Structured Exercise Program After Adjuvant Chemotherapy for Colon Cancer: A Cost-Utility Analysis of the CHALLENGE Trial
- Study type
- Clinical trial
- Study name
- CHALLENGE (CCTG CO.21)
- Design
- Prespecified economic evaluation (cost-utility analysis) based on prospectively collected data from the phase 3 randomised CHALLENGE trial
- Sample size
- 889 participants
- Source
- J Clin Oncol · 2026
In plain words
The CHALLENGE trial had shown that a structured 3-year exercise programme after surgery and chemotherapy improves survival in people with bowel cancer. This study looked at whether the programme is good value for money. It found that, despite the cost of running the programme, the total cost of care was lower in the exercise group, and patients had more years of life, and of better quality.
Key results
Treatment arms and regimens
No drug (the behavioural exercise intervention of the CHALLENGE trial). A 36-month personalised physical activity programme with a physical activity consultant, plus health education materials. The physical activity prescription was tailored to baseline fitness testing, activity history, performance status and patient preference (mostly walking; any activity of at least moderate intensity was acceptable).
- Phase 1 (first 6 months, intensive): 12 mandatory in-person behavioural support sessions every two weeks plus 12 mandatory supervised physical activity sessions (12 further supervised sessions in alternate weeks were recommended); target: an increase of 10 MET-hours per week over baseline.
- Phase 2 (months 6 to 12, reduced): 12 mandatory in-person or telephone behavioural support sessions every two weeks, with 12 recommended supervised sessions; target: an increase of 20 MET-hours per week.
- Phase 3 (months 12 to 36, minimal): mandatory monthly in-person or telephone behavioural support sessions with recommended supervised sessions; target: up to a total of 27 MET-hours per week.
The initial cost of delivering the programme was 2,917 Canadian dollars per participant.
No drug: general health education materials only, given once at the start of the study (the comparator group of the CHALLENGE trial).
Source of the regimen details: No drug; intervention content from ClinicalTrials.gov NCT00819208 (the parent CHALLENGE trial); programme cost from the abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Patients with stage 3 or high-risk stage 2 colon cancer who had completed surgery and adjuvant chemotherapy. Data from all trial participants (889) were used in the economic analysis.
Endpoints
Direct healthcare costs, life-years (LY) and quality-adjusted life-years (QALY) per participant. Measures calculated: incremental cost, incremental LY/QALY, incremental cost-effectiveness ratio (ICER, Canadian dollars per life-year gained) and incremental cost-utility ratio (Canadian dollars per QALY) where applicable. Uncertainty was assessed by bootstrapping (1,000 samples).
Safety and side effects
This paper is a cost-utility analysis and reports no new safety data; in the main CHALLENGE trial report, musculoskeletal adverse events were more frequent in the exercise group (18.5% vs 11.5%). The main cost drivers were cancer recurrence or a new malignancy and anticancer treatment.
Clinical significance and place in guidelines
Based on this analysis, the structured exercise programme was both less costly and more effective than health education materials from the perspective of the Canadian public payer. The authors consider this finding useful for payers and health systems in implementing such programmes in routine care. These results relate to the Canadian health system and 2024 costs. The status of clinical guideline recommendations and generalisability to other health systems should be checked separately.
Limitations
The abstract does not state limitations directly. The base-case scenario rests on the Canadian public payer perspective and 2024 Canadian dollar costs. SEP was dominant in only 53% of bootstrap samples. Utilities were mapped from SF-36 results rather than measured directly. See the full paper for further details.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.