Malnutrition and sarcopenia in cancer care - clinical fact sheet and MCQ

Cancer-related malnutrition affects up to 40% of people with cancer, and sarcopenia (loss of muscle mass and strength) up to 60%, depending on tumour type – yet almost half of these patients are not under dietetic care (1).

Both conditions can occur at any body mass index, including in patients who are overweight or obese, and are associated with reduced treatment tolerance, poorer survival, lower quality of life and higher health costs.

Recommendations for malnutrition/sarcopenia screening in general practice

All patients with cancer should be screened for malnutrition and sarcopenia at diagnosis, and re-screened whenever the clinical situation changes, such as

• commencement of a new treatment

• disease progression

• new symptoms suggestive of recurrence

Patients with cancer diagnoses or treatment plans known to carry a high risk of malnutrition may be referred directly for comprehensive assessment rather than undergoing formal screening first.

Patients at higher risk of malnutrition

Screening tools

The following malnutrition screening tools have been shown to be valid and reliable for identifying malnutrition and sarcopenia in people with cancer (2).

An 'at risk' result on either tool warrants referral for comprehensive assessment.

When and where to refer for assessment

GPs should consider referral regardless of weight/BMI when patients have:

• a positive malnutrition or sarcopenia screening result

• a cancer diagnosis or treatment plan associated with a higher risk of malnutrition

• unintentional weight loss, reduced food intake or swallowing difficulties

• declining muscle strength, physical function or mobility

• concerns about nutritional status from the patient, carer or treating team

Malnutrition: refer to an accredited practising dietitian (APD) for comprehensive assessment using validated tools such as the Patient-generated subjective global assessment or Subjective global assessment.  

Diagnosis is commonly aligned with the Global Leadership Initiative on Malnutrition (GLIM) criteria which require:

• at least one phenotypic criterion (weight loss, low BMI or reduced muscle mass,

• and at least one aetiologic criterion (reduced intake/absorption or inflammation

Sarcopenia: refer to a dietitian and an exercise physiologist or physiotherapist experienced in oncology for combined assessment of:

• muscle mass

• muscle strength

• physical performance

Assessment methods may include handgrip strength, chair-stand test, gait speed, or CT-derived skeletal muscle index (where imaging is already available).

There is currently no single universally accepted definition of sarcopenia, and cut points vary between assessment tools, populations and ethnic groups. Results should therefore be interpreted within the broader clinical context.

Core treatment principles

Nutrition 

• Individualised medical nutrition therapy from an APD.

• General targets are roughly 105–125 kJ/kg/day energy and 1.0–1.5 g/kg/day protein.

• Higher protein intakes and adjunct nutrients (leucine/HMB, vitamin D, omega-3 fatty acids) are under assessment for muscle preservation but are not yet standard practice.
  

Exercise

An individualised, multimodal supervised program combining:

• resistance training (2–3 sessions/week, major muscle groups) with

• aerobic exercise (about 150 minutes/week, moderate–vigorous intensity) and

• balance exercise

Symptom control

Proactively manage:

• anorexia: encourage small, frequent, high-energy and high-protein meals

• nausea and vomiting: optimise antiemetic therapy and address reversible causes

• mucositis and oral discomfort: promote good oral care and consider texture modification, analgesia and supportive mouth care measures

• dysphagia: assess swallowing difficulties promptly and refer where appropriate

• constipation: address contributing factors, particularly medications and reduced activity

• pain: optimise pain management

Psychosocial support

• Screen for distress, anxiety or depression that may affect eating and engagement with exercise, and refer to psychology or social work where indicated.

The GP's role in the multidisciplinary team

• Screen for malnutrition and sarcopenia at diagnosis and opportunistically during shared care:
  

  • treat unplanned weight loss, new swallowing difficulty or declining strength as triggers for re-screening.

• Facilitate timely referral to dietetics, exercise physiology/physiotherapy and other allied health as needed:
  

  • use local public or private services or telehealth where access is limited,

  • and consider use of chronic care management plans to facilitate Medicare rebates for patients.

• Reinforce the agreed nutrition and exercise plan, and monitor weight and function between specialist reviews.

• Consider early referral for both prehabilitation (both diet and exercise support) soon after diagnosis, particularly before major cancer surgery, and for rehabilitation during or after treatment.

• Maintain communication with the treating team so advice remains consistent.

• Involve carers and family in supporting intake and activity.

References

1. Clinical Oncology Society of Australia. Position statement: cancer-related malnutrition and sarcopenia. 2020. Available at: cosa-position-statement-malnutrition-and-sarcopenia-140820.pdf.

2. Clinical Oncology Society of Australia. Cancer-related malnutrition and sarcopenia implementation toolkit. 2026. Available at: https://cancermalnutritionandsarcopenia.org.au/. (last accessed Sept 2026).

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