# Write a rehabilitation prescription at the end of treatment, and fund it like a drug

Source: https://onco.cc/ideas/idea-rejuv-rehabilitation-prescription-at-discharge/  
OnCo record `idea-rejuv-rehabilitation-prescription-at-discharge` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Exercise after colon cancer has a hazard ratio a drug would be licensed on. It is in the guidelines and in almost no budgets, because it is a staffed service rather than a product.

## Summary

The end of treatment should produce a prescription, not a leaflet: a named programme, a named provider, a start date and a funded course. The components are already evidenced. Supervised aerobic and resistance training at the dose the American College of Sports Medicine roundtable specifies. Cognitive behavioural therapy for insomnia and for fatigue. Decongestive therapy and supervised resistance training for lymphoedema. Vocational rehabilitation where someone intends to return to work. Dietetic input where there is malnutrition or sarcopenia.

What is missing is the financing instrument. A drug has a marketing authorisation, a payment code and a tariff; an exercise programme with CHALLENGE's hazard ratio has none of those, so it is recommended by every guideline and delivered by whoever has spare capacity. The specific proposal here is narrower than a general call for more rehabilitation: create a reimbursable bundle triggered by the completion of curative treatment, with the components fixed, uptake audited, and the audit published by provider.

The cost is real and should be stated. A supervised programme is staff time, and the workforce that would deliver it is already short. The counterargument is the trial evidence and the 2.4 million follow-up oncology appointments England recorded in a single year, a large share of which exist to reassure rather than to find anything.

## Fields

- Kind: Idea
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; open-problem; rehabilitation; commissioning
- Hypothesis: A funded, audited rehabilitation bundle triggered at the end of curative treatment increases uptake of the interventions that already have randomised evidence, and improves function, return to work and, in the cancers where exercise has been tested, recurrence and survival.
- Rationale: CHALLENGE showed eight-year overall survival of 90.3 against 83.2 per cent with a three-year coached exercise programme after colon cancer chemotherapy. A meta-analysis of 113 studies put exercise and psychological therapy far ahead of drugs for fatigue. And across this entire front the repeated finding is that these services are not commissioned: few services employ anyone to deliver supervised resistance training, referral pathways from oncology to gastroenterology for bowel injury rarely exist, and no health service OnCo could find commissions a named service for fear of recurrence.
- Proposed test: Implement the bundle as a funded pathway in one health system with a stepped-wedge rollout across centres, measuring uptake, function, return to work and, where the cancer and the intervention match the trial evidence, recurrence. CanWork's embedded cost-effectiveness analysis is the model for the economic arm.
- Maturity: early-clinical
- Actor: payer

## Sources

- Courneya et al., Structured exercise after adjuvant chemotherapy for colon cancer, the CHALLENGE trial (NEJM 2025;393:13-25): https://doi.org/10.1056/NEJMoa2502760
- Campbell et al., Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable (Medicine and Science in Sports and Exercise 2019;51:2375-2390): https://doi.org/10.1249/MSS.0000000000002116
- Mustian et al., Comparison of pharmaceutical, psychological and exercise treatments for cancer-related fatigue: a meta-analysis (JAMA Oncology 2017;3:961): https://doi.org/10.1001/jamaoncol.2016.6914
- Department of Health, Living With and Beyond Cancer: Taking Action to Improve Outcomes (England, 29 March 2013): https://www.gov.uk/government/publications/living-with-and-beyond-cancer-taking-action-to-improve-outcomes
- ClinicalTrials.gov NCT06723899: https://clinicaltrials.gov/study/NCT06723899

## Connected records

- technologies: [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [Going back to work after cancer: the rates, and the programmes that change them](https://onco.cc/technologies/rejuv-life-return-to-work/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/), [What actually works after treatment](https://onco.cc/technologies/rejuv-frontier-what-works/)
- ideas: [Pay for supervised exercise the way we pay for drugs](https://onco.cc/ideas/idea-bio2-exercise-reimbursement/), [Vocational rehabilitation integrated into cancer care so survivors can return to work](https://onco.cc/ideas/idea-acc-return-to-work-rehabilitation/)
- trials: [CanWork: an occupational therapy programme to help women return to work after breast cancer](https://onco.cc/trials/rejuv-trial-canwork/)
- terms: [The National Cancer Survivorship Initiative in England, and the Recovery Package](https://onco.cc/terms/rejuv-history-ncsi-england/)
- roadmaps: [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Rehabilitation is recommended everywhere and commissioned almost nowhere](https://onco.cc/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

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