Aims
To implement and evaluate a pragmatic, risk-stratified model of care to identify patients at risk of physical function decline during chemotherapy and enable early, targeted intervention within routine oncology services.
Methods
The Physical Activity during Chemotherapy to Enhance Recovery (PACER) pathway was embedded within a tertiary day oncology unit. Patients commencing intravenous chemotherapy underwent brief, standardised screening integrated into routine care, including SARC-F, Five Times Sit-to-Stand, 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. Screening was conducted at baseline and monthly intervals. Predefined thresholds triggered stratified referral pathways ranging from self-management education to physiotherapy review and targeted rehabilitation. Implementation strategies included staff education, workflow redesign, multidisciplinary engagement, and dedicated assessment resources. Prospective service and clinical data were collected.
Results
Over 260 patients across mixed tumour streams were screened during early implementation. The model was feasible and successfully integrated into routine chemotherapy workflows. Approximately two-thirds of patients maintained or improved physical function during treatment. Within the curative breast cancer cohort, exploratory analysis demonstrated that baseline SMM had predictive utility for identifying patients at risk of subsequent physical decline (AUROC ~0.74). Early exploratory analysis identified that higher CBI-B scores were associated with maintenance or gain of skeletal muscle mass, suggesting behavioural capability may provide additional information for risk stratification. Key enablers included leadership support, multidisciplinary collaboration, and co-location within the oncology unit; barriers included workflow pressures, space constraints, and role clarity across disciplines.
Conclusions
PACER demonstrates that embedding brief physical function and behavioural screening into routine chemotherapy care is feasible and clinically meaningful. This evolving risk-stratified pathway supports earlier identification of patient needs, enables targeted intervention, and provides a scalable framework to integrate exercise oncology into routine cancer services.