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The interventions with the best evidence after cancer are supervised exercise, psychological therapy and specialist rehabilitation. The commonest finding across this whole front is that the evidence exists and the service does not.
This is the gap that appears most often across the two hundred records on this front, and it is not a gap in knowledge. Structured exercise has randomised evidence of improved survival in colon cancer; cognitive behavioural therapy has randomised evidence for insomnia and for fatigue; decongestive therapy and supervised resistance training have evidence in lymphoedema; vocational rehabilitation has trial evidence for return to work. What they have in common is that each needs a salaried person to deliver it, and most services do not employ one.
The facets of this round recorded the same finding independently. On muscle: few services employ anyone to deliver supervised resistance training. On fatigue: behavioural treatments need weeks of effort and are poorly funded. On exercise: supervision helps for mood and is hard to fund. On bowel function after pelvic radiotherapy: referral pathways from oncology to gastroenterology rarely exist. On teeth after head and neck radiotherapy: lifelong specialist dental care is not reliably paid for in most health systems and the cost falls on the survivor. On psychological care: what is missing is not evidence but a commissioned route, and the mind facet calls that the single clearest finding of its facet. On fear of recurrence, the most reported unmet need in survivorship, OnCo could not find a health service anywhere that commissions a named service for it with a referral route.
England measured the scale of this once. Its 2013 national report found that 24 per cent of people were offered a written assessment and care plan, averaged across trusts, which is the least demanding component of the package it was recommending.
The structural reason is that none of these interventions is a product. There is no marketing authorisation to obtain, no company to lobby for a payment code, and no tariff that follows a person out of the oncology clinic. A drug with CHALLENGE's hazard ratio would be in every guideline and on every formulary within a year; an exercise programme with the same hazard ratio is in the guidelines and in almost no budgets.
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.
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.
Shares Give survivorship interventions a shared control arm, Structured exercise programmes after curative treatment, The exercise prescription after cancer: the dose the guidelines state, 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 and the tags rejuvenation, survivorship, open-problem.
Shares Vocational rehabilitation integrated into cancer care so survivors can return to work, Structured exercise programmes after curative treatment, The exercise prescription after cancer: the dose the guidelines state and the tags rejuvenation, survivorship, rehabilitation.
Shares The exercise prescription after cancer: the dose the guidelines state, Prehabilitation before cancer surgery and the tags rejuvenation, survivorship, rehabilitation.
Shares The exercise prescription after cancer: the dose the guidelines state, Prehabilitation before cancer surgery and the tags rejuvenation, survivorship, rehabilitation.
Shares Vocational rehabilitation integrated into cancer care so survivors can return to work, The exercise prescription after cancer: the dose the guidelines state and the tags rejuvenation, survivorship, rehabilitation.
Shares Vocational rehabilitation integrated into cancer care so survivors can return to work and the tags rejuvenation, survivorship, rehabilitation.
Shares Bowel function after pelvic radiotherapy and the tags rejuvenation, survivorship, rehabilitation.
Shares Vocational rehabilitation integrated into cancer care so survivors can return to work and the tags rejuvenation, survivorship, rehabilitation.