Abstract
Cancer cachexia, a multifactorial syndrome of weight loss, muscle wasting, anorexia, and systemic inflammation, often goes unaddressed. Healthcare professionals at Uganda Cancer Institute (UCI) face substantial clinical workloads, limited resources and constrained access to guideline-based practice and limited multi-modal care, all of which adversely affect cancer cachexia recognition and management. To assess UCI professionals' knowledge levels, practice patterns, and attitudinal barriers regarding cancer-cachexia care. A longitudinal quasi-experimental pre-post study design using mixed methods was conducted among 50 healthcare professionals. Quantitative data were collected using an ASCO/ESMO/GLIM-adapted questionnaire and analyzed with McNemar's test, Chi-square tests, and Wilcoxon signed-rank tests (STATA-v18). In-depth interviews with 10 purposively selected participants were thematically analyzed using NVivo-v15. Participants were predominantly nurses (72%), the median age was 37 years, with 7 years of oncology experience, 64% were female. At baseline, 44% reported no prior cachexia training and assessments were largely subjective and conflated with malnutrition. Post-intervention, awareness of ASCO guidelines increased significantly to 89%, misconceptions regarding nutritional reversibility declined (p = 0.0097), and confidence in cachexia management rose by 36%. Evidence-based practices, including oral nutrition prioritization (p = 0.024), short-term corticosteroid use (p = 0.025), and anti-inflammatory therapy (p = 0.034), improved significantly. Confidence in management rose by 36% and non-assessment decreased, with modest gains in cachexia-specific assessment. Improving cachexia care in resource-limited settings requires structural integration into routine oncology practice more than individual awareness, through increased staffing, training, leadership, interdisciplinary coordination, and locally adapted guidelines.