# Treat wasting like sepsis: a trigger, a bundle, an audit

Source: https://onco.cc/ideas/idea-bio2-cachexia-pathway-code/  
OnCo record `idea-bio2-cachexia-pathway-code` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Hospitals have fast, standard responses to sepsis and heart attacks. Cancer wasting has no such pathway, so it is noticed late and treated inconsistently.

## Summary

Cachexia care is fragmented across oncology, dietetics, physiotherapy and palliative care, with no trigger threshold and no bundle. A defined pathway is a service intervention that requires no new drug: 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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: Stepped-wedge implementation across several centres with process measures and patient-reported outcomes, plus a cost analysis of avoided admissions.
- Maturity: speculative
- Actor: clinic

## Sources

- Bottleneck evidence (Cachexia, toxicity and the limits of the patient): Fearon et al., Definition and classification of cancer cachexia (Lancet Oncology 2011): https://doi.org/10.1016/S1470-2045(10)70218-7

## Connected records

- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- people: [Nathan Cherny](https://onco.cc/people/nathan-cherny/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/)
- key papers: [Definition and classification of cancer cachexia: an international consensus](https://onco.cc/key-papers/paper-fearon-lancet-oncol/)
- ideas: [A dietitian in every gastrointestinal and head and neck tumour board](https://onco.cc/ideas/idea-nl-dietitian-in-every-mdt/)

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