Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug

CHALLENGE randomised 889 patients with resected colon cancer who had completed adjuvant chemotherapy to a structured exercise programme or health-education materials over three years. At a median 7.9 years, disease-free survival favoured exercise with a hazard ratio of 0.72 (five-year disease-free survival 80.3 against 73.9 percent), and overall survival with a hazard ratio of 0.63 (eight-year overall survival 90.3 against 83.2 percent). Musculoskeletal adverse events were more common with exercise (18.5 against 11.5 percent).

The trial took 15 years to enrol because no commercial sponsor benefits from the result, and the intervention is a supervised programme with a behaviour-support consultant rather than advice to be more active. That is the gap: the evidence is now stronger than for several funded drugs in the same setting, and the implementation question, who employs the trainers and how patients are referred, has never been tested in a health system.