# Use of Instrumental Physical Therapies and Manual Therapy in Cancer Patients: A Systematic Review

## TL;DR

This systematic review finds that physical and manual therapies can help manage cancer-related symptoms without absolute contraindications.

## Contribution

The study provides evidence-based guidance on the indications and safe use of physiotherapy in cancer patients.

## Key findings

- Physiotherapy interventions reduce pain in cancer survivors during and after chemotherapy.
- No absolute contraindications for physiotherapy were found in cancer patients, including those with metastatic disease.
- Manual therapy and instrumental physical therapies are best used as part of a broader treatment plan.

## Abstract

Long-term cancer treatment leads to a range of complications, including physical deconditioning and associated physical and psychological consequences, which negatively affect quality of life. Oncology physiotherapy provides valuable support across different phases of the disease; however, to date, no specific guidelines exist regarding the type, timing, or dosage of physiotherapy interventions. The aim of this systematic review was to identify and analyze the available evidence on the indications and contraindications of physical and manual therapies in patients with cancer. Overall, the studies reviewed reported positive effects of both instrumental physical therapies and manual therapy in managing disease-related signs and symptoms. Absolute contraindications were not consistently identified; however, caution is recommended when applying treatments directly over tumor sites, avoiding strong manual pressure, and seeking prior clinical guidance from the treating oncologist.

Background/Objectives: The objective of this systematic review was to identify and analyze the available evidence on the indications and contraindications of physical and manual therapies in cancer survivors, including patients with metastatic disease and those with a history of neoplasia in follow-up. Methods: A literature search covering the period from 2017 to 2025 was conducted using the following databases: PubMed, NICE, NHS Evidence, PEDro, MEDLINE, and ScienceDirect. Systematic reviews and meta-analyses investigating manual or instrumental physiotherapy interventions in cancer survivors were identified and analyzed according to the PRISMA checklist. Results: Of the initial 2232 studies retrieved across the databases, 9 studies met the inclusion criteria. The available evidence suggests a positive effect of physiotherapy interventions on pain reduction in cancer survivors, both during and after chemotherapy. Conclusions: The clinical recommendation is to implement instrumental physical therapies and manual therapy as part of a multimodal approach rather than as isolated interventions. Close collaboration with the treating oncologist is recommended to determine whether the tumor type requires treatment to be performed away from the tumor site. No absolute contraindications to physiotherapy were identified, either during or after chemotherapy, including in patients with metastatic disease.