Professor Steele introduces this blog from Professor John Saxton (University of Hull and the SCF invited lecturer for 2024) recording.
In Scotland, there has been recent focus on prehabilitation i.e. improving fitness before surgery, particularly for cancer. The evidence base for this in terms of cancer-related survival is weak, however, and it was encouraging to see the recent publication of a landmark paper which provided some of the most robust evidence to date that a physically active lifestyle can improve cancer survival outcomes.
Professor Saxton
CHALLENGE was a large-scale international randomised controlled trial in which stage II and III colon cancer patients, having been treated with curative intent, were randomly allocated to a 3-year structured exercise programme plus health education materials (445 patients) or a health education materials only control group (444 patients). Patients randomised to exercise experienced a 28% improvement in disease-free survival and a 37% improvement in overall survival over a median follow-up time of eight years versus controls. This is an important study because it reports a causal link between exercise and cancer survival after primary cancer treatment. In so doing, it corroborates a sizable body of observational evidence for associations between habitual physical activity and survival outcomes after treatment for colon and other common cancers. However, some of the key challenges and frustrations of undertaking large-scale prospective trials, and of engaging patients in exercise after a cancer diagnosis, are also brought to light.
Importantly, despite the now widely acknowledged health benefits of structured exercise and physical activity to people living with and beyond cancer, recruitment of 889 patients from 55 international centres took considerably longer than anticipated (>12 years). This probably means that only a small proportion of eligible patients approached about the study volunteered to take part, an observation that is consistent with many previous exercise intervention trials. Is the message not quite getting through to those providing cancer care services in a prime position to capitalise on such opportunities to promote active lifestyles, or is there still some confusion amongst healthcare professionals and patients regarding who this is relevant for? On the latter point, it is interesting to note that patients recruited to the CHALLENGE trial were at the higher-functioning end of the spectrum, based on their aerobic capacity, current habitual physical activity levels and quality of life scores. And so, what steps can we take to reach a broader spectrum of patients, including those with poorer functional status who may well have more to gain – not forgetting that structured exercise, just like pharmacological treatments, should be (and can be) individually prescribed and tailored according to patient needs and characteristics?
Professor Steele comments …As the trial name suggests, this is a significant challenge and one we need to address as a cancer community to ensure that limited resources are optimised.
