# Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards

Source: https://onco.cc/roadmaps/survivorship-roadmap/  
OnCo record `survivorship-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Supportive care began as the drugs that let people get through chemotherapy. It is now a discipline with randomised proof that exercise, early palliative care and symptom monitoring lengthen life, and its next task is organised lifelong care for the growing population of people living after cancer.

## Summary

Modern chemotherapy was made deliverable by supportive care: 5-HT3 antiemetics, growth factors that prevent febrile neutropenia, implanted ports and structured pain management. The second phase recognised what cure costs. The Childhood Cancer Survivor Study, running since 1994, catalogued heart damage, infertility, second cancers and cognitive effects decades after treatment, and cardio-oncology, oncofertility and survivorship care plans grew out of it.

The third phase, now under way, is evidence that supportive interventions change hard outcomes. Early integrated palliative care, electronic symptom monitoring and geriatric assessment have each improved survival or reduced toxicity in randomised trials, and in 2025 the CHALLENGE trial showed that a coached exercise programme after colon cancer treatment reduces recurrence and death. Cheap fixes with strong evidence (scalp cooling, low-dose olanzapine, sodium thiosulfate for cisplatin hearing loss) are spreading unevenly. Cachexia, which has never had an approved drug in most countries, has its first candidate in GDF-15 blockade.

The pace is set by funding and organisation rather than science: survivorship research has no industry sponsor, late effects are not systematically recorded, and follow-up is delivered by whoever has capacity rather than by risk.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-10

## Sources

- CHALLENGE trial (NEJM 2025): https://www.nejm.org/doi/full/10.1056/NEJMoa2502760
- Childhood Cancer Survivor Study: https://ccss.stjude.org
- COG Long-Term Follow-Up Guidelines: http://www.survivorshipguidelines.org

## Connected records

- ideas: [A dedicated programme for cachexia and treatment toxicity research](https://onco.cc/ideas/idea-fund-cachexia-programme/), [A dose-finding trial for exercise after cancer](https://onco.cc/ideas/idea-nl-exercise-dose-finding/), [A lifelong late-effects registry linked to every treatment for adult survivors](https://onco.cc/ideas/idea-moon-adult-late-effects-registry/), [A national late-effects registry linking treatment exposures to outcomes decades later](https://onco.cc/ideas/idea-acc-national-late-effects-registry/), [A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compression](https://onco.cc/ideas/idea-moon-neuropathy-prevention-programme/), [A risk-stratified cardio-oncology pathway for everyone receiving heart-toxic cancer therapy](https://onco.cc/ideas/idea-acc-risk-stratified-cardio-oncology-pathway/), [A survivor biobank to find who will develop late effects before they do](https://onco.cc/ideas/idea-acc-survivor-biobank-late-effect-prediction/), [A survivorship research endowment funded by a levy on curative therapy prices](https://onco.cc/ideas/idea-fund-survivorship-endowment-levy/), [An ARPA-style programme to develop supportive-care drugs nobody else will](https://onco.cc/ideas/idea-moon-supportive-care-arpa/), [An open commons of patient-reported outcome data from cancer trials](https://onco.cc/ideas/idea-moon-open-pro-data-commons/), [Automatic palliative care referral triggered by diagnosis, not by decline](https://onco.cc/ideas/idea-acc-automatic-early-palliative-triggers/), [Biomarker-guided cardioprotection for everyone on cardiotoxic cancer therapy](https://onco.cc/ideas/idea-moon-cardioprotection-by-default/), [Embed cachexia treatment in chemotherapy trials: weight, muscle and treatment delivery as co-primary endpoints](https://onco.cc/ideas/idea-pdac-cachexia-trials-embedded-in-chemotherapy-trials/), [Fertility preservation offered and funded by default before gonadotoxic treatment](https://onco.cc/ideas/idea-moon-fertility-preservation-default/), [Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug](https://onco.cc/ideas/idea-crc-exercise-as-a-funded-treatment/), [Geriatric assessment by default for every patient over 70 starting cancer treatment](https://onco.cc/ideas/idea-acc-geriatric-assessment-by-default/), [Nurse-led follow-up clinics for survivors, freeing oncologists for active treatment](https://onco.cc/ideas/idea-acc-nurse-led-follow-up-clinics/), [Paid survivor peer-navigators as a recognised health workforce role](https://onco.cc/ideas/idea-moon-peer-navigator-workforce/), [Patient-reported side-effects (PRO-CTCAE) collected and published in every registrational trial](https://onco.cc/ideas/idea-moon-pro-ctcae-in-every-pivotal-trial/), [Prospective arm-volume surveillance to catch and reverse lymphoedema early](https://onco.cc/ideas/idea-acc-lymphoedema-prospective-surveillance/), [Qualify a physical function endpoint so anti-wasting drugs can be approved](https://onco.cc/ideas/idea-bio2-cachexia-function-endpoint/), [Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity](https://onco.cc/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/), [Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry](https://onco.cc/ideas/idea-acc-risk-stratified-follow-up/), [Risk-stratified lifelong care for tens of millions of survivors, automated and shared with primary care](https://onco.cc/ideas/idea-moon-survivor-lifelong-care-model/), [Screen every cancer patient for financial toxicity as a vital sign, with navigation](https://onco.cc/ideas/idea-reg-financial-toxicity-vital-sign/), [Survivorship care plans generated automatically from the treatment record](https://onco.cc/ideas/idea-acc-auto-generated-survivorship-plans/), [Tailored screening for second cancers in survivors with known high-risk exposures](https://onco.cc/ideas/idea-acc-tailored-second-cancer-screening/), [Treat cachexia as a disease: GDF-15 blockade plus anabolic and nutrition bundles](https://onco.cc/ideas/idea-moon-cachexia-as-treatable-disease/), [Vocational rehabilitation integrated into cancer care so survivors can return to work](https://onco.cc/ideas/idea-acc-return-to-work-rehabilitation/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first](https://onco.cc/roadmaps/paediatric-oncology-roadmap/), [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/), [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](https://onco.cc/roadmaps/rejuvenation-roadmap/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine](https://onco.cc/technologies/cachexia-appetite-pharmacotherapy/), [Cachexia-directed therapy (GDF-15 blockade)](https://onco.cc/technologies/cachexia-therapy/), [Cancer pain management](https://onco.cc/technologies/pain-management/), [Cancer-associated thrombosis prevention and treatment](https://onco.cc/technologies/cancer-associated-thrombosis/), [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/), [Cognitive behavioural therapy for insomnia (CBT-I)](https://onco.cc/technologies/cbt-insomnia-cancer/), [Compression, decongestive therapy and exercise for lymphoedema](https://onco.cc/technologies/lymphoedema-decongestive-therapy/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Electronic patient-reported outcomes and remote monitoring](https://onco.cc/technologies/remote-patient-monitoring/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/), [Growth factors: G-CSF and febrile neutropenia prevention](https://onco.cc/technologies/g-csf-growth-factors/), [Hospice and end-of-life care](https://onco.cc/technologies/hospice-end-of-life/), [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/), [Late deaths after childhood cancer, what causes them, and the proof that gentler treatment worked](https://onco.cc/technologies/rejuv-paed-late-mortality/), [Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss](https://onco.cc/technologies/minoxidil-chemotherapy-alopecia/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Resistance training and protein for cachexia and sarcopenia](https://onco.cc/technologies/resistance-training-cachexia/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- drugs: [Dexrazoxane](https://onco.cc/drugs/dexrazoxane/), [Sodium thiosulfate (otoprotectant)](https://onco.cc/drugs/sodium-thiosulfate/)
- trials: [CHALLENGE (CCTG CO.21)](https://onco.cc/trials/challenge/), [Childhood Cancer Survivor Study (CCSS)](https://onco.cc/trials/ccss/), [Low-dose olanzapine for cancer anorexia (Tata Memorial)](https://onco.cc/trials/olanzapine-appetite-tmh/), [Ponsegromab phase 2 in cancer cachexia](https://onco.cc/trials/ponsegromab-phase-2/), [PREHAB: multimodal prehabilitation before colorectal cancer surgery](https://onco.cc/trials/prehab-trial/), [ROMANA 1 and ROMANA 2](https://onco.cc/trials/romana-1-2/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [Journal of cancer survivorship](https://onco.cc/journals/journal-of-cancer-survivorship/)
- key papers: [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/), [Ponsegromab for the Treatment of Cancer Cachexia](https://onco.cc/key-papers/paper-groarke-ponsegromab-cancer-cachexia-nejm-2024/)

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JSON: https://onco.cc/api/v1/entities/survivorship-roadmap.json