{"entity":{"id":"idea-rejuv-survivorship-platform-trial","kind":"idea","name":"Give survivorship interventions a shared control arm","aka":[],"tldr":"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.\n\nPlatform 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.\n\nThis 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.","asOf":"2026-10-02","links":[{"label":"ClinicalTrials.gov NCT04754672","url":"https://clinicaltrials.gov/study/NCT04754672"},{"label":"Courneya et al., Structured exercise after adjuvant chemotherapy for colon cancer, the CHALLENGE trial (NEJM 2025;393:13-25)","url":"https://doi.org/10.1056/NEJMoa2502760"}],"tags":["rejuvenation","survivorship","open-problem","trials"],"related":["rejuv-trial-amico","idea-rejuv-core-outcome-set-for-late-effects","idea-moon-supportive-care-arpa","rejuvenation-roadmap"],"cancers":[],"sections":["rejuvenation","supportive-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["rejuv-agenda-no-agreed-outcome-measures","rejuv-agenda-rehabilitation-not-commissioned","b-trial-design","b-funding-allocation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"large","horizonYears":8},"route":"/ideas/idea-rejuv-survivorship-platform-trial/","neighbours":{"trial":[{"id":"rejuv-trial-amico","kind":"trial","name":"AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer","route":"/trials/rejuv-trial-amico/"}],"idea":[{"id":"idea-rejuv-core-outcome-set-for-late-effects","kind":"idea","name":"Agree what to measure, so the next systematic review can pool rather than narrate","route":"/ideas/idea-rejuv-core-outcome-set-for-late-effects/"},{"id":"idea-moon-supportive-care-arpa","kind":"idea","name":"An ARPA-style programme to develop supportive-care drugs nobody else will","route":"/ideas/idea-moon-supportive-care-arpa/"}],"roadmap":[{"id":"rejuvenation-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/rejuvenation-roadmap/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"rejuv-agenda-rehabilitation-not-commissioned","kind":"bottleneck","name":"Rehabilitation is recommended everywhere and commissioned almost nowhere","route":"/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/"},{"id":"rejuv-agenda-no-agreed-outcome-measures","kind":"bottleneck","name":"The field cannot pool its own studies, because it has not agreed what to measure","route":"/bottlenecks/rejuv-agenda-no-agreed-outcome-measures/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}]}}