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Exercise as Medicine for Preventing Colon Cancer Recurrence
While outcomes after surgery and adjuvant chemotherapy for stage II/III colon cancer are generally good, cancer still recurs in about 30% of patients, and quality of life and cardiorespiratory fitness are decreased. Structured exercise improves quality of life and cardiorespiratory outcomes, but conclusive data for cancer outcomes are lacking.
The randomized, phase 3 CHALLENGE trial included nearly 900 patients with high-risk stage II or III colon cancer after completion of adjuvant chemotherapy. Half the patients received a structured, behaviorally supported exercise program over 3 years; the other half received only health-education materials. The primary endpoint was disease-free survival.
Structured exercise notably improved several outcomes compared to education alone:
- 5-year disease-free survival was significantly higher (80.3% vs. 73.9%).
- 8-year overall survival was also significantly higher (90.3% vs. 83.2%).
- Cardiorespiratory fitness showed significantly greater improvement.
- Musculoskeletal adverse events were slightly more common (18.5% vs. 11.5%).
Comment
These are remarkable results: Sustained moderate to vigorous exercise didn't just improve quality of life and cardiorespiratory fitness, it yielded a 6–7% absolute improvement in long-term disease-free and overall survival for patients with stage II/III colon cancer — as good or better than adjuvant chemotherapy. The survival improvements were driven by fewer cancer deaths. In light of these results, we should urge our patients to join and consistently follow a structured, personalized exercise program, guided by a skilled trainer — and we must expand our infrastructure and insurance coverage paradigm to ensure everyone has equitable access to this lifesaving intervention.
Citation(s)
Author:
Courneya KS et al.
Title:
Structured exercise after adjuvant chemotherapy for colon cancer.
Source:
N Engl J Med
2025
Jul
3; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Suneel D. Kamath, MD
Empfohlen von
Vlad G. Zaha, MD, PhD, FACC, FAHA