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National Collaborating Centre for Cancer (UK). The Diagnosis and Treatment of Lung Cancer (Update). Cardiff (UK): National Collaborating Centre for Cancer (UK); 2011 Apr. (NICE Clinical Guidelines, No. 121.)

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The Diagnosis and Treatment of Lung Cancer (Update).

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Appendix 7Guideline Scope

Guideline title

The diagnosis and treatment of lung cancer (update of NICE clinical guideline 24).

Short title

Lung cancer update.

Background

The National Institute for Health and Clinical Excellence (‘NICE’ or ‘the Institute’) has commissioned the National Collaborating Centre for Cancer to review recent evidence on the management of lung cancer and to update the existing guideline ‘The diagnosis and treatment of lung cancer’ (NICE clinical guideline 24, 2005) for use in the NHS in England and Wales. The update will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.

NICE clinical guidelines support the implementation of National Service Frameworks (NSFs) in those aspects of care for which a Framework has been published. The statements in each NSF reflect the evidence that was used at the time the Framework was prepared. The clinical guidelines and technology appraisals published by NICE after an NSF has been issued have the effect of updating the Framework.

NICE clinical guidelines support the role of healthcare professionals in providing care in partnership with patients, taking account of their individual needs and preferences, and ensuring that patients (and their carers and families, if appropriate) can make informed decisions about their care and treatment.

Clinical need for the guideline

There are more than 38,000 new cases of lung cancer in the UK each year and more than 35,000 people die from the condition; more than for breast cancer and colorectal cancer combined.

Lung cancer is now the leading cause of cancer death in women.

About 90% of lung cancers are caused by smoking. Now that fewer men smoke, lung cancer deaths in men have decreased by more than a quarter in the UK (a 27% reduction between 1971 and 2006). However, the number of women who smoke has risen and deaths from lung cancer in women have increased.

Only about 5.5% lung cancers can be cured. Although the cure rate is rising slowly, the rate of improvement has been slower than that for other common cancers.

Outcomes in the UK are worse than those in some European countries and North America.

There is evidence that outcomes vary within the UK, which – among other factors – may be explained by variations in the standard of care.

NICE clinical guidelines are regularly reviewed, and updated as necessary. As part of its review of NICE clinical guideline 24, the National Collaborating Centre for Cancer convened a Lung Cancer Expert Advisory Group in June 2007 to discuss whether any part (or all) of the existing guideline needed updating. The advisory group comprised members of the original Guideline Development Group and other invited specialists involved in the delivery of lung cancer services.

The Advisory Group identified significant progression and expansion of the evidence base since the publication of NICE clinical guideline 24, indicating that a large number of recommendations would need to be updated. It also identified new topics not included in the original guideline.

In September 2007 the NICE Guidance Executive agreed to a partial update of the guideline (including new topics where appropriate) with an 18 month development time. In order to produce a high quality update within the allotted time, in line with the methods set out in ‘The guidelines manual’ (2009), it will not be possible to update the entire lung cancer guideline. Therefore we intend to focus on topics:

  • for which there is important new published evidence
  • that are still controversial or uncertain
  • in which there continues to be identifiable variation in practice, and
  • that will have the most significant impact on the clinical service and management of patients with lung cancer.

A draft list of the prioritised clinical topics to be included in the updated guideline were then developed using advice from the Advisory Group, the GDG chair, the GDG clinical lead and attendees at the stakeholder scoping workshop. These topics were included as an Appendix in the draft scope that was issued to stakeholders for consultation in November 2008.

The guideline

The guideline development process is described in detail in two publications that are available from the NICE website (see ‘Further information’). ‘The guideline development process: an overview for stakeholders, the public and the NHS’ describes how organisations can become involved in the development of a guideline. ‘The guidelines manual’ provides advice on the technical aspects of guideline development.

This scope defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider.

The guideline update will include:

  • updated topics and recommendations, and supporting evidence
  • new topics and recommendations, and supporting evidence
  • ‘old’ topics and recommendations that do not need updating and are therefore still valid.

The evidence that supported these recommendations will not be updated.

There will be some important topics that need updating but are not part of the final prioritised list. These will be added to a holding list for future consideration and the final guideline will make this clear to the reader.

The areas that will be addressed by the guideline are described in the following sections.

Population

Groups that will be covered

Adults (18 years and older) with newly diagnosed non-small-cell lung cancer (NSCLC).

Adults with newly diagnosed small cell lung cancer (SCLC).

Adults with relapsed NSCLC.

Adults with relapsed SCLC.

Groups that will not be covered

Adults with mesothelioma.

Adults with lung metastases arising from primary cancers originating outside the lung.

Children (younger than 18) with lung cancer.

Adults with rare lung tumours (for example, pulmonary blastoma).

Adults with benign lung tumours (for example, bronchial adenoma).

Healthcare setting

Primary care – excluding population-based and opportunistic screening and prevention.

Secondary care.

Tertiary care by services offering specialist care (for example, thoracic surgery, radiotherapy and interventional bronchoscopy).

Clinical management (including service delivery where appropriate)

  • Diagnosis and staging.
  • Information for patient and carers.
  • Radical treatment of patients with NSCLC.
  • Palliative endobronchial therapies.
  • Management of patients with SCLC.
  • Follow up.
  • Service organisation and inequality of management at key decision points to be addressed by the needs assessment Status

Status

Scope

This is the final scope.

Guideline

The development of the guideline recommendations will begin in February 2009.

Related NICE guidance

Published guidance

The following guidance will be cross referred to as appropriate:

Relevant guidance published by other organisations

  • Department of Health (1998) Guidance on commissioning cancer services: improving outcomes in lung cancer: the manual. London: Department of Health. Available from: www.dh.gov.uk

Under development

NICE is in the process of developing the following guidance (details available from www.nice.org.uk). Recommendations from these technology appraisals will be incorporated in the lung cancer guideline update.

  • Pemetrexed for the first-line treatment of non-small cell-lung cancer. NICE technology appraisal guidance. Publication expected August 2009.
  • Topotecan for the treatment of small-cell-lung cancer (second line treatment). NICE technology appraisal guidance. Publication expected November 2009.
  • Cetuximab for the treatment of advanced non-small-cell lung cancer. NICE technology appraisal guidance. Publication expected November 2009.
  • Gefitinib for the treatment of non-small-cell lung cancer. NICE technology appraisal guidance. Publication expected January 2010.
  • Erlotinib, in combination with bevacizumab for the maintenance treatment of non-squamous advanced or metastatic non-small-cell lung cancer after previous platinum-containing chemotherapy. NICE technology appraisal guidance. Publication expected October 2010.
  • Pemetrexed for maintenance treatment following first-line chemotherapy for non-small-cell lung cancer. NICE technology appraisal guidance. Publication date to be confirmed.
  • Erlotinib monotherapy for the maintenance treatment of non-small-cell lung cancer after previous platinum containing chemotherapy. NICE technology appraisal guidance. Publication date to be confirmed.
  • Vandetanib within its licensed indications, for the second and subsequent line treatment of non-small-cell lung cancer after previous platinum containing chemotherapy. NICE technology appraisal guidance. Publication date to be confirmed.

Further information

  • The guideline development process is described in: ‘How NICE clinical guidelines are developed: an overview for stakeholders' the public and the NHS’
  • ‘The guidelines manual’.

These are available from www.nice.org.uk/guidelinesmanual. Information on the progress of the guideline will also be available from the NICE website (www.nice.org.uk).

Copyright © 2011, National Collaborating Centre for Cancer.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licenses issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK99034

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