Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Quality of life and fitness outcomes from the CCTG CO.21/CHALLENGE trial: structured exercise after adjuvant chemotherapy for colon cancer (146048)

Janette L Vardy 1 2 , Haryana M Dhillon 3 , Christopher Booth 4 , Kerry S Courneya 5 , Christopher J O'Callaghan 6 , Shahid Ahmed 7 , John Zalcberg 8 , Stephen J Clarke 1 , Sharlene Gill 9 , Christine Friedenreich 10 11 , Rebecca K S Wong 12 , Victoria Coyle 13 , Neil Chua 14 , Derek Jonker 15 , Philip J Beale 16 , Patricia A Tang 17 , Tony Bonaventura 18 , Ralph Wong 19 , Howard J Lim 20 21 , Matthew Burge 20 22 , Patti O'Brien 23 , Stacey Hubay 24 , Michael Santani 25 , Anthony Reiman 26 , Dongsheng Tu 6 , Michael Brundage 4
  1. University of Sydney, Concord, NSW, Australia
  2. Australian Research Centre for Cancer Survivorship , University of New South Wales, Sydney, NSW, Australia
  3. Faculty of Science, Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney, Australia
  4. Department of Oncology, Queen’s University, Kingston, ON, Canada
  5. Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Canada
  6. Canadian Cancer Trials Group, Queen’s University, ON, Canada
  7. Saskatoon Cancer Centre, Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon, Canada
  8. Dept. Medical Oncology, Alfred Health and School of Public Health, Faculty of Medicine,, Monash University, Melbourne, Australia
  9. BC Cancer, Vancouver, BC, Canada
  10. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
  11. Cancer Care Alberta, Calgary, Canada
  12. Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto
  13. Queen’s University Belfast, Belfast, UK
  14. Cross Cancer Institute, University of Alberta, Edmonton, Canada
  15. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
  16. Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
  17. Arthur J.E. Child Comprehensive Cancer Centre, University of Calgary , Calgary, Alberta, Canada
  18. Newcastle Private Hospital, New Lambton Heights, NSW
  19. CancerCare Manitoba, St Boniface General Hospital , Winnipeg, Canada
  20. Faculty of Medicine, University of British Columbia, Vancouver, Canada
  21. BC Cancer-Vancouver, Vancouver, Canada
  22. University of Queensland, Brisbane, Queensland, Australia
  23. Canadian Cancer Trials Group, Queens University, Kingston, Canada
  24. Department of Oncology, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
  25. Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
  26. Department of Oncology, Saint John Regional Hospital, School of Integrated Health, University of New Brunswick, Department of Medicine, Dalhousie University, Saint John, New Brunswick, Canada

Background
The phase III Canadian Cancer Trials Group CO.21/CHALLENGE trial, demonstrated a 3-year structured exercise program (SEP) led to significantly improved disease-free and overall survival compared to health education materials (HEM) alone after adjuvant chemotherapy for colon cancer. Here, we report quality-of-life (QOL) and objective fitness outcomes.

Methods
Six a priori key secondary endpoints related to QOL were SF-36 physical function and physical component scores, FACT-Fatigue (fatigue subscale and FACT-G), HADS depression subscale, and PSQI subjective sleep quality. Fitness outcomes included the 6 Senior Fitness Test (SFT) components. Analyses included cross-sectional analysis of mean changes from baseline, linear mixed modelling of central trends, comparisons of proportions of patients improved/worsened, and sensitivity analyses.

Results
445 participants were randomized to SEP; 444 to HEM alone. PRO completion rates: baseline >95%; 24-months >70%. Mean change scores from baseline showed significant between-arm differences at 6-months for all key PRO domains. Between-arm differences in SF-36 physical were sustained to 36-months. Generalised linear modelling confirmed a significant positive impact of the intervention for all 6 measures. Analysis of proportions improved/unchanged/worsened at each time-point: more SEP improved in physical functioning (59% vs 44%), and fewer worsened (20% vs 30%, p< 0.001). SEP participants had significantly greater improvement across all six SFT measures at most post-baseline assessments.

Conclusions
A structured exercise program improved survival and overall QOL, physical functioning, sleep quality and physical fitness, and reduced fatigue and depression in colon cancer patients after adjuvant chemotherapy. Benefits were observed early and sustained across many outcomes. Referral pathways to a structured exercise program should be standard of care for adjuvant colon cancer survivors.