Current Practice and Barriers to Cardio-Oncology Rehabilitation Among Physical Therapists ― A Cross-Sectional Survey in Japan ―

Background: Cardio-oncology rehabilitation (CORE) has gained attention as a multidisciplinary approach to managing cardiovascular complications in patients with cancer. Physical therapists play a central role in delivering CORE, but their overall awareness of onco-cardiology, extent of CORE implementation, and barriers to its clinical practice remain poorly understood, so in this study we aimed to investigate the awareness, clinical practice, and perceived barriers to CORE among physical therapists. Methods and Results: This cross-sectional study used a web-based questionnaire distributed to members of the Japanese Society of Physical Therapy for Oncology and Lymphedema. A total of 158 responses were analyzed (response rate, 22.7%). Overall, 96 respondents (60.8%) reported a general understanding of onco-cardiology, and 80 (50.6%) had experience providing physiotherapy for patients with cancer therapy-related cardiovascular toxicity (CTR-CVT). Among these 80 respondents, only 2 (2.5%) reported that physiotherapy for CTR-CVT was fully implemented. Major barriers to CORE implementation included a lack of therapists with expertise in onco-cardiology (65 respondents, 81.3%), insufficient cardiovascular knowledge (48 respondents, 60.0%), and unclear timing and criteria for initiating physiotherapy (42 respondents, 52.5%). Only 2 respondents (2.5%) reported “sufficient” multidisciplinary collaboration. Conclusions: Awareness of onco-cardiology and implementation of CORE among physical therapists remain insufficient. Key barriers include a lack of specialized knowledge, healthcare system limitations, and insufficient multidisciplinary collaboration. Addressing these barriers may facilitate the integration of CORE into clinical practice.