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

The research, published in Supportive Care in Cancer, involved twelve adults with advanced bladder or renal cancer receiving immune checkpoint inhibitor therapy at a tertiary cancer centre in London. Through individual semi-structured interviews lasting between 34 and 69 minutes, the team led by Nicola Peat of Guy’s and St Thomas’ Hospital NHS Foundation Trust explored how patients perceive and experience physical activity during immunotherapy. The interviews were transcribed verbatim and analysed using Braun and Clarke’s six-phase thematic analysis, a rigorous framework for identifying patterns across qualitative data. Four main themes emerged: the purpose of physical activity participation, the factors that help or hinder it, the striking lack of support from healthcare professionals, and the kind of support patients actually want.

The scientific rationale for the study is compelling. Physical activity is known to mitigate many cancer treatment side-effects, including fatigue and anxiety, and is associated with improved physical function and health-related quality of life across cancer populations. More intriguingly, emerging evidence suggests exercise may exert immunomodulatory effects that contribute directly to tumour control. In preclinical research, moderate-intensity exercise has been shown to reduce tumour size by mobilising highly differentiated natural killer cells and increasing the infiltration of CD8-positive T cells into tumours, the very immune mechanisms that checkpoint inhibitors are designed to enhance. This has led researchers to propose that exercise may have both a conditioning effect and a tumour immune surveillance effect, potentially amplifying the benefits of immunotherapy itself.

Current guidelines recommend that adults with cancer engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week, plus two resistance-training sessions. Yet physical activity levels typically decline after a cancer diagnosis, with fewer than 30 percent of individuals meeting these recommendations. The new study reveals how this gap plays out in the lives of patients on immunotherapy. Most participants described a decline in activity following diagnosis, driven by frequent hospital visits, debilitating side-effects, and a simple lack of knowledge about what was safe or beneficial. Fatigue emerged as the dominant barrier, with one participant describing having absolutely no energy, and another attributing profound exhaustion to treatment-induced pituitary and thyroid dysfunction, telling researchers they were more worn out than during their army days.

Pain also limited movement, particularly where cancer had spread to bones in the hip and leg, while nausea, vomiting, skin rash and itchiness added further obstacles. Psychological factors mattered too. One participant described falling into a dark period after diagnosis, spending most days in bed with the blanket over their head, and reflected that help to snap out of it might have changed everything. Notably, the study identified barriers unique to checkpoint inhibitor therapy: endocrine-related fatigue, nausea and skin symptoms that fluctuate across treatment cycles, creating a moving target for both patients and anyone prescribing exercise. Social support cut both ways, with some patients encouraged by family members to walk to the shops, and others told by worried relatives to cancel gym memberships and rest.

Against these barriers, participants described powerful motivations. Physical activity represented independence, normalcy and control, a way of living life on their own terms. Walking was the most common activity, woven into daily routines such as commuting, shopping and playing with grandchildren. Immunotherapy itself acted as a beacon of hope, with one patient describing the treatment as a last chance of survival and a reason to be as fit and well as possible. Participants also credited exercise with lifting mood, managing comorbidities such as pre-diabetes, and easing fatigue and pain, with one describing how supervised treadmill sessions at the cancer centre gym restored the ability to walk at a good pace and take grandchildren to the park. Several described physical activity as their therapy place, a source of routine, sanctuary and a happiness factor.

The most striking finding, however, was the silence of the clinical team. Every participant reported receiving little or no physical activity advice during routine appointments. Some recalled only vague encouragement to keep doing what they were doing, while the majority received nothing at all. When asked whether advice would have helped, all but one said yes, with one patient noting that information about exercise would totally have changed the way they felt about it. Several said that simply reading the study information sheet sparked a desire to become more active, and argued that such information should be given to patients at the start of treatment. Participants perceived that clinicians prioritised drug-based management of side-effects over conversations about movement, and physiotherapy referrals, when they occurred, focused on managing impairments rather than broader activity benefits.

What patients want, the study found, is structured, personalised and expert-led support rather than leaflets or generic exhortations. They wanted someone to show them the right exercises for their specific tumour sites and limitations, trusted professionals with knowledge of both cancer and exercise, clear targets and progress tracking, and flexible programmes that accommodate the good and bad days of treatment cycles. Walking and strength training were the most favoured activities, followed by cycling and swimming, and participants favoured hybrid models combining supervised hospital or gym sessions with home-based activity. Crucially, they endorsed a periodised, auto-regulated approach, doing less during treatment weeks and more in the weeks after, an approach consistent with research showing that chemotherapy-periodised exercise improves adherence and symptom management compared with linear progression.

The authors argue that structured physical activity is a promising but underutilised strategy for managing cancer and treatment-related side-effects during checkpoint inhibitor therapy, and that these patients have distinct needs requiring personalised support. Their recommendations include embedding professionals with cancer-specific exercise expertise, such as physiotherapists, directly into cancer clinics and care pathways, improving referral routes to rehabilitation specialists, and training healthcare professionals to close knowledge and confidence gaps. Prior research suggests only between 6 and 44 percent of cancer patients receive physical activity information during oncology appointments, and this study suggests immunotherapy patients are no exception. Given exercise’s potential to enhance both quality of life and possibly immunotherapy response, the researchers call for future studies to evaluate which checkpoint inhibitor side-effects can be mitigated through activity, and to test accessible, scalable interventions across patient groups.

The study has limitations. Recruitment came from a single UK tertiary centre with a relatively homogeneous group of bladder and renal cancer patients, all receiving checkpoint inhibitors, which may limit generalisability to broader populations or other treatments. The supportive context of the specialist unit and good transport links may also have under-represented socioeconomic and environmental barriers reported elsewhere. Nevertheless, the methodology was rigorous, reported against the COREQ checklist, with ethical approval, member-checked transcripts and reflexive analysis. For patients whose treatment is their last hope of survival, the message from this research is clear: they want to move, they believe movement helps, and the healthcare system needs to start telling them how.

Subject of Research: Patient perspectives and experiences of physical activity during immune checkpoint inhibitor treatment for advanced urological cancers

Article Title: Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences

Article References: Peat, N., Jones, G. D., Veal, I., Kinsella, N., Karagiannis, S. N., & Van Hemelrijck, M. (2026). Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences. Supportive Care in Cancer, 34(10), Article 963. https://doi.org/10.1007/s00520-026-11195-8

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11195-8

Keywords: physical activity, immune checkpoint inhibitors, immunotherapy, bladder cancer, renal cancer, urological cancer, qualitative research, exercise oncology, cancer rehabilitation, fatigue, supportive care, patient perspectives