Chiropractic Care Shows Gains in Function and Pain Relief for Cancer Patients

Cancer survival has improved dramatically over the past few decades, but the treatments that save lives often leave behind a difficult physical legacy. Chemotherapy, radiation therapy, hormone-blocking medication, and surgery are all associated with a high burden of musculoskeletal disorders, ranging from postsurgical adhesions and radiation-induced fibrosis to chemotherapy-induced peripheral neuropathy and hormone therapy-related joint pain. These complications can produce elevated pain levels, reduced range of motion, postural changes, and difficulty performing everyday activities. Research indicates that cancer survivors face roughly a threefold increased risk of functional impairment compared with the general population, and rehabilitation data link greater pain with poorer function in survivor populations. Against this backdrop, a new study published in Supportive Care in Cancer offers some of the first quantitative evidence that a carefully modified form of chiropractic care may help restore function and ease pain in patients treated at a comprehensive cancer center.

The study, conducted by Scott Siegel of City of Hope Atlanta along with Karina Szymulanska-Ramamurthy and Digant Gupta of City of Hope Chicago, set out to fill a striking gap in the literature. Although integrative medicine is increasingly woven into oncology care, and the World Health Organization defines it as an interdisciplinary, evidence-based approach combining biomedical and complementary practices, virtually no published research has evaluated the impact of spinal manipulation and chiropractic care on functional outcomes in cancer patients. A literature search by the team found no prior studies analyzing outcomes on the Patient-Specific Functional Scale, a validated instrument that tracks activities each patient personally identifies as difficult, in this population. The researchers hypothesized that oncology patients receiving chiropractic care would show improvements in both function and pain intensity between a baseline visit and two subsequent follow-up visits.

Technically, the investigation took the form of a single-arm retrospective observational study, a chart review of 97 adult oncology patients treated within the Integrative Medicine Department at City of Hope Cancer Center Atlanta in Newnan, Georgia, during a 12-month window from June 1, 2024, to June 1, 2025. To be included, patients needed a documented cancer diagnosis, musculoskeletal complaints appropriate for chiropractic intervention, and Patient-Specific Functional Scale and pain intensity scores recorded before treatment at baseline and at the next two eligible visits. The exclusion criteria were extensive and clinically meticulous: patients were removed from consideration if they received only one chiropractic visit, lacked eligible follow-up within three months, or were undergoing concurrent interventions such as physical therapy, massage, acupuncture, orthopedic surgery, pain medication, or recent corticosteroid injections that could confound results. Manual chiropractic care was also ruled out where contraindicated, including in cases of severe osteoporosis, extremely low platelet counts, acute compression fracture, recent surgery, vertebral artery stenosis, blood clots, or cauda equina syndrome. Charts were additionally screened for indwelling devices and osseous metastases identified on imaging.

The intervention itself was deliberately adapted for oncology. Rather than traditional high-velocity, low-amplitude spinal manipulation, which could pose risks given cancer-related structural vulnerabilities, clinicians delivered low-force or instrument-assisted spinal and extremity manipulation, myofascial techniques, flexion-distraction, therapeutic exercise instruction, ergonomic advice, and counseling on activities of daily living. Each treatment plan was individualized and delivered by a licensed chiropractor embedded in the oncology clinic, reflecting the growing recognition that comprehensive cancer centers must offer a wide range of services to address the interrelated physical needs of their patients.

The measurement strategy centered on two patient-reported tools with established reliability, validity, and responsiveness in musculoskeletal and rehabilitation populations. The Patient-Specific Functional Scale asks patients to name an activity they find difficult and then rate their ability to perform it from 0, meaning unable to perform, to 10, meaning able to perform at their prior level. In this study, one patient-selected activity was tracked per patient across three ordered visits. Pain intensity was captured on an 11-point numerical rating scale from 0, no pain, to 10, worst pain. Importantly, the authors emphasize that the first and second follow-up visits, labeled FU1 and FU2, represent visit order rather than standardized elapsed-time points, because clinical scheduling was not protocolized. The mean interval from baseline to FU1 was 18.3 days, while the mean interval from baseline to FU2 was 37.5 days, with wide individual variation.

The statistical analysis was appropriately sophisticated for repeated-measures data. Linear mixed-effects models were used to account for within-subject correlation across the three visits, with visit as a categorical fixed effect and subject as a random intercept. Pairwise comparisons between baseline, FU1, and FU2 were adjusted using the Holm-Bonferroni method, and clinically meaningful change was evaluated through responder analyses using a minimal clinically important difference of at least 2.0 points for both outcomes. The models were further extended with interaction terms to test whether patterns of change differed by gender or race.

The results were statistically striking. Mean Patient-Specific Functional Scale scores rose from 4.45 at baseline to 5.13 at FU1 and 5.53 at FU2, while mean pain intensity fell from 6.07 at baseline to 5.10 at FU1 and 4.64 at FU2. All pairwise comparisons were significant at adjusted p values below 0.001. For function, the mean difference from baseline to FU2 was 1.077 points, and for pain the baseline-to-FU2 difference was 1.423 points. Clinically meaningful improvement, defined as at least a 2-point change, was achieved by 13.4 percent of patients for function and 22.7 percent for pain at FU1, rising to 26.8 percent and 44.3 percent respectively at FU2. The cohort had a mean age of 57.4 years, was predominantly female, and breast cancer was the most common diagnosis category.

Equally notable was the consistency of the response across demographic subgroups. Both males and females showed comparable patterns of functional gain and pain reduction, and the visit-by-gender interactions were not statistically significant for either outcome. Similarly, White and African American patients demonstrated parallel improvements, with no significant visit-by-race interactions, suggesting that the observed benefits did not diverge across these key patient characteristics. The authors argue that this consistency across subgroups supports the robustness of the observed patterns, even though the study could not establish causation.

The clinical implications are considerable. If the findings hold up under more rigorous testing, modified chiropractic care could become a nonpharmacological option for managing the musculoskeletal symptom burden of cancer treatment, potentially improving mobility, daily functioning, and quality of life alongside standard medical management. The authors stress that careful patient selection and coordination with the oncology care team remain essential for safety and appropriateness, particularly given the structural and hematologic vulnerabilities many cancer patients carry. This caution is well founded: the retrospective, single-arm, pre-post design without a concurrent control group means the improvements could reflect natural recovery, regression to the mean, expectations, or concurrent oncologic and supportive treatments such as analgesics, rehabilitation therapy, or palliative care, none of which could be fully controlled. The modest single-center sample, self-reported outcomes vulnerable to reporting bias, and heterogeneous follow-up intervals further limit the strength of any causal claim.

Nevertheless, the study has real strengths. It employed repeated, patient-centered outcome measures capturing both function and pain, evaluated clinically meaningful thresholds in addition to statistical significance, used two follow-up measurements rather than a single post-intervention assessment, and applied analytical methods that account for within-subject correlation. The authors are clear about the path forward: a properly powered prospective randomized trial with an appropriate comparison group, standardized assessment windows, documentation of co-interventions, and evaluation of the durability of changes, followed by multicenter studies to assess generalizability across oncology settings and cancer types. Mixed-methods and pragmatic research could further illuminate patient experience, optimal treatment frequency, and how such services might be implemented within comprehensive cancer care pathways. For now, the study stands as a provocative first quantification of functional improvement in cancer patients receiving chiropractic care, and a signal that one of the most common forms of complementary medicine may deserve a rigorously tested place in modern supportive oncology.

Subject of Research: Chiropractic care and functional outcomes in cancer patients

Article Title: Functional outcomes in oncology patients receiving chiropractic care: a retrospective chart review

Article References: Functional outcomes in oncology patients receiving chiropractic care: a retrospective chart review. (n.d.). https://doi.org/10.1007/s00520-026-11248-y

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11248-y

Keywords: chiropractic care, oncology, cancer rehabilitation, pain management, musculoskeletal disorders, integrative medicine, supportive care, patient-specific functional scale, cancer survivors, retrospective study, spinal manipulation, quality of life