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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.
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.
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.
Query for this technology: (TITLE:"exercise" OR ABSTRACT:"exercise" OR TITLE:"physical activity" OR ABSTRACT:"physical activity") AND (TITLE:"cancer survivors" OR ABSTRACT:"cancer survivors" OR TITLE:"survivorship" OR ABSTRACT:"survivorship") AND (randomized OR randomised OR survival). Results are unfiltered search hits about What actually works after treatment, not a curated reading list.
Shares Structured exercise programmes after curative treatment, Exercise during chemotherapy and radiotherapy, Prehabilitation before cancer surgery, Quality of life and the tags rejuvenation, survivorship.
Shares Cognitive behavioural therapy for insomnia (CBT-I), Structured exercise programmes after curative treatment, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship.
Shares Cognitive behavioural therapy for insomnia (CBT-I), Quality of life, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.