Author(s): ZARDO, W., GAZZAROLI, D., ROVEDA, E., PODDA, M., COLOMBO, V., CHISARI, M., MASSIMINO, M., SPREAFICO, F., GOZZOLI, C., Institution: FONDAZIONE IRCCS ISTITUTO NAZIONALE DEI TUMORI, Country: ITALY, Abstract-ID: 1845

INTRODUCTION:
Exercise interventions are increasingly recognized as safe and beneficial in pediatric oncology. However, their integration into routine care remains inconsistent across centers due to organizational (e.g., lack of structures/staff), cultural, and resource-related barriers, limiting scalability. This study explored the organizational factors that enabled the implementation of a long-standing structured exercise project in a pediatric oncology setting, whose goal was to integrate exercise within the broader concept of care.
METHODS:
We conducted a qualitative exploratory study at the Fondazione IRCCS Istituto Nazionale dei Tumori (Milan, Italy), where a sport/exercise program has been implemented in the pediatric department since 2013. Nineteen healthcare professionals from diverse roles (oncologists, physiotherapists, exercise physiologists, nurses, psychologists, educators/schoolteachers, and a social worker) were purposively recruited and interviewed using a semi-structured guide. Semi-structured interviews (30-45 minutes) allowed flexibility to explore participants' lived experiences while ensuring coverage of key domains (e.g., program facilitators, barriers, and integration into care pathways); open-ended questions encouraged detailed narratives, with probes for clarification and depth, enabling inductive theme generation reflective of organizational realities.
RESULTS:
Participants described pediatric oncology care as a multidimensional process encompassing clinical treatment as well as relational, emotional, educational, and social components. The exercise program was consistently framed as meaningful and increasingly integral to routine care. Its implementation was supported by institutional endorsement, strong clinical leadership, dedicated exercise professionals, and established multidisciplinary communication routines. Key facilitators included daily coordination with the referring pediatric oncologist, clear role definition, stable staffing, and structured scheduling to minimize conflicts with other clinical and educational activities. Ongoing challenges were primarily organizational and cultural, including limited recognition of exercise as a standard publicly funded component of care and constraints in physical space and resources, which restricted scalability and transferability
CONCLUSION:
In a well-supported multidisciplinary environment, structured exercise can be embedded in pediatric oncology as a routine supportive care practice. Our findings identified actionable organizational conditions—leadership, dedicated personnel, communication structures, exercise physiologist involved and sustainable funding mechanisms—that may guide implementation of exercise programs in other pediatric oncology centers. In this context, the “exercise as medicine” paradigm is operationalized through the contribution of exercise physiologist, and exercise is perceived as a valued component of the pediatric cancer care pathway rather than a barrier.