ideasIdea
Treat wasting like sepsis: a trigger, a bundle, an audit
Hospitals have fast, standard responses to sepsis and heart attacks. Cancer wasting has no such pathway, so it is noticed late and treated inconsistently.
Cachexia care is fragmented across oncology, dietetics, physiotherapy and palliative care, with no trigger threshold and no bundle. A defined pathway — automatic trigger on weight loss or low muscle mass, same-week multidisciplinary assessment, a standard bundle of nutrition, resistance exercise, symptom control and medication review, and audited outcomes — is a service intervention that requires no new drug.
Hypothesis
A triggered cachexia bundle increases the proportion of at-risk patients receiving nutritional and exercise intervention from a minority to over 70%, and improves treatment completion and quality of life.
Rationale
Bundled care with automatic triggers transformed sepsis, stroke and hip fracture outcomes by reducing variation rather than adding technology. Cachexia has the same profile: known components, poor delivery.
What would test it
Stepped-wedge implementation across several centres with process measures and patient-reported outcomes, plus a cost analysis of avoided admissions.
Maturity
speculative
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
4
Bottlenecks it attacks
- Cachexia, toxicity and the limits of the patient · Patients often die of wasting or cannot tolerate the doses that would work. Treating the patient, not just the tumour, lags far behind.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.
- Pain relief and palliative care are unavailable to most · Most people who die of cancer worldwide do so without adequate pain relief.