Developing a supportive care pathway for sarcopenia prevention in nasopharyngeal carcinoma: a context-sensitive and...

Patients with nasopharyngeal carcinoma (NPC) undergoing definitive treatment commonly experience muscle loss, nutritional deterioration, symptom burden, and functional decline, increasing sarcopenia risk. This study aimed to develop a context-sensitive supportive care pathway integrating multidisciplinary care strategies for sarcopenia prevention across the NPC treatment trajectory.

A multidisciplinary team (MDT) developed the pathway iteratively, guided by the updated Medical Research Council framework for complex interventions. Development integrated evidence synthesis, semi-structured interviews with healthcare professionals, programme theory, economic and resource considerations, contextual analysis, and informal consultations with patients and family caregivers. These inputs informed implementation requirements, professional roles, longitudinal care procedures, and core supportive care domains.

Evidence was most extensive for nutritional interventions; evidence for exercise and probiotic approaches was more limited and heterogeneous. Interviews with 21 healthcare professionals generated three themes comprising 11 subthemes, synthesised into four implementation requirements: recognition and professional competency; care organisation and MDT coordination; longitudinal monitoring and continuity of care; and patient self-management and family-supported care. Patient and caregiver consultations informed refinements to education, home-based self-management, and family involvement. The final pathway specified MDT roles, six longitudinal care procedures, and five integrated domains: nutritional and immune management, exercise management, head and neck symptom cluster management, gastrointestinal symptom cluster management, and psycho-behavioural support.

The resulting pathway provides a context-sensitive, implementation-informed structure for coordinating multidisciplinary sarcopenia prevention across the NPC treatment trajectory. It incorporates clinical workflow, resource considerations, and continuity of care, but its feasibility, implementation, and effectiveness require prospective evaluation.