Table 3.

Strategic domains of the developed supportive care pathway

Strategic domain	Intended purpose	Rationale for inclusion
Nutritional and immune management	To support adequate nutritional intake and nutritional status during definitive treatment, with supplementary monitoring of immune-nutritional and inflammatory status	Nutritional deterioration contributes to sarcopenia risk and may compromise treatment tolerance. Nutritional support is therefore integrated with symptom-responsive care. GINI, HALP, and PNI provide supplementary longitudinal information on nutritional, immune, and inflammatory status to inform reassessment and MDT decision-making; they are not used as standalone diagnostic criteria or independent intervention thresholds.
Exercise management	To help preserve muscle mass, physical function, and activity tolerance during treatment	Reduced physical activity and treatment-related deconditioning were identified as modifiable contributors to sarcopenia risk. Exercise guidance needed to be tailored to treatment stage, symptoms, and functional capacity.
Head and neck symptom cluster management	To reduce local treatment-related barriers to eating, swallowing, communication, and daily functioning	Patients receiving treatment for NPC commonly experience oral, swallowing, taste, and radiation-related symptoms. These symptoms may compromise nutritional intake, adherence to supportive care, and quality of life.
Gastrointestinal symptom cluster management	To manage gastrointestinal symptoms that may interfere with intake, hydration, and treatment tolerance	Gastrointestinal symptoms may aggravate nutritional deterioration, reduce adherence to nutritional and exercise recommendations, and increase the risk of treatment-related decline.
Psycho-behavioural support	To strengthen self-efficacy, perceived control, adherence, and sustained engagement in self-management	By targeting attitudes, subjective norms, and perceived behavioural control, psycho-behavioural support is expected to improve adherence to nutritional, exercise, and self-management recommendations, thereby supporting nutritional intake, physical activity, and functional maintenance relevant to sarcopenia prevention.

GINI global immune-nutrition-inflammation index, HALP hemoglobin, albumin, lymphocyte, and platelet, MDT multidisciplinary team, NPC nasopharyngeal carcinoma, PNI prognostic nutritional index