Clinical research has established exercise as a safe and effective intervention to counteract the adverse physical and psychological effects of cancer and its treatment. This article summarises the position of the Clinical Oncology Society of Australia (COSA) on the role of exercise in cancer care, taking into account the strengths and limitations of the evidence base. It provides guidance for all health professionals involved in the care of people with cancer about integrating exercise into routine cancer care. Main recommendations: COSA calls for: exercise to be embedded as part of standard practice in cancer care and to be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment; all members of the multidisciplinary cancer team to promote physical activity and recommend that people with cancer adhere to exercise guidelines; and best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care. Changes in management as a result of the guideline: COSA encourages all health professionals involved in the care of people with cancer to: discuss the role of exercise in cancer recovery; recommend their patients adhere to exercise guidelines (avoid inactivity and progress towards at least 150 minutes of moderate intensity aerobic exercise and two to three moderate intensity resistance exercise sessions each week); and refer their patients to a health professional who specialises in the prescription and delivery of exercise (ie, accredited exercise physiologist or physiotherapist with experience in cancer care).

Aim: The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor‐parent‐child communication in the outpatient setting. Methods: Fifty‐one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions. Results: Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%). Control: Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor. Conclusion: Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient‐centred approach.

Background: Cancer treatments are frequently associated with impaired physical fitness, quality of life (QOL), and fatigue, often persisting into survivorship. Studies in older adults with cancer have demonstrated benefits from exercise; however, this has not been rigorously investigated in adolescents and young adults (AYA). The aim of this study was to determine whether a structured 10-week exercise intervention was associated with improved cardiorespiratory fitness (VO 2peak), fatigue, and QOL in AYA who have recently completed cancer treatment. Method: Forty-three AYA (median age 21 ± 6 years) were randomly assigned to an exercise group (n = 22) or a control group (n = 21). The exercise group received a structured 10-week exercise program comprising progressive aerobic and resistance exercise; the control arm received routine care. VO 2peak was measured at baseline, 10 weeks, and six months. Fatigue and QOL were assessed by the FACIT fatigue scale and the PEDS QL, respectively. Results: Mean VO 2peak at baseline was 26.5 ± 7.2 mL.kg −1 .min −1 , which is substantially lower than population norms. The exercise group demonstrated significant improvement in VO 2peak at 10 weeks compared with controls (33.8 ± 8.1 vs 29.6 ± 7.6 mL.kg −1 .min −1 , P = 0.0002), but by six months, the difference was no longer significant (32.9 ± 7.0 vs 30.9 ± 11.0 mL.kg −1 .min −1 , P = 0.21). There were no significant differences in fatigue or total QOL scores between groups. Conclusion: Cancer treatment is associated with reduced VO 2peak in AYA. Improvement in VO 2peak was accelerated by a 10-week exercise program; however, no significant benefit was observed in QOL or fatigue. The plateau in VO 2peak at six months suggests that a maintenance exercise program may be beneficial.

Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient-centred approach.

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