Prescribing Exercise to Cancer Patients Suffering from Increased Bone Fracture Risk Due to Metastatic Bone Disease or Multiple Myeloma in Austria—An Inter- and Multidisciplinary Evaluation Measure

SIMPLE SUMMARY: Some cancer patients are at increased risk of fractures due to their disease. Since these patients would still benefit from physical exercise overall, they should be given exercise recommendations that take their individual musculoskeletal situation into account. This article describes how this process should be handled according to Austrian experts. Each patient should be considered an individual case managed by his or her medical case manager (physiatrist/rehabilitation specialist). There should be specialists who assess the fracture risk (radiologist, oncologist, orthopedist, and radiation specialist), specialists who assess cardiovascular risk (internist and cardiologist), specialists who choose suitable exercises (sport scientist and physiatrist), and specialists for additional physical treatment (physiatrist and physical therapist). ABSTRACT: Introduction: In the current absence of specific functional fracture risk assessment technology, the planning of physical exercise interventions for cancer patients suffering from increased bone fracture risk remains a serious clinical challenge. Until a reliable, solely technical solution is available for the clinician, fracture risk assessment remains an inter- and multidisciplinary decision to be made by various medical experts. The aim of this short paper is depicting how this challenge should be approached in the clinical reality according to Austrian experts in cancer rehabilitation, presenting the best-practice model in Austria. Following referral from the specialist responsible for the primary cancer treatment (oncologist, surgeon, etc.), the physiatrist takes on the role of rehabilitation case manager for each individual patient. Fracture risk assessment is then undertaken by specialists in radiology, orthopedics, oncology, and radiation therapy, with the result that the affected bone regions are classified as being at highly/slightly/not increased fracture risk. Following internal clearance, exercise planning is undertaken by a specialist in exercise therapy together with the physiatrist based on the individual’s fracture risk assessment. In the case in which the patient shows exercise limitations due to additional musculoskeletal impairments, adjuvant physical modalities such as physiotherapy should be prescribed to increase exercisability. Conclusion: Exercise prescription for cancer patients suffering from increased fracture risk is an inter- and multidisciplinary team decision for each individual patient.