ENACT-65

ENabling ACTion on Integrated Nutritional and Exercise Care in Cancer – for Patients 65 and Beyond

Older adults carry the greatest cancer burden in Europe, accounting for nearly two-thirds of new diagnoses and three-quarters of cancer deaths. Yet the majority do not receive systematic nutritional or Older adults carry the greatest cancer burden in Europe, accounting for nearly two-thirds of new diagnoses and three-quarters of cancer deaths. Yet the majority do not receive systematic nutritional or exercise support, despite clear evidence that malnutrition and frailty worsen survival, treatment tolerance and quality of life. This represents one of the most urgent and neglected gaps in oncology care.

ENACT-65 will be the first large-scale, pragmatic multicentre randomised trial to close this gap. Conducted across five European countries, it will recruit 394 patients aged 65+ with metastatic lung or colorectal cancer receiving systemic therapy. The intervention integrates two proven approaches: a digitally supported Nutritional Care Pathway (MyPath) and a six-month, live-remote supervised exercise programme. Together, these deliver systematic screening, AI-assisted personalised meal planning reviewed by dietitians, weekly monitoring and escalation of care, alongside structured resistance and aerobic training tailored to older adults.

With co-primary endpoints of overall survival and quality of life (EORTC QLQ-C30), ENACT-65 will also evaluate nutritional status, treatment tolerance, health economics and patient and caregiver experiences. By embedding supportive care directly into oncology workflows, the project will provide actionable clinical and policy evidence, scalable digital tools and training resources for adoption across Europe. ENACT-65 will set a new benchmark for age-inclusive, person-centred cancer care, delivering on the EU Cancer Mission and Europe’s Beating Cancer Plan by measurably improving survival and quality of life for the patients who need it most.

This project is currently in grant preparation with the European Commission.

This project contributes to the UN Sustainable Development Goals (SDGs) 3.

• Universitätsklinikum Freiburg (DE)
• Institut Gustave Roussy (FR)
• Universitair Medisch Centrum Utrecht (NL)
• Netherlands Cancer Institute (NL)
• Biogipuzkoa Health Research Institute (ES)
• DNV Imatis (NO)
• International Society of Geriatric Oncology (CH)