Practice Challenges and Research Directions in Rural Drug and Alcohol Treatment: A Focus Group Study of Clinician Perspectives.

Cancer and its treatment are frequently accompanied by a broad range of adverse effects, including declines in muscle strength, aerobic capacity, flexibility, balance, and the ability to perform activities of daily living, resulting in reduced quality of life and functional independence. Large longitudinal studies have demonstrated that cancer survivors—particularly older adults—experience accelerated declines in physical function following diagnosis compared with age-matched controls, with impairments often persisting years beyond treatment completion. Objective indicators of physical performance, such as gait speed and grip strength, are consistently lower in older cancer survivors than in individuals without a cancer history, and these deficits are associated with increased disability burden, poorer quality of life, and potentially worse clinical outcomes. In routine oncology practice, functional capacity is commonly assessed using the Eastern Cooperative Oncology Group (ECOG) Performance Status Scale. While ECOG is widely applied to guide treatment decisions, it is a single-item, clinician-rated measure that lacks objectivity and granularity, often showing only moderate agreement with standardized physical performance tests and failing to capture specific domains such as strength, mobility, and balance. Accordingly, multiple studies have emphasized that objective, performance-based assessments provide complementary and often more sensitive information regarding patients’ functional reserve than ECOG alone. The Senior Fitness Test (SFT) is a validated, standardized functional fitness battery originally developed for older adults that assesses lower and upper body strength, cardiorespiratory endurance, flexibility, agility, balance, and functional mobility. It offers age- and sex-specific normative values that are closely linked to everyday functional independence and enable meaningful comparisons across populations. The SFT has been successfully applied in various clinical populations, including breast cancer survivors and mixed oncology cohorts, to objectively quantify functional deficits and to inform individualized exercise interventions. This is particularly relevant given the growing evidence that tailored aerobic and resistance exercise improves physical function and selected clinical outcomes in cancer patients and survivors, leading major professional organizations to recommend individualized, progressive exercise training for most people living with and beyond cancer.