Aims
To develop and evaluate a multidimensional risk-stratification model incorporating physical function, skeletal muscle health, and behavioural capability to identify patients at risk of decline during chemotherapy and enable personalised, targeted intervention.
Methods
The Physical Activity during Chemotherapy to Enhance Recovery (PACER) pathway was implemented within a tertiary cancer centre. Patients commencing intravenous chemotherapy underwent baseline and monthly screening including SARC-F, Five Times Sit-to-Stand (5xSTS), bioimpedance spectroscopy (BIS) to assess skeletal muscle mass (SMM), and the Cancer Behavioural Index-Brief (CBI-B) to assess behavioural capability related to physical activity and health behaviours. Predefined thresholds were used to stratify patients according to risk and trigger tailored intervention pathways ranging from self-management education to physiotherapy assessment and targeted rehabilitation. Prospective clinical and service data were collected to evaluate predictive performance and clinical utility.
Results
Over 260 patients across diverse tumour streams were included. Baseline SMM demonstrated predictive utility for identifying patients at risk of functional decline, with exploratory analysis in the curative breast cancer cohort demonstrating an odds ratio of ~0.63 per kg and AUROC ~0.74. Approximately two-thirds of patients maintained or improved physical function during chemotherapy. Early analysis of the CBI-B demonstrated that higher behavioural capability scores were associated with maintenance or gain of skeletal muscle mass (median 94 vs 81, p=0.0012), with fair discrimination for muscle outcomes (AUROC 0.688). These findings suggest behavioural capability may provide additional information alongside objective physical measures to refine personalised risk stratification.
Conclusions
The PACER pathway demonstrates the feasibility of integrating objective measures of muscle health, physical function, and behavioural capability to support precision supportive care during chemotherapy. This risk-stratified approach enables earlier identification of patient needs and delivery of targeted interventions, providing a scalable framework for personalised exercise oncology care.