Advances in Treatment Have Major Impact on Short- and Long-term Outcomes
NORTHBROOK, Ill., May 7, 2013 /PRNewswire-USNewswire/ -- The American College of
Chest Physicians (ACCP) third edition of evidence-based lung cancer guidelines,
Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest
Physicians Evidence-Based Clinical Practice Guidelines, recommends offering
low-dose computed tomography (LDCT) scanning for lung cancer screening to people
with a significant risk of lung cancer due to age and smoking history.
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Published as a special supplement to the May issue of CHEST, ACCP's
peer-reviewed journal, the guidelines cite evidence to show lung cancer
screening, through a structured and specific protocol, can reduce lung cancer
deaths among individuals who are at elevated risk of developing lung cancer. The
guidelines also document the advances made over the past 5 years in the
treatment of tobacco use, including the benefits of tobacco cessation programs,
in patients with lung cancer. The most effective deterrent to acquiring lung
cancer is avoidance of tobacco products.
"Our new lung cancer guidelines take into account the many advances and new
information in the field by providing comprehensive and nuanced recommendations
related to prevention, screening, diagnosis, staging, and medical and surgical
treatments," said Guideline Panel Chair, W. Michael Alberts, MD, MBA, FCCP,
Moffitt Cancer Center, Tampa, FL. "It also showcases the importance of
multidisciplinary, team-based care when it comes to effective lung cancer
treatment--collaborative decisions based on collective knowledge provide the
most comprehensive patient-focused care."
For individuals at elevated risk of developing lung cancer, the guidelines
recommend offering LDCT scanning to screen for lung cancer in the context of a
structured, organized screening program. The recommendation is based on a
systematic review of the data that shows an important reduction in deaths from
lung cancer when screening is done in an organized program. This is a clear
change from the prior edition of the guidelines released in 2007, when such
evidence was not available.
Lung cancer screening is a complex interplay of an individual's risk and many
other key factors, including how LDCT scanning is performed and interpreted by
the team. This must then be coupled with careful judgment that minimizes
interventions to those that are necessary and education to appropriately balance
concerns associated with lung cancer, radiation, and observation of incidental
nodules. The guidelines call for the establishment of a registry designed to
help address the large number of unanswered questions that arise as screening is
implemented, as well as to clarify frequent misconceptions around lung cancer
screening among patients and physicians. Additionally, the guidelines call for
establishment of quality metrics so that benefits are optimized, and harm is
"Lung cancer screening offers a potential benefit for select individuals, but it
is not a substitute for stopping smoking," said Frank Detterbeck, MD, FCCP, Yale
University, New Haven, CT, and Vice-Chair of the Guidelines Panel. "However,
screening is not a scan, it is a process. We have much to learn as we embark
upon implementation of screening. Education on screening is the key to
overcoming misconceptions and misguided fears. The guidelines include
recommendations that help the patient and physician with the decision process.
It provides a structure that gives a clearer interpretation of what we know and
what we can only speculate."
ADVANCES IN TREATMENT
Treatment of lung cancer is progressing rapidly, with significant advances in
all modalities, including surgery, radiation, and chemotherapy. Treatment
procedures detailed in the guidelines include the benefits of minimally invasive
surgery whenever possible, as well as the benefit of treatment at specialized
centers. Today, patients with limited lung function also have treatment options
such as stereotactic body radiosurgery, which is similar to using a GPS system
to deliver a laser-accurate strike to a tumor. Molecular-based targeted
chemotherapy can also shut down the cellular engine driving a tumor's growth as
dramatically as flipping a switch. The guidelines also make it clear that a
sophisticated approach to symptom control and palliative care can markedly
improve both quality and quantity of life for individuals with lung cancer.
However, the data presented in the guidelines also underscore the importance of
an integrated collaborative team of individuals, each with lung cancer expertise
within his or her own specialty.
"All stages of non-small cell lung cancer involve complex factors," said Darcy
Marciniuk, MD, FCCP, Royal University Hospital, Saskatoon, Saskatchewan, and
ACCP President. "In the guidelines, we highlight these factors throughout all
stages, including symptom management, special treatment, complementary or
alternative therapies, and end-of-life care."
TREATMENT OF TOBACCO USE
An ounce of prevention is still best; and the science behind treatment of
tobacco dependency has matured tremendously. This edition of the guidelines
outlines how to select the right interventions for someone who smokes and
improve the rate of successful abstinence from smoking.
"Smoking is a difficult addiction to overcome; however, significant advances
have increased our understanding of the physiological and biological changes
that make this chronic medical condition so challenging. Today, we have multiple
treatment options to help these patients," said Frank Leone, MD, FCCP,
University of Pennsylvania, Philadelphia, PA, and topic editor of "Treatment of
Tobacco Use in Lung Cancer," in Diagnosis and Management of Lung Cancer, 3rd ed:
American College of Chest Physicians Evidence-Based Clinical Practice
Guidelines. "The guidelines include a detailed summary of the scientific basis
and management strategies for an up-to-date, sophisticated, and evidence-based
treatment program for tobacco use."
SYMPTOM MANAGEMENT AND PALLIATION
For patients with advanced lung cancer, a major concern is palliation, easing
the severity of pain and symptoms. In the past, the approach to palliative care
was largely empiric, but as summarized in the guidelines, a large body of
research has led to the development of a more formal evidence-based process.
Many tools are available that provide an effective structure for both symptom
management and for facilitating the process of end-of-life care. The data also
demonstrate that early inclusion of a palliative care team in the management of
advanced lung cancer has meaningful quality of life benefits for the patient.
"The scope of this chapter is very large," said Michael J. Simoff, MD, FCCP,
Henry Ford Hospital, Detroit, MI, and topic editor of "Symptom Management in
Patients With Lung Cancer," in Diagnosis and Management of Lung Cancer, 3rd ed:
American College of Chest Physicians Evidence-Based Clinical Practice
Guidelines. "Few classic double-blind, randomized studies exist to give guidance
in many of the areas covered in the chapter. Experts in many specialties were
brought together to ask the questions necessary and get the best answers
possible from the literature to guide physician management of the symptoms
encountered in lung cancer patients."
The guidelines also devote attention to complementary therapies and integrative
medicine in lung cancer. This includes interventions such as acupuncture,
nutrition, and mind-body therapies. The guidelines outline which treatments and
situations are scientifically supported for integration with standard treatments
for lung cancer.
The ACCP is at the forefront of defining the methodologic science of guideline
development. The lung cancer guidelines are distinguished by this methodologic
rigor and is a body of work that is as evidence-based, unbiased, and
scientifically accurate as possible. The process involved thousands of hours and
systematic reviews of the available data, conducted by over 100 expert panel
members, including pulmonologists, medical oncologists, radiation oncologists,
thoracic surgeons, integrative medicine specialists, oncology nurses,
pathologists, health-care researchers, and epidemiologists, as well as trained
methodologists. The guidelines were further reviewed and approved by the ACCP
Thoracic Oncology NetWork, the Guidelines Oversight Committee, the ACCP Board of
Regents, and external reviewers from the journal CHEST. The guidelines have been
endorsed by the European Society of Thoracic Surgeons, Oncology Nursing Society,
American Association for Bronchology and Interventional Pulmonology, and The
Society of Thoracic Surgeons.
About Lung Cancer in the United States
Lung cancer continues to be the leading cause of cancer deaths in men and women
in the United States and across the world, causing more deaths than the next
four most common cancers combined, including colon, breast, pancreas, and
prostate. Deaths from lung cancer in women surpassed those due to breast cancer
in 1987. Declining rates of smoking have slowly reduced the rates of lung
cancer, and the majority of those diagnosed with this disease today successfully
quit smoking years earlier. Nevertheless, lung cancer remains a common cancer,
even in lifelong never-smokers.
About CHEST and The American College of Chest Physicians
CHEST is a peer-reviewed journal published by the ACCP. It is available online
each month at http://journal.publications.chestnet.org/. The ACCP is a global
community of clinicians and allied health professionals working in pulmonary,
critical care, and sleep medicine. The ACCP is recognized as a resource for
advanced training through simulation education, conferences, and innovative
courses. Headquartered in Northbrook, IL, the ACCP represents more than 18,700
members from more than 100 countries.
SOURCE American College of Chest Physicians