Referral to cancer rehabilitation in the cancer care continuum: barriers, inequities, and opportunities for integration-a scoping review.

Background: Functional impairments among people living with and beyond cancer can affect treatment tolerance, daily functioning, participation, and quality of life. Despite the potential benefits of rehabilitation, referral remains inconsistent. Referral barriers may also arise within related supportive-care pathways, particularly palliative care, although the purposes and indications of these services differ. Objective: This scoping review aimed to synthesize evidence on facilitators and barriers affecting referral across two related but conceptually distinct service contexts: palliative care and cancer rehabilitation or allied health services. Methods: A comprehensive search of major electronic databases and gray literature sources was conducted for studies published in English between January 2011 and January 2025. Eligible studies examined factors affecting referral to cancer rehabilitation or allied health services or addressed palliative care referral when rehabilitation-relevant factors were reported. Two authors independently screened the studies and appraised their evidence level and methodological quality using the Johns Hopkins Evidence-Based Practice Research Evidence Appraisal Tool. Findings were synthesized thematically and stratified by service context. Results: Eighteen studies were included: eight examined referral to palliative care and ten examined cancer rehabilitation, allied health services, or rehabilitation screening and triage pathways. The evidence consisted of 12 quantitative, three qualitative, and three mixed-methods studies and was predominantly Level III. Four themes were identified: clinicians' perceptions of referral and services; the influence of social determinants of health; individual cancer characteristics and demographics; and interdisciplinary coordination, communication, and education. In palliative care, referral was commonly associated with advanced disease, symptom burden, uncertainty regarding referral timing, and misconceptions about the purpose of palliative care. In rehabilitation and allied health services, referral was more dependent on recognition of functional needs, clinicians' knowledge of rehabilitation roles and available services, and the presence of clear referral pathways. Limited interdisciplinary coordination, clinician-dependent decision-making, and inequities in access were evident across both contexts, although their manifestations differed. Conclusions: Referral barriers should be interpreted within the distinct clinical purposes and pathways of palliative care and cancer rehabilitation. Structured, context-specific referral pathways may support more consistent access. Within cancer rehabilitation, routine functional screening, explicit referral criteria, and stronger integration of rehabilitation professionals into oncology teams warrant further implementation and evaluation.