NICE issues guidance for diagnosis and treatment of lung cancer

Guidelines for achieving earlier diagnosis, greater use of evidence based treatments, and better coordination of care for patients with lung cancer have been published for England and Wales this week. The recommendations, from the National Institute for Clinical Excellence (NICE), are aimed at improving the poor survival rates from lung cancer.

The guidelines recommend urgent referral for chest x ray examination for anyone with haemoptysis or unexplained or persistent symptoms that might indicate lung cancer, including cough, chest pain, dyspnoea, or weight loss. Patients whose chest x ray examination or computed tomogram suggests lung cancer should be referred urgently to a chest physician working as a member of a lung cancer multi-disciplinary team.

Figure 1.

Chest x ray film of a 70 year old woman showing lung cancer

Credit: P MARAZZI/SPL

Every cancer network must have rapid access to 18F-deoxyglucose positron emission tomography (FDG-PET) to improve staging of lung cancer, say the guidelines. They also recommend that all cancer units should have one or more trained lung cancer nurse specialists to see patients before and after diagnosis to provide continuing support and to facilitate communication between all professionals involved in an individual patient's care.

Currently just 5.5% of people diagnosed with lung cancer in England and 6% of those in Wales live for more than five years. This is about 5% lower than the European average and 7-10% lower than the rate for the United States.

The guidance is based on a review of evidence by NICE and the National Collaborating Centre for Acute Care, a group set up by NICE to include representatives from the medical royal colleges, professional bodies, and patient organisations. For the first time, NICE worked in collaboration with the Scottish Intercollegiate Guidelines Network (SIGN).

Dr Jesme Baird, director of patient care with the Roy Castle Lung Cancer Foundation and chairwoman of the guideline development group, commented: “Despite being the commonest cancer, lung cancer remains a disease associated with much negativity. The recommendations made in this guideline highlight many positive developments.”

The guidelines recommend greater use of modern, evidence based treatments. Patients with stages I or II non-small cell lung cancer that is medically inoperable should be treated using continuous hyperfractionated accelerated radiotherapy (CHART)—an intensive form of radiotherapy given three times a day over a relatively short period of just over two weeks—rather than standard radiotherapy. The guidelines also recommend offering chemotherapy to patients with stages III and IV non-small cell lung cancer who are generally well—to improve survival, disease control, and quality of life.