study, cancer care, prehabilitation, telehealth, supportive care, Victoria