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Evidence-based lung cancer guidelines to debut in January

New guidelines for the detection and treatment of lung cancer, due to appear this coming January, were previewed at the annual meeting of the American College of Chest Physicians (ACCP), held last month in San Diego.

About three years ago, the ACCP saw a need for new comprehensive, evidence-based guidelines. First, technology for improved lung cancer detection and treatment has been advancing rapidly, with new detection methods and with Food & Drug Administration approval of eight drugs for lung cancer between 1996 and 2001. Also, survival rates for different modes of lung cancer treatment have changed. Accordingly, the guidelines in place were becoming obsolete.

Second, there were no evidence-based guidelines for lung cancer available. In addition, the ACCP membership believed that since multidisciplinary approaches to lung cancer treatment were proving to be more effective than those achieved by a single discipline, and since the organization had always been multidisciplinary in nature, it was the right group for the task.

The Lung Cancer Guidelines Project began with an extensive review of the relevant literature, which was accomplished by an international team of more than 80 lung cancer experts representing 13 medical specialty societies in addition to ACCP. Their mandate was to assess scientifically proven methods of detection and treatment and make recommendations based on those assessments in order to help practicing physicians give their patients the best possible treatment. Project participants anticipate that these guidelines will have a huge positive impact on lung cancer treatment and on the health of the nation, since more people die of lung cancer than of breast, prostate, and colorectal cancers combined.

The result is a comprehensive set of recommendations based on proven scientific findings, which will be published in early 2003. These guidelines will be the first lung cancer guidelines to be entirely evidence based. They will be organized into 28 chapters and appear in several different formats. The full document will be published as a printed version of several hundred pages, as a CD-ROM, and on the ACCP Web site (www.chestnet.org).

ACCP also expects to publish a handy version for personal digital assistants (PDAs). The information will also be distilled into much briefer Quick Reference Guides. The guidelines, in all formats, will be accessible to anyone who wants them--patients as well as physicians and other healthcare providers.

ACCP will develop tools to help physicians and hospitals implement these guidelines. The organization has made a commitment to help physicians work with these guidelines and implement best practices.

Each recommendation begins with a clear statement defining the appropriate patient population to which the recommendation applies. To further increase their utility, the guidelines will be updated yearly, as technological advances continue, according to Michael Alberts, M.D., FCCP, associate center director of clinical affairs at the H. Lee Moffitt Cancer Center in Tampa and chair of the ACCP Lung Cancer Guidelines Project.

Alberts also noted that because the recommendations are exclusively evidence based, there would not be a recommendation for every situation; in some situations, there is insufficient scientific evidence to support a recommendation. He also pointed out that the requirement for rigorous scientific evidence has led to controversies in areas where existing evidence fails to corroborate some strongly held beliefs about treatments. One of those areas is neoadjuvant chemotherapy administered prior to surgery, which hasn't been proven to be beneficial.

Lorraine Lica, Ph.D.

The author is a writer based in San Diego.

Lorraine Lica. Evidence-based lung cancer guidelines to debut in January.

Drug Topics

2002;23:HSE6.