Malnutrition and sarcopenia are prevalent amongst those undergoing cancer treatment; however, both are under-recognised and under-treated. The 2020 Clinical Oncology Society of Australia (COSA) position statement on cancer-related malnutrition and sarcopenia highlights the importance of establishing processes to improve screening, assessment, treatment, and multidisciplinary management of these conditions. Currently, there are no published reports on practice alignment with the recommendations, and understanding factors related to adherence is an important evidence gap. We aimed to determine adherence to the COSA position statement on cancer-related malnutrition and sarcopenia screening, assessment, and treatment to identify improvement opportunities in a regional Queensland oncology unit. A retrospective chart audit of 100 randomly selected adult patients (53% male; mean (SD) age 61.8 (1.3) years; 23% lung cancer) who commenced treatment in 2021 was conducted at time of diagnosis, cycle 1 (C1) of chemotherapy and/or immunotherapy, and 3 months following C1 (3M). Charts were audited against a data collection tool mapped to the COSA position statement recommendations. Gaps were highlighted at all steps of the malnutrition and sarcopenia management pathway. There was no screening, assessment, or treatment of sarcopenia. Malnutrition screening with a validated tool was significantly higher at C1 (diagnosis 26%, C1 73%, 3M 47%; p<.001). Referral to a dietitian varied (C1 27% and 44% for those with a high nutritional risk diagnosis). Nutrition assessment using a validated tool increased over time (diagnosis 40% vs 3M 71%). A multidisciplinary team was available at all points however no malnourished patients received allied health input apart from dietetics. This audit provides early data reporting adherence to the COSA position statement on cancer-related malnutrition and sarcopenia. It has identified evidence-practice gaps with the current management of these conditions, highlighted areas for further action, and contributes to the development of data describing malnutrition and sarcopenia management practices in regional facilities.