NICE Updates Guidance On The Diagnosis And Treatment Of Lung Cancer

NICE Updates Guidance On The Diagnosis And Treatment Of Lung Cancer

Main Category: Lung Cancer
Also Included In: Cancer / Oncology
Article Date: 27 Apr 2011 – 5:00 PDT

NICE has today published an update to its clinical guideline on diagnosing and treating lung cancer. The new recommendations replace those previously published in 2005.

NICE clinical guidelines are updated regularly so that recommendations take into account any important new information that has come to light since publication of the original recommendations. Since NICE published guidance on this condition in February 2005, new evidence has emerged about how to diagnose and treat lung cancer and therefore the guideline has been updated.

There are more than 39,000 new cases of lung cancer in the UK each year and with more than 35,000 people each year dying as a result of the condition, it is the most common cause of cancer-related death in both men and women. Smoking is the single biggest risk factor for lung cancer, accounting for an estimated 90% of cases.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: “This updated guideline contains a number of new recommendations reflecting up-to-date developments since the original guideline was published which include: the diagnosis and staging of the disease, different approaches to treatment – including offering surgery to those patients who are medically fit and suitable – and a new emphasis on follow-up. The guideline also builds on previous recommendations around supporting the patient, including a new section on communicating with the patient.

“Lung cancer is the second most common form of cancer in the UK and the leading cause of death from cancer – more people now die as a result of it than breast cancer and colorectal cancer. The aim of this guideline is to help ensure patients across the country are diagnosed quickly and accurately and receive the best possible care.”

Updated recommendations include:

– Communication: Ensure that a lung cancer clinical nurse specialist is available at all stages of care to support patients and carers.

– Diagnosis and staging: Choose investigations that give the most information about diagnosis and staging with the least risk to the patient. Think carefully before performing a test that gives only diagnostic pathology when information on staging is also needed to guide treatment.

– Surgery with curative intent for non-small-cell lung cancer: Offer patients with non-small-cell lung cancer who are medically fit and suitable for treatment with curative intent, lobectomy as the treatment of first choice. For patients with borderline fitness and smaller tumours, consider lung parenchymal-sparing operations if a complete resection can be achieved.

– Combination treatment for non-small-cell lung cancer: Ensure all patients potentially suitable for multimodality treatment (surgery, radiotherapy and chemotherapy in any combination) are assessed by a thoracic oncologist and by a thoracic surgeon.

– Follow-up and patient perspectives: Offer all patients an initial specialist follow-up appointment within 6 weeks of completing treatment to discuss ongoing care. Offer regular appointments thereafter, rather than relying on patients requesting appointments when they experience symptoms.

Barrie White, Neurosurgeon, Queens Medical Centre, Nottingham and Chair of the guideline development group said: “This updated guideline builds on the comprehensive recommendations from 2005. The new guideline reemphasises the importance of public awareness of early symptoms and signs, recognising that this remains the key to reducing the number of deaths from lung cancer. Other new key priorities include the need for rapid, efficient diagnosis and staging, and ensuring multi-disciplinary team decisions integrate the patient’s wishes at every step to ensure the very best outcomes.”

Dr David Baldwin, Consultant Physician, Nottingham University Hospital NHS Trust and clinical lead on the guideline development group said: “We know that the frequency with which treatments, such as surgery and chemotherapy are offered to patients with lung cancer vary quite markedly up and down the country but the average is below the standard we see in Europe and the US. However, in some parts of the country we are as good as or better than other countries so we need to ensure the same high standard is applied wherever people live. This guideline clearly sets out what healthcare professionals should do and what patients should expect from them. I hope that it will help to tackle inequalities in the care of patients with lung cancer and contribute to ensuring survival is amongst the best in Europe.”

Thomas Haswell, patient and carer representative on the guideline development group said: “These guidelines contain recommendations for all patients to receive all necessary diagnostic tests to ensure the most appropriate treatments, care and follow up. It is important that equality of diagnosis treatment and care is available for all patients, no matter where they live. The guidelines also highlight the importance for all patients to have the support of a lung cancer clinical nurse specialist throughout their treatment and care pathway.

“From a patient perspective, I was impressed with the expertise, knowledge, experience, dedication and genuine concern shown by everyone who was involved in developing these guidelines.”


About the guidance

1. The guidance will be available on the NICE website from 27 April 2011.

2. NICE clinical guidelines are updated so that recommendations take into account important new information. New evidence is checked 3 years after publication, and healthcare professionals and patients are asked for their views; we use this information to decide whether all or part of a guideline needs updating. If important new evidence is published at other times, we may decide to do a more rapid update of some recommendations.

NICE has a formal process for reviewing and updating clinical guidelines. The guidelines manual gives details of this process.

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