The reason exercise is not prescribed during cancer treatment is usually not disagreement about whether it helps. It is that nobody is confident it is safe in this particular patient, and the check feels like it needs a specialist.
It does not. Four things decide it: is there bone metastatic disease, and where; is there uncontrolled cardiac disease or recent cardiotoxic therapy; is there peripheral neuropathy or a balance problem; and is the haemoglobin or platelet count low enough to matter today. Each has an obvious modification rather than a prohibition - avoid axial loading, keep intensity submaximal, use seated or supported work, defer on the day of a low count.
Write the answers in the referral, not just the referral. A supervised programme that receives 'prostate cancer on ADT, please assess' will spend the first session doing what you could have done in four minutes, and some patients do not come back for a second.
- Bone metastases: avoid axial loading and high-impact work, do not avoid exercise
- Recent anthracycline or chest radiotherapy: keep intensity submaximal and review symptoms
- Neuropathy or poor balance: seated and supported work rather than free weights
- Check today's haemoglobin and platelets before a session, not just at the last clinic
- Put all four answers in the referral letter so the first session is not spent on triage
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