THE PHYSICAL THERAPIST'S HISTORIC ROLE IN ACUTE CARE ONCOLOGYPhysical therapist (PT) services in the acute care setting are historically focused on addressing basic functional limitations and facilitating transition to the next level of care. With the rapidly growing body of evidence of the importance and benefit of exercise at all points during cancer care, there is likely to be an increased demand for and referrals to PT services for advanced mobility, cardiovascular exercise, higher-level balance retraining, and health optimization. As many acute rehabilitation departments have limited staffing resources, this results in an ethical dilemma of prioritization: With limited resources, which patients should be prioritized? Those with substantial functional limitations or those who need higher-level exercise for optimization of their cancer treatment regimen? If PTs are not available to provide these services and there is not a clear system to provide support for supervised or prescribed physical activity, is this ethical clinical practice? The purpose of this article is to describe the limitations, opportunities, and implications of providing ongoing physical therapy interventions for people with cancer with high functional status in the acute care setting.

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At this time, patients navigating cancer care have unique needs, often requiring care in multiple locations and by several types of professionals. Therefore, patients experience a myriad of issues related to accessing cancer care including transportation, complexity of care, 1 risk of infection, appointment fatigue, costs related to care management, 2 work and home life absence, social and community obligations, and psychosocial effects. 3 The COVID-19 pandemic has also created additional barriers to care, further inflating many of the aforementioned factors and adding another layer of complexity with sometimes unforeseeable disruptions to cancer treatment plans. Any combination of these reasons, in addition to financial burden and difficulty with scheduling care due to work or other home obligations, often poses limitations to accessing traditional rehabilitation services.As the current model of care dictates, patients often follow up with their oncology physician or advanced care provider to better understand issues or treatment-related side effects they encounter. Then, the provider makes a referral to a rehabilitation professional such as a physical therapist (PT), occupational therapist, or speech-language pathologist if the provider deems it necessary. However,