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

Cancer incidence and survival are rising across Africa, creating an urgent need for sustainable survivorship care. Physiotherapy effectively manages cancer-related impairments, yet a significant implementation gap exists globally, particularly in low-resource settings. This scoping review with expert-informed framework development aimed to map the global evidence for physiotherapy across the oncology continuum and develop a context-specific action framework for African health systems. Following Joanna Briggs Institute methodology, we conducted a hybrid review combining systematic evidence mapping with expert-informed framework development. We searched PubMed/MEDLINE, CINAHL, Scopus, Cochrane Library, and African Journals Online in July 2025 for publications dated January 2010 to July 2024, including systematic reviews, meta-analyses, randomized controlled trials, clinical practice guidelines, implementation studies, and narrative reviews. We employed hybrid inductive-deductive thematic analysis to develop a conceptual model and expert-informed action framework, distinguishing evidence-derived findings from those informed by author expertise. From 2,505 records, 25 sources constituted the final evidence base. No eligible sources were excluded on the basis of perceived importance. The literature consistently reports physiotherapy benefits from prehabilitation through palliative care. Multimodal prehabilitation reduces postoperative complications by approximately 50%, and trials like CHALLENGE report improved disease-free survival. The PT Matrix visualizes physiotherapy’s dynamic role across care phases and patient needs. In Africa, systemic barriers are magnified: critical workforce shortages (<0.5 physiotherapists/100,000 population), absent reimbursement, fragmented care pathways, and scant implementation research. No included RCTs were conducted in African settings, highlighting a critical evidence gap. The literature consistently reports physiotherapy benefits across the cancer care continuum, with some studies suggesting potential disease-modifying effects. As no formal critical appraisal was conducted, these findings represent broad trends rather than definitive efficacy judgments. For African health systems, we propose a hypothesis-generating, expert-informed four-pillar action framework: (1) Policy Integration and Financing; (2) Workforce and Service Innovation; (3) Contextual Implementation Research; and (4) Community Engagement and Cultural Adaptation. These recommendations are starting points for further research and adaptation, not definitive solutions. Without coordinated action, cancer survival gains may be accompanied by preventable disability, potentially undermining quality of life gains. Not applicable.