{"entity":{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","aka":[],"tldr":"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.\n\nThe 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.\n\nThe 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.","asOf":"2026-09-10","links":[{"label":"CHALLENGE trial (NEJM 2025)","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa2502760"},{"label":"Childhood Cancer Survivor Study","url":"https://ccss.stjude.org"},{"label":"COG Long-Term Follow-Up Guidelines","url":"http://www.survivorshipguidelines.org"}],"tags":[],"related":["idea-acc-risk-stratified-follow-up","idea-acc-auto-generated-survivorship-plans","idea-acc-national-late-effects-registry","idea-moon-adult-late-effects-registry","idea-acc-tailored-second-cancer-screening","idea-acc-risk-stratified-cardio-oncology-pathway","idea-moon-cardioprotection-by-default","idea-reg-financial-toxicity-vital-sign","idea-acc-return-to-work-rehabilitation","idea-acc-nurse-led-follow-up-clinics","idea-moon-fertility-preservation-default","idea-acc-lymphoedema-prospective-surveillance","idea-bio2-cachexia-function-endpoint","idea-moon-cachexia-as-treatable-disease","idea-acc-survivor-biobank-late-effect-prediction","idea-moon-open-pro-data-commons","idea-nl-exercise-dose-finding","idea-moon-neuropathy-prevention-programme","idea-moon-pro-ctcae-in-every-pivotal-trial","idea-moon-supportive-care-arpa","idea-fund-survivorship-endowment-levy","idea-fund-cachexia-programme","idea-acc-automatic-early-palliative-triggers","idea-acc-geriatric-assessment-by-default","idea-moon-survivor-lifelong-care-model","idea-moon-peer-navigator-workforce","nutrition-lifestyle-roadmap","prostate-roadmap","idea-prostate-other-cause-mortality-as-a-reported-service-outcome"],"cancers":[],"sections":["supportive-care","rejuvenation"],"technologies":["g-csf-growth-factors","infusion-devices-vascular-access","pain-management","hospice-end-of-life","palliative-care","remote-patient-monitoring","geriatric-assessment","cardio-oncology","fertility-preservation","survivorship-care-plan","exercise-oncology","structured-exercise-survivorship","prehabilitation","psycho-oncology","scalp-cooling","integrative-oncology","cbt-insomnia-cancer","lymphoedema-decongestive-therapy","cachexia-therapy","cachexia-appetite-pharmacotherapy","resistance-training-cachexia","oncology-nutrition","cancer-associated-thrombosis","minoxidil-chemotherapy-alopecia"],"targets":[],"drugs":["sodium-thiosulfate","dexrazoxane"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["ccss","challenge","prehab-trial","olanzapine-appetite-tmh","ponsegromab-phase-2","romana-1-2"],"people":[],"bottlenecks":["b-survivorship","b-cachexia-supportive","b-toxicity-qol","b-aging-comorbidity","b-palliative","b-funding-allocation"],"keyPapers":[],"journals":["journal-of-cancer-survivorship"],"dependsOn":[],"notes":[],"steps":[{"era":"1970s-1990s","title":"Making chemotherapy deliverable","description":"Curative regimens depended on drugs and devices that never made a headline: 5-HT3 antiemetics replaced days of vomiting, G-CSF let full doses be given on schedule by preventing febrile neutropenia, implanted ports and ambulatory pumps moved infusions out of hospital, and the WHO analgesic ladder made cancer pain a treatable problem. Hospice and palliative medicine became specialties in the same years.","refs":["g-csf-growth-factors","infusion-devices-vascular-access","pain-management","hospice-end-of-life","cancer-associated-thrombosis"],"status":"historic"},{"era":"1994-2016","title":"Counting the cost of cure","description":"The Childhood Cancer Survivor Study, following tens of thousands of people cured as children, showed that anthracyclines, chest radiation and alkylators leave heart failure, second cancers and infertility decades later, and produced the first risk-based follow-up guidelines. Cardio-oncology, oncofertility and survivorship care plans grew from this evidence; dexrazoxane was shown to protect the heart from anthracyclines.","refs":["ccss","survivorship-care-plan","cardio-oncology","dexrazoxane","fertility-preservation","idea-moon-fertility-preservation-default"],"status":"historic"},{"era":"2010-2026","title":"Supportive care that lengthens life","description":"Randomised trials moved supportive care from kindness to treatment. Early integrated palliative care improved quality of life and, in some trials, survival; weekly electronic symptom reporting with nurse response reduced emergency visits and extended survival; geriatric assessment before chemotherapy cut severe toxicity in older patients. In 2025 CHALLENGE showed that a three-year coached exercise programme after colon cancer treatment reduces recurrence and improves survival, and PREHAB showed that four weeks of training before colorectal surgery cuts complications.","refs":["palliative-care","remote-patient-monitoring","geriatric-assessment","challenge","exercise-oncology","structured-exercise-survivorship","prehabilitation","prehab-trial","psycho-oncology","idea-acc-geriatric-assessment-by-default","idea-acc-automatic-early-palliative-triggers"],"status":"current"},{"era":"2015-2026","title":"Cheap fixes with strong evidence","description":"Scalp cooling preserves hair through chemotherapy, sodium thiosulfate halves permanent hearing loss from cisplatin in children, a 2.5 mg dose of olanzapine restores appetite and weight for pennies (Tata Memorial), acupuncture eases hot flushes and aromatase inhibitor joint pain, cognitive behavioural therapy treats the insomnia that persists for years, and compression and exercise reverse early lymphoedema. Each is proven; none is universally offered.","refs":["scalp-cooling","sodium-thiosulfate","olanzapine-appetite-tmh","integrative-oncology","cbt-insomnia-cancer","lymphoedema-decongestive-therapy","minoxidil-chemotherapy-alopecia","idea-acc-lymphoedema-prospective-surveillance"],"status":"current"},{"era":"2026-2029","title":"Cachexia gets a drug","description":"Wasting kills many patients with advanced cancer and stops many more from tolerating treatment, and no drug has been approved for it in most of the world. Ponsegromab, an antibody that blocks GDF-15, the hormone that drives much of the wasting, improved weight and activity in phase 2; anamorelin is licensed only in Japan; resistance training and protein remain the only widely available intervention. A physical-function endpoint that regulators accept is the gating step for approval.","refs":["cachexia-therapy","ponsegromab-phase-2","cachexia-appetite-pharmacotherapy","romana-1-2","resistance-training-cachexia","oncology-nutrition","idea-bio2-cachexia-function-endpoint","idea-moon-cachexia-as-treatable-disease","idea-fund-cachexia-programme"],"status":"emerging"},{"era":"2026-2030","title":"Survivorship as a system, not a leaflet","description":"Tens of millions of people live after cancer, and follow-up is still organised by habit. The system being built: risk-stratified follow-up with low-risk survivors in primary care and fast re-entry, survivorship plans generated automatically from the treatment record, late-effects registries that link exposures to outcomes decades later, biomarker-guided cardioprotection for everyone on cardiotoxic therapy, screening for financial toxicity as a vital sign, and vocational rehabilitation so people can return to work.","refs":["idea-acc-risk-stratified-follow-up","idea-acc-nurse-led-follow-up-clinics","idea-acc-auto-generated-survivorship-plans","idea-acc-national-late-effects-registry","idea-moon-adult-late-effects-registry","idea-acc-risk-stratified-cardio-oncology-pathway","idea-moon-cardioprotection-by-default","idea-acc-tailored-second-cancer-screening","idea-reg-financial-toxicity-vital-sign","idea-acc-return-to-work-rehabilitation","idea-moon-survivor-lifelong-care-model","idea-moon-peer-navigator-workforce"],"status":"emerging"},{"era":"2030+","title":"Predicting late effects before they happen","description":"A survivor biobank could show who will develop heart failure or a second cancer before they do; an open commons of patient-reported outcome data from trials would let side-effects be compared across drugs the way efficacy is; exercise could be dosed like a drug once dose-finding trials exist; and chemotherapy-induced neuropathy, still without a proven prevention, has candidates in SARM1 inhibitors and limb cooling. An ARPA-style programme for supportive-care drugs that no company will develop is the funding proposal that would make most of this happen.","refs":["idea-acc-survivor-biobank-late-effect-prediction","idea-moon-open-pro-data-commons","idea-nl-exercise-dose-finding","idea-moon-neuropathy-prevention-programme","idea-moon-pro-ctcae-in-every-pivotal-trial","idea-moon-supportive-care-arpa"],"status":"speculative"},{"era":"What sets the pace","title":"No sponsor, no registry, no organiser","description":"Supportive care has no patent to protect, so its trials are publicly funded or not run. Late effects are not systematically recorded, so their scale is estimated rather than known. Toxicity and quality of life are measured less rigorously than survival in registrational trials. And most people who die of cancer worldwide do so without adequate pain relief. A survivorship research endowment funded by a levy on curative therapies is one proposal to fix the first problem.","refs":["b-survivorship","b-cachexia-supportive","b-toxicity-qol","b-aging-comorbidity","b-palliative","b-funding-allocation","idea-fund-survivorship-endowment-levy"],"status":"current"}],"watch":[]},"route":"/roadmaps/survivorship-roadmap/","neighbours":{"idea":[{"id":"idea-fund-cachexia-programme","kind":"idea","name":"A dedicated programme for cachexia and treatment toxicity research","route":"/ideas/idea-fund-cachexia-programme/"},{"id":"idea-nl-exercise-dose-finding","kind":"idea","name":"A dose-finding trial for exercise after cancer","route":"/ideas/idea-nl-exercise-dose-finding/"},{"id":"idea-moon-adult-late-effects-registry","kind":"idea","name":"A lifelong late-effects registry linked to every treatment for adult survivors","route":"/ideas/idea-moon-adult-late-effects-registry/"},{"id":"idea-acc-national-late-effects-registry","kind":"idea","name":"A national late-effects registry linking treatment exposures to outcomes decades later","route":"/ideas/idea-acc-national-late-effects-registry/"},{"id":"idea-moon-neuropathy-prevention-programme","kind":"idea","name":"A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compression","route":"/ideas/idea-moon-neuropathy-prevention-programme/"},{"id":"idea-acc-risk-stratified-cardio-oncology-pathway","kind":"idea","name":"A risk-stratified cardio-oncology pathway for everyone receiving heart-toxic cancer therapy","route":"/ideas/idea-acc-risk-stratified-cardio-oncology-pathway/"},{"id":"idea-acc-survivor-biobank-late-effect-prediction","kind":"idea","name":"A survivor biobank to find who will develop late effects before they do","route":"/ideas/idea-acc-survivor-biobank-late-effect-prediction/"},{"id":"idea-fund-survivorship-endowment-levy","kind":"idea","name":"A survivorship research endowment funded by a levy on curative therapy prices","route":"/ideas/idea-fund-survivorship-endowment-levy/"},{"id":"idea-moon-supportive-care-arpa","kind":"idea","name":"An ARPA-style programme to develop supportive-care drugs nobody else will","route":"/ideas/idea-moon-supportive-care-arpa/"},{"id":"idea-moon-open-pro-data-commons","kind":"idea","name":"An open commons of patient-reported outcome data from cancer trials","route":"/ideas/idea-moon-open-pro-data-commons/"},{"id":"idea-acc-automatic-early-palliative-triggers","kind":"idea","name":"Automatic palliative care referral triggered by diagnosis, not by decline","route":"/ideas/idea-acc-automatic-early-palliative-triggers/"},{"id":"idea-moon-cardioprotection-by-default","kind":"idea","name":"Biomarker-guided cardioprotection for everyone on cardiotoxic cancer therapy","route":"/ideas/idea-moon-cardioprotection-by-default/"},{"id":"idea-pdac-cachexia-trials-embedded-in-chemotherapy-trials","kind":"idea","name":"Embed cachexia treatment in chemotherapy trials: weight, muscle and treatment delivery as co-primary endpoints","route":"/ideas/idea-pdac-cachexia-trials-embedded-in-chemotherapy-trials/"},{"id":"idea-moon-fertility-preservation-default","kind":"idea","name":"Fertility preservation offered and funded by default before gonadotoxic treatment","route":"/ideas/idea-moon-fertility-preservation-default/"},{"id":"idea-crc-exercise-as-a-funded-treatment","kind":"idea","name":"Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug","route":"/ideas/idea-crc-exercise-as-a-funded-treatment/"},{"id":"idea-acc-geriatric-assessment-by-default","kind":"idea","name":"Geriatric assessment by default for every patient over 70 starting cancer treatment","route":"/ideas/idea-acc-geriatric-assessment-by-default/"},{"id":"idea-acc-nurse-led-follow-up-clinics","kind":"idea","name":"Nurse-led follow-up clinics for survivors, freeing oncologists for active treatment","route":"/ideas/idea-acc-nurse-led-follow-up-clinics/"},{"id":"idea-moon-peer-navigator-workforce","kind":"idea","name":"Paid survivor peer-navigators as a recognised health workforce role","route":"/ideas/idea-moon-peer-navigator-workforce/"},{"id":"idea-moon-pro-ctcae-in-every-pivotal-trial","kind":"idea","name":"Patient-reported side-effects (PRO-CTCAE) collected and published in every registrational trial","route":"/ideas/idea-moon-pro-ctcae-in-every-pivotal-trial/"},{"id":"idea-acc-lymphoedema-prospective-surveillance","kind":"idea","name":"Prospective arm-volume surveillance to catch and reverse lymphoedema early","route":"/ideas/idea-acc-lymphoedema-prospective-surveillance/"},{"id":"idea-bio2-cachexia-function-endpoint","kind":"idea","name":"Qualify a physical function endpoint so anti-wasting drugs can be approved","route":"/ideas/idea-bio2-cachexia-function-endpoint/"},{"id":"idea-prostate-other-cause-mortality-as-a-reported-service-outcome","kind":"idea","name":"Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity","route":"/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/"},{"id":"idea-acc-risk-stratified-follow-up","kind":"idea","name":"Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry","route":"/ideas/idea-acc-risk-stratified-follow-up/"},{"id":"idea-moon-survivor-lifelong-care-model","kind":"idea","name":"Risk-stratified lifelong care for tens of millions of survivors, automated and shared with primary care","route":"/ideas/idea-moon-survivor-lifelong-care-model/"},{"id":"idea-reg-financial-toxicity-vital-sign","kind":"idea","name":"Screen every cancer patient for financial toxicity as a vital sign, with navigation","route":"/ideas/idea-reg-financial-toxicity-vital-sign/"},{"id":"idea-acc-auto-generated-survivorship-plans","kind":"idea","name":"Survivorship care plans generated automatically from the treatment record","route":"/ideas/idea-acc-auto-generated-survivorship-plans/"},{"id":"idea-acc-tailored-second-cancer-screening","kind":"idea","name":"Tailored screening for second cancers in survivors with known high-risk exposures","route":"/ideas/idea-acc-tailored-second-cancer-screening/"},{"id":"idea-moon-cachexia-as-treatable-disease","kind":"idea","name":"Treat cachexia as a disease: GDF-15 blockade plus anabolic and nutrition bundles","route":"/ideas/idea-moon-cachexia-as-treatable-disease/"},{"id":"idea-acc-return-to-work-rehabilitation","kind":"idea","name":"Vocational rehabilitation integrated into cancer care so survivors can return to work","route":"/ideas/idea-acc-return-to-work-rehabilitation/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"},{"id":"paediatric-oncology-roadmap","kind":"roadmap","name":"Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first","route":"/roadmaps/paediatric-oncology-roadmap/"},{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"},{"id":"prostate-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/prostate-roadmap/"},{"id":"rejuvenation-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/rejuvenation-roadmap/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"cachexia-appetite-pharmacotherapy","kind":"technology","name":"Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine","route":"/technologies/cachexia-appetite-pharmacotherapy/"},{"id":"cachexia-therapy","kind":"technology","name":"Cachexia-directed therapy (GDF-15 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ports, and ambulatory chemotherapy devices","route":"/technologies/infusion-devices-vascular-access/"},{"id":"rejuv-paed-late-mortality","kind":"technology","name":"Late deaths after childhood cancer, what causes them, and the proof that gentler treatment worked","route":"/technologies/rejuv-paed-late-mortality/"},{"id":"minoxidil-chemotherapy-alopecia","kind":"technology","name":"Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss","route":"/technologies/minoxidil-chemotherapy-alopecia/"},{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"fertility-preservation","kind":"technology","name":"Oncofertility and fertility preservation","route":"/technologies/fertility-preservation/"},{"id":"prehabilitation","kind":"technology","name":"Prehabilitation before cancer 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thiosulfate (otoprotectant)","route":"/drugs/sodium-thiosulfate/"}],"trial":[{"id":"challenge","kind":"trial","name":"CHALLENGE (CCTG CO.21)","route":"/trials/challenge/"},{"id":"ccss","kind":"trial","name":"Childhood Cancer Survivor Study (CCSS)","route":"/trials/ccss/"},{"id":"olanzapine-appetite-tmh","kind":"trial","name":"Low-dose olanzapine for cancer anorexia (Tata Memorial)","route":"/trials/olanzapine-appetite-tmh/"},{"id":"ponsegromab-phase-2","kind":"trial","name":"Ponsegromab phase 2 in cancer cachexia","route":"/trials/ponsegromab-phase-2/"},{"id":"prehab-trial","kind":"trial","name":"PREHAB: multimodal prehabilitation before colorectal cancer surgery","route":"/trials/prehab-trial/"},{"id":"romana-1-2","kind":"trial","name":"ROMANA 1 and ROMANA 2","route":"/trials/romana-1-2/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the 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survivorship","route":"/journals/journal-of-cancer-survivorship/"}],"paper":[{"id":"paper-challenge-exercise-nejm-2025","kind":"paper","name":"CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer","route":"/key-papers/paper-challenge-exercise-nejm-2025/"},{"id":"paper-groarke-ponsegromab-cancer-cachexia-nejm-2024","kind":"paper","name":"Ponsegromab for the Treatment of Cancer Cachexia","route":"/key-papers/paper-groarke-ponsegromab-cancer-cachexia-nejm-2024/"}]}}