Telerehabilitation for Pain, Function, and Quality of Life in Patients with Cancer: A Systematic Review.

INTRODUCTION: Cancer rehabilitation improves function, quality of life, and symptom control, yet access to specialized programs is limited by geographic, financial, and systemic barriers. Telerehabilitation has emerged as a scalable alternative; however, its effectiveness across cancer types and intervention modalities remains heterogeneous.

METHODS: We conducted a systematic review of randomized clinical trials (RCTs) and nonrandomized comparative studies evaluating telerehabilitation in adults with cancer. Searches were performed in MEDLINE, LILACS, ScienceDirect, PEDro, Cochrane Central, Scopus, Springer, Taylor & Francis, and Google Scholar from January 1, 2010 to September 30, 2025. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the PEDro scale (RCTs) and the MINORS tool (nonrandomized studies). Given heterogeneity in measures and outcome definitions, we applied structured narrative synthesis with vote counting (SWiM/Cochrane), complemented by effect-direction and albatross plots.

RESULTS: Thirteen studies (11 randomized controlled trials and 2 nonrandomized comparative trials) were included, encompassing populations with breast, lung, and esophageal cancers, hematologic malignancies, gliomas, and mixed cohorts. Interventions were categorized into three main delivery modalities: supervised synchronous exercise via videoconferencing, web- or app-based programs incorporating remote monitoring, and telephone-based counseling. Across studies, telerehabilitation consistently demonstrated improvements in physical function (e.g., walking capacity, muscular strength, and peak VO) and reductions in fatigue. Effects on pain were modest and heterogeneous, while outcomes related to health-related quality of life (HRQoL) were mixed. The most pronounced benefits were observed in supervised synchronous interventions, whereas asynchronous or maintenance models exhibited diminished effects, indicating a lower likelihood of achieving functional improvement. Adherence, as reported by the primary study authors, ranged from moderate to high, and no serious adverse events attributable to the interventions were documented.

CONCLUSION: Telerehabilitation is a safe and effective strategy to improve function and reduce fatigue in oncology, with less consistent evidence for HRQoL and pain. Supervised synchronous models provide the strongest benefits. Multicenter RCTs with standardized outcomes and longer follow-up are needed.