Background: Despite recommendations within the COSA position statement on cancer-related malnutrition and sarcopenia, a model to guide clinical practice for sarcopenia is not currently available.
Aims: This study aimed to (1) develop an evidence-based care pathway for the multidisciplinary management of cancer-related sarcopenia (“sarc-pathway”) and (2) pilot test the feasibility (reach, intervention fidelity, patient and clinician acceptability) of the sarc-pathway in an inpatient cancer ward.
Methods: The sarc-pathway was developed using a care pathway format and informed by current literature. Patients admitted to a 32-bed inpatient cancer ward were recruited to receive care as described on the sarc-pathway and feasibility outcomes assessed. A pre-and-post adherence audit of clinical practice in regard to sarcopenia management was conducted against the 15 recommendations from the COSA Cancer-related malnutrition and sarcopenia position statement.
Results: Of 317 patients admitted to the ward, 160 were eligible during the 3.5-month pilot, of which 159 consented to sarc-pathway care [median (IQR) age 61 (49, 70) years; 56.0% males] with 30.2% considered at risk of (probable) sarcopenia/sarcopenia. The sarc-pathway components of screening, assessment and treatment were delivered as intended, however low completion of clinical assessment measures was seen for muscle mass (bioimpedance spectroscopy, 20.5%) and physical function (5-times chair stand, 50.0%). Patient and multidisciplinary clinician acceptability of the sarc-pathway was high and moderate, respectively. The implementation of the sarc-pathway improved the ability to meet clinical recommendations from the COSA position statement (2 of 15 pre-pilot and 15 of 15 post-pilot recommendations, respectively).
Conclusions: In an inpatient cancer ward, the sarc-pathway was a feasible and acceptable clinical model to deliver and adhere to the sarcopenia clinical parameters specified, albeit with further exploration of feasible clinical assessment measures. Future work will focus on evaluating the effectiveness of multi-modal interventions in clinical practice for cancer patients with or at risk of sarcopenia.