Disparities in exercise referral practices and barriers among oncologists in public and private institutions in Latin America.

Abstract

1629 Background: Exercise offers significant benefit for patients with cancer, improving physical function, quality of life, and treatment-related outcomes. However, barriers such as limited referral practices and insufficient knowledge hinder its integration into care. This study compared referral practices, exercise assessment, and physicians’ perceptions in public (PUB) and private institutions (PRI). Methods: A cross-sectional survey of 454 physicians from 21 Latin American countries was conducted using a 25-item questionnaire on referral practices, patients’ exercise habits, and perceived barriers and facilitators to implementing exercise programs. Descriptive statistics summarized respondent characteristics and adherence to exercise-related practices. Chi-square tests were used to compare differences in referral practices and perceived barriers/facilitators between physicians working in PUB versus PRI institutions. Results: Out of 454 participants, most were from PUB (52%), mainly from Mexico (17%), Brazil (12%), and Colombia (10%). In the PRI (48%), Brazil led with 51%, followed by Argentina (18%), and Peru (8%). Female representation was higher in PUB compared to PRI (57% vs. 43%, P = 0.01). Physicians in PUB were less likely than those in PRI to assess exercise habits (53% vs. 18%, P = 0.001), refer patients (72% vs. 36%, P = 0.001), or provide guidance (56% vs. 12%, P = 0.001). Resource limitations were more common in PUB (e.g., no referral location: 86% vs. 70%, P = 0.04). Barriers included treatment side effects (PUB: 66% vs. PRI: 40%, P = 0.001) and lack of knowledge on prescribing exercise (PUB: 63% vs. PRI: 27%, P = 0.001). Physicians in PUB emphasized facilitators like access to qualified professionals (90% vs. 66%, P = 0.001) and personal experience (90% vs. 80%, P = 0.01). Conclusions: This study reveals significant disparities in cancer exercise practices between oncologists in public and private institutions across Latin America. Oncologists in public institutions were less likely to assess exercise, refer patients to exercise programs, and provide guidance. They also reported greater barriers, such as treatment side effects and lack of knowledge on exercise prescription and resources. Facilitators such as access to qualified professionals were less prominent in public institutions. These findings highlight the need for targeted interventions to improve exercise integration in cancer care, particularly in resource-limited settings.