Exercise referral in oncology among physicians across Latin America.

483 Background: Exercise is increasingly recognized as a critical component of cancer care, yet its integration into oncology practices varies across regions. In Latin America, data on physicians' perceptions, referral practices, barriers, and facilitators regarding exercise in the oncology setting remain scarce. This study evaluates these perspectives to identify challenges and opportunities for improving exercise implementation in oncology care. Methods: A prospective survey study was conducted from December 18, 2024, to January 18, 2025, across 21 Latin American countries. The survey included 25 closed-ended questions, predominantly Likert-scale-based, assessing perceptions, practices, and barriers related to exercise in oncology. Descriptive statistics summarized participant characteristics and adherence to exercise-related practices. Chi-square tests evaluated associations between referral and evaluation practices and key factors. Results: A total of 454 physicians (61% oncologists) participated, with most respondents from Brazil (32%), Argentina (12%), Mexico (11%), and Peru (7%). Among them, 37% worked in public institutions and 34% in private practices. Whereas only 15% reported institutional exercise programs, 62% routinely assessed patients’ exercise engagement. Notably, 87% had no formal education on exercise, which may contribute to the low referral rates – only 11% consistently referred patients to exercise programs, and 58% rarely or never made referrals. Moreover, 65% did not prescribe exercise effectively. Key barriers included patients' lack of motivation (78%), uncertainty about referral locations (75%), and misconceptions about exercise during treatment that included excessive fatigue (60%) and a belief in rest (60%). Facilitators included recognizing exercise as a treatment component (85%) and personal experience with exercise (85%). Significant differences in practices were noted by professional role (p=0.005), years of experience (p=0.001) and type of institution (public vs private) (p=0.001). Conclusions: This study highlights substantial gaps in exercise integration within oncology practices across Latin America. Barriers such as referral uncertainties and patient misconceptions highlight the need for targeted strategies to support exercise adoption. Future efforts should focus on formalizing exercise recommendations, improving referral pathways, leveraging technology for remote exercise support, and promoting greater accessibility in low- and middle-income countries (LMICs).