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NICE updates lung cancer guidance

New guidance on diagnosis and treatment to bring national consistency

Louise Prime

Thursday, 28 April 2011

NICE has updated its guidance on the diagnosis and treatment of lung cancer, to improve the speed of diagnosis and ensure that patient care is consistently good across the country.

It stresses the importance of raising public awareness of signs and symptoms, and an integrated approach to treatment.

Since NICE’s previous guideline was published in 2005, much new evidence has emerged from studies looking at how best to diagnose and treat lung cancer, which kills more than 35,000 UK residents every year.

Dr Fergus Macbeth, director of NICE’s centre for clinical practice, 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, a neurosurgeon at Queens Medical Centre in Nottingham and chair of the guideline development group said: “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 at Nottingham University Hospital NHS Trust and clinical lead on the guideline development group, said: “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.

“I hope that [this guideline] will help to tackle inequalities in the care of patients with lung cancer and contribute to ensuring survival is amongst the best in Europe.”

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