Can exercise and rehab services be integrated into breast cancer care?

A recent randomized controlled trial reveals the potential of a program designed to connect patients who have breast cancer to needed exercise and rehabilitation services starting at diagnosis and throughout care. Participants provided positive feedback about the program, supporting efforts to integrate exercise and rehabilitation services as part of routine cancer care. The trial’s findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Exercise services for individuals with breast cancer can improve functional deficits, fitness, and strength. Rehabilitation services treat neurological and musculoskeletal deficits, such as impaired shoulder range of motion and peripheral nerve injury. Depending on where a patient is on the cancer care continuum, they may require both services concurrently or in tandem.

The 24-week clinical trial assessing exercise and rehabilitation services for patients with breast cancer involved a program, or clinical workflow algorithm, called CORE (Comprehensive Oncology Rehabilitation and Exercise). A total of 72 U.S. patients with newly diagnosed stage I–III breast cancer requiring surgery as first-line treatment were randomized 2:1 to CORE or standard of care.

Based on patient questionnaire responses regarding self-reported exercise and functional status, patients were triaged to receive an exercise service, a rehabilitation service, or were instructed to exercise on their own (exercise self-management, which was not a service). The exercise self-management group was for individuals who reported meeting physical activity guidelines with no declines in function. The exercise service involved a hospital-based exercise oncology program. The rehabilitation service was provided for individuals with complex functional deficits of the neurological, musculoskeletal, or cardiopulmonary systems and involved assessments to see if the patients needed physical therapy.

Ninety-three percent of participants in CORE completed the triaging process, indicating that the algorithm was feasible. Among those triaged to a service, 62% completed the service program to which they were referred.

Overwhelmingly positive feedback was noted from study participant focus groups. For most patients, the connection to exercise and rehabilitation services greatly helped treat their symptoms after cancer treatment. They also reported that exercise and rehabilitation services throughout their care had a positive impact on their physical activity engagement and physical function.

“CORE may serve as a model workflow algorithm aimed to integrate both exercise and rehabilitation services from time of diagnosis and beyond. Findings from this trial support national efforts led by the American College of Sports Medicine to integrate exercise and rehabilitation services as part of routine cancer care,” says senior author Adriana M. Coletta, PhD, MS, RD, an investigator at Huntsman Cancer Institute at the University of Utah. “If other cancer centers and clinics do not have exercise or rehabilitation services embedded in their institution, they could use the algorithm and triaging tool in coordination with the American College of Medicine’s Moving Through Cancer Exercise Program Directory.”

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

Full Citation:
“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.” Lea Haverbeck Simon, Carson Saviers-Steiger, Emily R. Dunston, Patrick Galyean, Elisabeth R. Kimball, Justine Mendez, Susan L. Zickmund, Pamela A. Hansen, Cornelia M. Ulrich, Paul C. LaStayo, David Steinberg, Christopher S. Noren, A’Lisha Finch, Leanne Seckinger, Emma Braun, Jonathan Chipman, Kirstyn E. Brownson, Sonal Oza, and Adriana M. Coletta. CANCER; Published Online: April 28, 2025 (DOI: 10.1002/cncr.35798).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35798

Author Contact: Nina Earnest, Public Affairs Specialist, Huntsman Cancer Institute at the University of Utah, at Nina.Earnest@hci.utah.edu or +1 801-213-8437

About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley
Wiley is one of the world’s largest publishers and a trusted leader in research and learning. Our industry-leading content, services, platforms, and knowledge networks are tailored to meet the evolving needs of our customers and partners, including researchers, students, instructors, professionals, institutions, and corporations. We empower knowledge-seekers to transform today’s biggest obstacles into tomorrow’s brightest opportunities. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram.