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

Breast cancer patients commonly face a multitude of functional impairments and physical challenges throughout their treatment trajectory. Exercise services have been shown to counteract these challenges by improving patients’ physical fitness, muscle strength, and overall functional capacity. Concurrently, rehabilitation services address specific neurological and musculoskeletal deficits often resulting from both the malignancy and its treatment, such as reduced shoulder mobility and peripheral nerve damage. Depending on their individual condition, patients might require either or both interventions—exercise and rehabilitation—either sequentially or in parallel to optimize recovery and long-term function.

The focus of this clinical trial was the implementation of CORE (Comprehensive Oncology Rehabilitation and Exercise), a clinical workflow algorithm specifically engineered to triage and guide newly diagnosed breast cancer patients through appropriate exercise and rehabilitation pathways. The trial spanned 24 weeks and enrolled 72 U.S.-based patients harboring stage I to III breast cancer, all scheduled to undergo surgery as their initial treatment modality. Participants were randomized in a 2:1 ratio to either receive CORE-guided services or continue with the institutional standard of care, allowing investigators to rigorously assess the feasibility and efficacy of this structured clinical strategy.

At the core of the program was a patient-centric triaging process that utilized detailed questionnaire responses to evaluate self-reported exercise habits alongside functional status metrics. This comprehensive assessment enabled the precise classification of patients into one of three groups: those requiring guided exercise services, those necessitating rehabilitation interventions, and those capable of managing physical activity independently under a self-management protocol. Patients fulfilling physical activity guidelines without noted functional deterioration were directed towards the exercise self-management group, effectively reserving clinical services for those demonstrating measurable need. The exercise service component was embedded within a hospital-based oncology exercise program designed to provide supervised, individualized physical conditioning. Meanwhile, rehabilitation services catered to patients exhibiting complex deficits across neurological, musculoskeletal, or cardiopulmonary domains and involved thorough assessments to determine physical therapy requirements.

Results from the trial revealed an impressive 93% completion rate of the triaging process among participants allocated to the CORE program, underscoring the clinical feasibility and acceptability of the workflow algorithm in real-world oncology settings. Moreover, among the subgroup triaged to receive targeted services—whether exercise or rehabilitation—62% successfully completed the recommended programs. This high adherence rate signifies strong patient engagement and suggests substantial acceptability of these intervention pathways when integrated as part of routine care.

Qualitative data gathered from study participant focus groups shed further light on the efficacy of the CORE program, revealing overwhelmingly positive patient experiences. Many patients attested to the significant alleviation of post-treatment symptoms achieved through continued access to exercise and rehabilitation services. Importantly, patients reported that participation in these programs fostered greater ongoing engagement in physical activity, which they identified as instrumental in maintaining and improving their physical function throughout and beyond their cancer treatment course.

According to Dr. Adriana M. Coletta, the senior author and an investigator at the Huntsman Cancer Institute at the University of Utah, the CORE algorithm represents a replicable and scalable model for integrating exercise and rehabilitation services longitudinally from diagnosis onwards. Dr. Coletta highlights the alignment of the study findings with broader national initiatives led by the American College of Sports Medicine, which advocate for embedding exercise and rehabilitation frameworks decisively into standard oncologic care pathways. She further recommends that cancer centers lacking existing on-site services consider adopting the CORE workflow in collaboration with the American College of Medicine’s Moving Through Cancer Exercise Program Directory to bridge these treatment gaps.

From a physiological and mechanistic standpoint, exercise interventions stimulate multiple beneficial pathways in cancer patients, including enhancement of cardiovascular endurance, muscle hypertrophy, and neuromuscular coordination. These effects collectively mitigate the declines in physical function often precipitated by chemotherapy, radiation, and surgery. Rehabilitation services, meanwhile, deploy specialized therapeutic modalities to address nerve injuries, joint contractures, and cardiopulmonary impairments, leveraging interventions such as manual therapy, targeted exercises, and electrotherapy to restore optimal functionality. By synchronizing these approaches via the CORE triaging system, patients receive precisely calibrated care that adapts dynamically in response to symptomatology and disease progression.

Implementing an integrated clinical workflow that seamlessly directs breast cancer patients toward customized exercise and rehabilitation regimens may also yield broader systemic benefits. For oncology institutions, it holds the promise of improved patient satisfaction, reduction in treatment-related complications, and potentially enhanced survival outcomes due to greater physical resilience. Furthermore, embedding such services early in the cancer care continuum aligns with emerging survivorship paradigms, which emphasize functional optimization and quality of life as vital endpoints alongside traditional clinical measures of remission and recurrence.

The innovation established by the CORE model stands to challenge existing clinical norms by positioning exercise and rehabilitation not merely as adjunctive options, but as essential, standardized components of multidisciplinary cancer care. This paradigm shift underscores an evolving recognition within oncology that treating the disease extends beyond tumor eradication to encompass proactive management of treatment sequelae and maintenance of long-term patient well-being. As further trials validate and refine such workflow algorithms, oncology care protocols may increasingly incorporate similar patient-centric, service-integrated approaches.

Looking ahead, the scalability of the CORE algorithm across diverse healthcare settings remains a critical area for ongoing inquiry. Variations in institutional resources, patient demographics, and healthcare infrastructure must be considered when adapting this model. Additionally, future research will be needed to quantify long-term clinical outcomes, cost-effectiveness, and potential impacts on healthcare disparities. Nevertheless, the current trial sets a robust precedent, demonstrating that thoughtfully designed clinical workflows can effectively bridge gaps in cancer care and empower patients through enhanced physical rehabilitation and exercise interventions.

In summary, the CORE clinical workflow embodies a successful integration of exercise oncology and rehabilitation medicine into breast cancer care, delivering a structured, evidence-based approach that is both feasible and well-received by patients. As the oncology community increasingly embraces holistic treatment models, initiatives like CORE illuminate the path toward comprehensive, patient-centered care that supports physical restoration and quality of life from the moment of diagnosis onward.

Subject of Research: Feasibility and acceptability of a clinical workflow algorithm integrating exercise and rehabilitation for breast cancer patients

Article Title: Feasibility and Acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) Clinical Workflow Algorithm in Newly Diagnosed Stage I-III Breast Cancer Patients with Surgery as First-Line Treatment

News Publication Date: April 28, 2025

Web References:

• https://acsjournals.onlinelibrary.wiley.com/journal/10970142
• http://dx.doi.org/10.1002/cncr.35798

References:
Haverbeck Simon L., Saviers-Steiger C., Dunston E.R., et al. (2025). Feasibility and Acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) Clinical Workflow Algorithm in Newly Diagnosed Stage I-III Breast Cancer Patients with Surgery as First-Line Treatment. CANCER. https://doi.org/10.1002/cncr.35798

Keywords: Breast cancer, Physical exercise, Cancer patients, Cancer treatments, Controlled trials