Clinical practice guideline and expert consensus recommendations for rehabilitation among children with cancer: A systematic review.

Children treated for cancer often face lasting effects like fatigue, pain, and nerve or cognitive changes, yet it has been unclear how much formal guidance exists to help rehabilitation professionals respond to these needs. This systematic review set out to map what guidelines and expert consensus reports actually say about rehabilitation referral, assessment, and treatment for people diagnosed with cancer before age 18. After screening tens of thousands of records, the authors identified 28 relevant reports, a mix of 18 clinical practice guidelines and 10 expert consensus statements, spanning disease-specific, symptom-specific, and long-term follow-up contexts. Recommendations did exist, covering things like physical activity and energy-conservation strategies for fatigue, physical therapy referral for chronic pain, ongoing psychosocial monitoring, and speech-language referral for hearing loss.

The strongest evidence base supported long-term follow-up care, fatigue management, and psychosocial screening, while actual intervention recommendations were sparse overall. The main limitation is that this reflects existing guidance rather than new trial data, and much of pediatric oncology rehabilitation still lacks high-level evidence to draw on.

If your child has been treated for cancer, you may already know that the effects can linger well after treatment ends, things like tiredness, pain, thinking or memory changes, or hearing problems. This review looked at what official guidelines and expert groups currently recommend to help rehabilitation professionals, like physical therapists, support children through these challenges.

The researchers combed through a huge number of published reports and found 28 that contained relevant recommendations. The good news is that guidance does exist for several common issues: encouraging physical activity and pacing strategies for fatigue, referring children with persistent pain to physical therapy, keeping an eye on emotional wellbeing over time, and connecting children with hearing loss to speech-language specialists. The strongest backing was found for long-term follow-up care, fatigue management, and mental health screening.

However, the review also found that specific treatment recommendations were often missing, meaning there's still a lot of this field that hasn't been thoroughly studied. This isn't a new treatment test, it's a stocktake of existing guidance, and it shows both what's known and how much remains uncertain.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a basic gap in clinical reasoning for pediatric oncology rehabilitation: what formal guidance actually exists to inform referral, assessment, and intervention decisions for children treated for cancer, and how strong that guidance is. The authors systematically searched for clinical practice guidelines and expert consensus reports published between 2000 and 2022, ultimately identifying 28 eligible reports (18 guidelines, 10 consensus statements) spanning disease-specific, impairment-specific, adolescent and young adult, and long-term follow-up populations. For practice, this informs where rehabilitation recommendations currently rest on firmer ground, namely long-term follow-up care, fatigue management, and psychosocial or mental health screening, areas the review describes as supported by higher-level evidence.

Recommendations touching physical therapy involvement include referral for chronic pain and physical activity or energy-conservation approaches for fatigue, alongside speech-language referral for hearing loss. Importantly, the review notes that few reports contained detailed intervention-level recommendations, meaning the evidence informing specific treatment choices remains limited. What this does not establish is the clinical effectiveness of any particular intervention; this is a synthesis of existing guidance documents, not a trial or outcomes study, and inherits whatever evidence gaps and variability in rigor exist across those underlying guidelines.

The authors frame pediatric oncology rehabilitation as a developing field and call for greater involvement of rehabilitation providers in future guideline development, which itself signals how incomplete current recommendations are.