Missing Script · Evidence review
Exercise can sound like one more item on an already exhausting list. Finish treatment. Manage the side effects. Get back to work. And somehow find the energy to move more.
I think we owe people a more useful conversation than that. If we are going to talk about movement as part of cancer care, we should explain the evidence and make the support practical.
What changed with CHALLENGE?
The 2025 CHALLENGE randomized trial compared a three-year structured exercise program with health education after adjuvant chemotherapy for resected colon cancer. This was a specific setting: high-risk stage II or stage III disease after surgery and chemotherapy.
At five years, disease-free survival was 80.3% with the exercise program and 73.9% with education, a difference of 6.4 percentage points. This endpoint included recurrence, a new primary cancer or death. The results also supported longer overall survival.
Musculoskeletal adverse events were more common with exercise: 18.5% versus 11.5%. That matters. The intervention deserves attention, and it deserves a plan that accounts for the person doing it.
Support is part of the intervention
My takeaway is that we should take the program seriously. A supported intervention is different from handing someone a brochure and hoping they can make it work.
There are questions here about access. Who can help someone start? Where does that support happen? What if transportation, work or caregiving makes a formal program difficult? A result becomes more useful when we think about how people can actually receive the intervention that produced it.
What about other cancers?
We should keep the colon cancer survival finding attached to the population studied. It does not establish the same survival benefit in every cancer or at every stage.
There is a broader supportive-care conversation, though. ASCO’s exercise guideline recommends regular aerobic and resistance exercise during active treatment with curative intent. Its review found benefits for fatigue, fitness, strength and physical function. Those outcomes matter even when a survival claim is not established.
A better question for the next visit
Instead of stopping at “Should I exercise?”, I would start with: “What kind of movement is appropriate for where I am in treatment, and who can help me build a plan?”
Then ask how the plan should change with symptoms, what progress to track, and whether rehabilitation or an oncology exercise referral is available. The goal is a plan someone can return to, adjust and sustain.
For me, this is a central Missing Script question: when evidence supports care around treatment, how do we make that care part of the conversation?
Educational discussion. Review personal treatment and supplement decisions with your oncology team. Explore the article library → · Podcast: coming soon →
