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Background: Incurable cancer is a major contributor to societal suffering and disability, and palliative rehabilitation is recommended to be integrated within and between cancer services at all healthcare levels. However, little knowledge exists on how integration of palliative rehabilitation in cancer is understood and achieved in clinical practice. INSPIRE (Integrated short-term palliative rehabilitation to improve quality of life and equitable care access in incurable cancer) is a large European-funded project that aims to promote quality of life through a novel rehabilitation model for people disabled by advanced cancer., Aim: To compare the existing integration of palliative rehabilitation in cancer within official documents and in clinical practice across five European countries including United Kingdom, France, Denmark, Norway, and Italy., Methods: Mixed methods study with a concurrent research design, comprising a document analysis (N = 23), stakeholder interviews (N = 22), and an online survey (N = 225). Data from each sub-study were analysed separately before results were merged., Results: There was limited integration of palliative rehabilitation in cancer in official documents and in clinical practice, though some indicators of integration, including participation in multidisciplinary teams and adherence to standardised pathways, were identified in the survey. Notably, integration of palliative rehabilitation in cancer in clinical practice was observed within limited organisations in secondary healthcare systems, without widespread adoption. Although palliative rehabilitation in cancer as a concept was sparingly used by stakeholders, they recognised the need for a comprehensive approach including multidisciplinary teams that aligns with the individual patient's needs and goals. Moreover, the ambiguous distinction between the terms 'palliative rehabilitation' and 'palliative care', insufficient funding, lack of well-defined care pathways and competence gaps among healthcare professionals represented barriers to integration of palliative rehabilitation in cancer into clinical practice., Conclusion: Integration of palliative rehabilitation in cancer was limited in the five EU partnership countries investigated. Clarifying the concept of palliative rehabilitation, including adoption of the concept into official documents and delineating it from palliative care, is essential for more successful integration. This can possibly be achieved by addressing the barriers identified and fostering close collaboration across disciplines., Competing Interests: Declarations Ethics approval and consent to participate All data handling adhered to EU’s General Data Protection Regulation (GDPR) 2018 and the University of Bergen regulations for GDPR and safe data handling. According to the national regulations for medical and health research (the Health Research Act of 2008-06-20 no. 44; •• 4a and 4d), ethical approval was deemed unnecessary by the Regional Ethics Committee (REC West). However, approval from the Norwegian Agency for Shared Services in Education and Research was required, as the interviews were recorded (reference number 414708). The study was registered in University of Bergen’s System for Risk and Compliance (ID F2402). Written and/or oral informed consent was provided by all participants in the interviews and cross-sectional survey. Consent for publication All authors have provided their consent for publication. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)