Background and rationale
Cancer-related muscle loss affects 30-50% of people with cancer, leading to reduced capacity to tolerate treatment and contributing to worse survival. Currently there is no suitable screening tool, meaning people who would benefit from early intervention remain unrecognised. The EPICCS project, funded by the Medical Research Future Fund, is using an evidence-based stepwise approach to develop a validated short and simple screening tool for cancer-related muscle loss and integrate it into practice and policy.
Methods
Phase 1a (2024-2025) involved a Delphi survey of international experts to establish critical factors to include in a screening tool, operationalising these factors into questions and testing face validity with consumers and health professionals. Phase 1b (2025-2026) will determine the smallest set of questions with the highest sensitivity and specificity to detect low muscle mass. Phase 1c (2024-2025) will involve a series of workshops with stakeholders to co-design referral pathways to evidence-based care and inform implementation into practice. In Phase 2 (2026-2028), a stepped wedge cluster randomised trial will embed the screening tool and referral pathways into four specialist and rural cancer services and evaluate the impact on access to care, the workforce impact and cost-effectiveness. In Phase 3 (2027-2028) the screening tool will be embedded in national clinical guidelines.
Impact on practice
The EPICCS project is expected to transform care for cancer-related muscle loss through early identification and referral to evidence-based care. Our partnerships with rural and specialist health service partners will immediately impact clinical practice through implementation of screening and referral pathways in these health services. Partnerships with government and professional societies will support integration into policy and clinical guidelines.
Discussion
The EPICCS project will deliver the first tool designed for cancer-related sarcopenia screening globally, with substantial potential for national scalability leading to improved capacity for optimal cancer care.