# What actually works after treatment

Source: https://onco.cc/technologies/rejuv-frontier-what-works/  
OnCo record `rejuv-frontier-what-works` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Exercise, sleep, not smoking, treating what is treatable and keeping up surveillance outperform everything currently sold as rejuvenation, by a wide margin and with randomised trials behind them. The measurable ageing that treatment causes is real and is a reason for research, not a reason to buy something.

## Summary

Exercise has the strongest evidence of anything on this front and it is not close. In the CHALLENGE trial, 889 people with resected colon cancer who had finished adjuvant chemotherapy were randomised at 55 centres to a structured, supervised exercise programme or to health-education materials, over three years. At a median follow-up of 7.9 years, disease-free survival was longer with exercise (hazard ratio 0.72, 95% CI 0.55 to 0.94, P = 0.02); five-year disease-free survival was 80.3 against 73.9 per cent. Overall survival was longer (hazard ratio for death 0.63, 95% CI 0.43 to 0.94), with eight-year overall survival 90.3 against 83.2 per cent. Musculoskeletal adverse events were more frequent in the exercise group (18.5 against 11.5 per cent), which is the honest cost. The 2019 international multidisciplinary roundtable sets out doses for fatigue, anxiety, depression, physical function and quality of life. The records for exercise during and after treatment are linked below.

Sleep is next, and it has a treatment with randomised evidence that is better than sleeping tablets and lasts longer: cognitive behavioural therapy for insomnia, recommended first line ahead of hypnotics, which has its own record on OnCo. Smoking cessation after a cancer diagnosis is the other free intervention with survival evidence behind it.

Treating what is treatable means the ordinary medicine that survivorship care exists to deliver: blood pressure, lipids, diabetes, thyroid replacement, hearing aids, bone protection, cardiac surveillance after anthracyclines, and the risk-based screening in a survivorship care plan. In the joint St Jude and Childhood Cancer Survivor Study analysis of subsequent neoplasms, treatment and genetic predisposition accounted for most of the attributable risk and lifestyle factors contributed negligibly to second cancers; that does not reduce the case for exercise, which rests on function, recurrence of the primary cancer and overall survival, but it does mean surveillance, not lifestyle, is what catches a second cancer.

Fasting and fasting-mimicking diets around chemotherapy sit on the boundary. The randomised DIRECT trial of 131 people with HER2-negative stage II or III breast cancer found a radiological response more often with a fasting-mimicking diet before and during neoadjuvant chemotherapy (odds ratio 3.168, P = 0.039) and a Miller and Payne 4 or 5 pathological response more often in the per-protocol analysis (odds ratio 4.109, P = 0.016), with no difference in toxicity despite dexamethasone being omitted. Adherence was the problem and there are no survival data. OnCo grades the fasting-mimicking diet insufficient on its own record, and it should be done inside a trial or with a dietitian, not alone.

The acceleration of biological age by treatment is measurable and documented on this front. Nothing sold on the strength of it has been shown to reverse it. The gap between those two sentences is where the research belongs.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; evidence:strong; exercise; sleep; survivorship
- Principle: The interventions with the best evidence share a property: they were tested against a control in people who had had cancer, with an outcome a person would notice, and they held up. That is a higher bar than any marketed rejuvenation product has cleared, and it is the bar.
- Strengths: A phase 3 randomised trial with disease-free and overall survival benefits for structured exercise; Guideline-backed doses for exercise and first-line status for cognitive behavioural therapy for insomnia; Free or low cost, and available through the NHS and most systems; Benefits are in outcomes people notice: function, fatigue, recurrence, survival
- Limitations: The exercise trial was in resected colon cancer and the result does not automatically transfer to other cancers; Musculoskeletal adverse events were more common with structured exercise; Supervised programmes need staff and funding that many services do not have; None of these reverses the measured acceleration of biological ageing; no intervention has been shown to

## Sources

- Courneya et al., Structured exercise after adjuvant chemotherapy for colon cancer, the CHALLENGE trial (NEJM 2025): https://doi.org/10.1056/NEJMoa2502760
- Campbell et al., Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable (Med Sci Sports Exerc 2019): https://doi.org/10.1249/MSS.0000000000002116
- de Groot et al., Fasting mimicking diet as an adjunct to neoadjuvant chemotherapy for breast cancer in the multicentre randomized phase 2 DIRECT trial (Nat Commun 2020): https://doi.org/10.1038/s41467-020-16138-3
- Qin et al., Epigenetic age acceleration and chronic health conditions among adult survivors of childhood cancer (JNCI 2021): https://doi.org/10.1093/jnci/djaa147

## Connected records

- technologies: [After a transplant or cell therapy: what to ask for](https://onco.cc/technologies/rejuv-tx-what-to-ask-for/), [Clonal haematopoiesis after cancer treatment](https://onco.cc/technologies/rejuv-age-clonal-haematopoiesis-after-therapy/), [Cognitive behavioural therapy for insomnia (CBT-I)](https://onco.cc/technologies/cbt-insomnia-cancer/), [Compounded hormone pellets](https://onco.cc/technologies/rejuv-frontier-hormone-pellets/), [Epigenetic age after cancer treatment](https://onco.cc/technologies/rejuv-age-epigenetic-clocks/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [Exosome injections](https://onco.cc/technologies/rejuv-frontier-exosome-injections/), [Fasting and fasting-mimicking diets around chemotherapy](https://onco.cc/technologies/fasting-mimicking-diet/), [Fat grafting after cancer surgery](https://onco.cc/technologies/rejuv-frontier-fat-grafting/), [Frailty and late effects in survivors](https://onco.cc/technologies/rejuv-age-frailty-and-late-effects/), [Hyperbaric oxygen sold as rejuvenation](https://onco.cc/technologies/rejuv-frontier-hyperbaric-oxygen-claims/), [Intravenous NAD+ drips](https://onco.cc/technologies/rejuv-frontier-nad-infusions/), [Mesenchymal stromal cells for tissue damage](https://onco.cc/technologies/rejuv-frontier-mesenchymal-stromal-cells/), [Metformin as an anti-ageing drug after cancer](https://onco.cc/technologies/rejuv-frontier-metformin-ageing/), [NAD+ precursors taken by mouth](https://onco.cc/technologies/rejuv-frontier-nad-precursors/), [Ozone therapy](https://onco.cc/technologies/rejuv-frontier-ozone-therapy/), [Platelet-rich plasma for survivors](https://onco.cc/technologies/rejuv-frontier-platelet-rich-plasma/), [Post-traumatic growth: what people report, and what the measurement actually captures](https://onco.cc/technologies/rejuv-mind-post-traumatic-growth/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Rapamycin and mTOR inhibition for ageing](https://onco.cc/technologies/rejuv-frontier-rapamycin-ageing/), [Rebuilding the immune system after treatment](https://onco.cc/technologies/rejuv-frontier-immune-reconstitution/), [Senescent cells and p16 after chemotherapy](https://onco.cc/technologies/rejuv-age-senescent-cells-after-treatment/), [Senolytics after cancer treatment](https://onco.cc/technologies/rejuv-frontier-senolytics/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Stem cell clinics and stem cell tourism](https://onco.cc/technologies/rejuv-frontier-stem-cell-tourism/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Telomere length after treatment](https://onco.cc/technologies/rejuv-age-telomere-length/), [Unlicensed peptides sold for recovery](https://onco.cc/technologies/rejuv-frontier-unlicensed-peptides/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Stopping smoking](https://onco.cc/terms/smoking-cessation/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/)

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