Multidisciplinary supportive care, integrating the dimensions of exercise alongside oncological treatments, is now regarded as a new paradigm to improve patient survival and quality of life. Its impact is important on the factors that control tumor development, such as the immune system, inflammation, tissue perfusion, hypoxia, insulin resistance, metabolism, glucocorticoid levels, and cachexia. An increasing amount of research has been published in the last years on the effects of physical activity within the framework of oncology, marking the appearance of a new medical field, commonly known as “exercise oncology”. This emerging research field is trying to determine the biological mechanisms by which, aerobic exercise affects the incidence of cancer, the progression and/or the appearance of metastases. We propose an overview of the current state of the art physical exercise interventions in the management of cancer patients, including a pragmatic perspective with tips for routine practice. We then develop the emerging mechanistic views about physical exercise and their potential clinical applications. Moving toward a more personalized, integrated, patient-centered, and multidisciplinary management, by trying to understand the different interactions between the cancer and the host, as well as the impact of the disease and the treatments on the different organs, this seems to be the most promising method to improve the care of cancer patients.

Background Frailty, malnutrition, and sarcopenia are highly prevalent in digestive oncology and adversely affect treatment tolerance, toxicity, and survival. The integration of multimodal, multidisciplinary supportive care may mitigate these risks, but feasibility and clinical impact in routine practice remain uncertain. Methods We conducted two complementary single-center studies at a French cancer center. We developed a Nutritional Frailty Score to assess the risk of nutritional deterioration in patients receiving first-line chemotherapy for digestive cancers. ParcoursDig (NCT04478175) prospectively assessed the feasibility of systematic multimodal supportive care (dietitian, physiotherapist, palliative care) using risk stratification based on this score in patients with localized or advanced digestive cancers. PrePOP was a retrospective observational study of patients with pancreatic or esophagogastric cancers receiving perioperative chemotherapy and surgery. Outcomes included treatment completion, nutritional changes, toxicities, surgical complications, and survival. Results In ParcoursDig, only 44% of patients completed the full supportive care pathway (63% in sensitivity analysis), falling short of the predefined feasibility threshold. No significant improvements were seen in health-related quality of life or survival, highlighting real-world implementation challenges. In PrePOP, baseline malnutrition prevalence was 71% (31% severe). Malnutrition was clinically associated with higher rates of chemotherapy dose reduction but not with surgical complications or survival. Weight loss during systemic therapy was common, but early nutritional intervention appeared to prevent further deterioration for some patients. Muscle mass loss during follow-up correlated with poorer prognosis, emphasizing the need for longitudinal, muscle-specific assessment. Conclusions Low intensity interventions are not sufficient to improve patient outcomes. High-intensity modalities and individualized care trajectories with longitudinal follow-up warrant further evaluation in this population.