Physiotherapy stays scarce in African cancer care despite proven benefits, review finds

Cancer survival is improving across Africa, but a new scoping review warns that the rehabilitation services patients need to recover are largely missing from the continent's health systems. Published in BMC Health Services Research, the study by Lawan Umar and colleagues maps the global evidence for physiotherapy across the entire cancer care continuum and proposes a four-pillar action framework tailored to African settings. The review, which combined systematic evidence mapping with expert-informed framework development, found consistent reports that physiotherapy benefits patients from prehabilitation before surgery through palliative care at the end of life, yet almost none of the supporting trials were conducted in Africa.

The team followed Joanna Briggs Institute methodology, searching PubMed/MEDLINE, CINAHL, Scopus, the Cochrane Library and African Journals Online in July 2025 for publications dated January 2010 to July 2024. The search covered systematic reviews, meta-analyses, randomized controlled trials, clinical practice guidelines, implementation studies and narrative reviews. From 2,505 records, 25 sources formed the final evidence base, and the authors report that no eligible sources were excluded on the basis of perceived importance.

Using hybrid inductive-deductive thematic analysis, they developed a conceptual model called the PT Matrix, which visualizes physiotherapy's dynamic role across care phases and patient needs, and an action framework in which evidence-derived findings are explicitly distinguished from those informed by the authors' expertise. The evidence base points to substantial clinical gains. Multimodal prehabilitation, which combines exercise and other physical interventions before surgery, reduces postoperative complications by approximately 50 percent according to the reviewed literature.

Trials such as CHALLENGE report improved disease-free survival, and the review's plain language summary notes that exercise may help people live longer after cancer. The authors are careful, however, to frame these conclusions as broad trends rather than definitive efficacy judgments: because no formal critical appraisal was conducted, the findings represent consistent patterns in the literature, with some studies suggesting potential disease-modifying effects rather than proving them. In Africa, the review finds that systemic barriers magnify a global implementation gap.

Workforce shortages are critical, with fewer than 0.5 physiotherapists per 100,000 population in many settings. Reimbursement for physiotherapy services is largely absent, care pathways are fragmented, and implementation research is scant. Perhaps the starkest finding is that no randomized controlled trials included in the review were conducted in African settings, leaving a critical evidence gap about how rehabilitation interventions perform in the continent's health systems.

The plain language summary adds that few physiotherapists are trained in cancer care, health insurance usually does not cover these services, and most countries do not include physiotherapy in their national cancer plans. To address these gaps, the authors propose a hypothesis-generating, expert-informed four-pillar action framework. The first pillar, Policy Integration and Financing, calls for embedding physiotherapy in cancer policies and health insurance schemes.

The second, Workforce and Service Innovation, focuses on training more workers and deploying technology such as telehealth to extend scarce expertise. The third pillar, Contextual Implementation Research, urges studies conducted in African settings rather than importing evidence from elsewhere. The fourth, Community Engagement and Cultural Adaptation, emphasizes working with communities to make programs culturally appropriate.

The authors stress that these recommendations are starting points for further research and adaptation, not definitive solutions. The stakes extend beyond comfort and mobility. As cancer incidence and survival rise across Africa, the review warns that without coordinated action, survival gains may be accompanied by preventable disability, potentially undermining quality of life gains.

Survivors commonly face lasting problems such as fatigue, pain and difficulty moving, all of which physiotherapy can address when services exist. The review's limitations deserve emphasis. Because the evidence base was mapped without formal critical appraisal, the reported benefits reflect broad trends across the literature rather than judgments about definitive efficacy.

The action framework is explicitly expert-informed and hypothesis-generating, meaning its pillars require testing and adaptation in local contexts before they can be considered established practice. The authors also note that the published version was shared early to provide faster access to peer-reviewed, accepted research, and is subject to further edits before the final Version of Record. What the study delivers is a structured starting point.

By consolidating 25 sources into a visual model of physiotherapy's role across the oncology continuum and pairing it with a context-specific framework, the review gives African policymakers, funders and researchers a common reference for planning. The evidence consistently reports benefits at every stage of cancer care, from prehabilitation through palliative support, while the implementation gap in low-resource settings is documented in workforce numbers, financing arrangements and the near-total absence of African trials. Closing that gap, the authors conclude, will require coordinated action on policy, workforce, research and community engagement, or many cancer survivors will face unnecessary disability alongside their hard-won survival.

Subject of Research: Physiotherapy integration into African cancer survivorship care

Article Title: Integrating physiotherapy services into African cancer care: a scoping review with expert-informed framework development

Article References: Umar, L., Kaka, B., Abdulahi, U., Shehu, B. B., & Abubakar, A. (2026). Integrating physiotherapy services into African cancer care: a scoping review with expert-informed framework development. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15951-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15951-8

Keywords: Integrating, physiotherapy, services, African, cancer, care, scoping, review, expert-informed, framework, development, scientific research