# Give survivorship interventions a shared control arm

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

## TL;DR

Every survivorship intervention currently raises its own small trial with its own control arm and its own endpoint. A platform trial with a shared control and a common outcome set would test several at the cost of one and a half.

## Summary

The structural weakness of this literature is not that it is wrong but that it is small and fragmented. Single-centre trials of forty to a hundred people, each with its own comparator and its own questionnaire, are what a field without a sponsor produces. They are rarely large enough to change practice and almost never comparable with one another.

Platform trials solved an equivalent problem in treatment: a shared protocol, a shared control arm, prespecified rules for adding and dropping interventions, and a common endpoint set. Applied to survivorship, the obvious domains are fatigue, physical function, cognition and return to work, each with several candidate interventions and none with a dominant one. The efficiency gain comes from the shared control: a trial comparing four interventions against one control arm uses roughly half the participants of four separate two-arm trials.

This only works if the core outcome set work is done first or alongside, which is why the two proposals are linked. It also needs a funder willing to commit to a decade of infrastructure rather than a sequence of three-year grants, which is the part that has not happened.

## Fields

- Kind: Idea
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; open-problem; trials
- Hypothesis: A multi-arm, multi-stage platform trial with a shared control arm and a common outcome set would test survivorship interventions at a fraction of the per-intervention cost, and produce results large enough to change commissioning.
- Rationale: The trials on this front are small and heterogeneous: the largest randomised trial of exercise for cancer-related cognitive impairment had 253 participants; the best long-term study of cognition after CAR-T has 40; the only sham-controlled trial of scrambler therapy was a pilot. AMICO already uses a Bayesian adaptive multi-arm multi-stage design with interim analyses to drop ineffective arms, which is the method this proposal generalises.
- Proposed test: Stand up one platform in a national trials network for a single domain, beginning with physical function after curative treatment, with three intervention arms, a shared usual-care control and a prespecified core outcome set. Judge it on cost per randomised comparison against the preceding decade of standalone trials in the same domain.
- Maturity: speculative
- Actor: research

## Sources

- ClinicalTrials.gov NCT04754672: https://clinicaltrials.gov/study/NCT04754672
- 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

## Connected records

- trials: [AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer](https://onco.cc/trials/rejuv-trial-amico/)
- ideas: [Agree what to measure, so the next systematic review can pool rather than narrate](https://onco.cc/ideas/idea-rejuv-core-outcome-set-for-late-effects/), [An ARPA-style programme to develop supportive-care drugs nobody else will](https://onco.cc/ideas/idea-moon-supportive-care-arpa/)
- 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: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Rehabilitation is recommended everywhere and commissioned almost nowhere](https://onco.cc/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/), [The field cannot pool its own studies, because it has not agreed what to measure](https://onco.cc/bottlenecks/rejuv-agenda-no-agreed-outcome-measures/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)

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