The Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, was published as a supplement to the May issue of CHEST
The print supplement includes the Executive Summary, which features all the recommendations, the Introduction, and Methodology chapters. The online version provides the complete supplement, with all full-text articles, supplemental tables, podcasts, and more. The guidelines can be viewed on any smartphone using the mobile-enhanced site or on the CHEST journal app for iOS devices
The ACCP lung cancer guidelines, first published in 2003, have become one of the most comprehensive and respected guidelines in the lung cancer community. The 2nd edition had more than 300,000 accesses from the journal’s website and, even 5 years later, more than 163,000 views were chronicled in this past year alone through the National Guideline Clearinghouse.
Readers will note many advances in the updated guidelines. This 3rd edition of the guidelines (LC III) heralds a significant advance in the science of evidence-based medicine. Innovative procedural and methodological advances1 have resulted in many changes in the recommendations, both clinically and in terms of the strength of the recommendations. Some of the strong recommendations in the 2nd edition have been downgraded to moderate or weaker levels mainly because the newer more rigorous assessments of the quality of the evidence have led to lower confidence in the estimates of effect.
The ACCP Guidelines Oversight Committee conducted meticulous reviews of nominees’ conflicts of interest. The final manuscripts underwent a thorough and precise review process, resulting in recommendations that readers can trust.
Specific changes to these guidelines include:
The screening recommendations in LC III are very specific and more inclusive of other modalities. These follow a 2012 multisociety guideline2«???» on screening in which the ACCP was a leading partner.
An article on tobacco cessation for lung cancer patients breaks new ground in this publication. Patients with lung cancer who smoke should be treated by their physicians using pharmacotherapeutic and behavioral approaches to help end their dependence on tobacco.
The newest staging system is demonstrated, and methods for staging lung cancer in patients are explored in detail. As with past editions, the treatment articles are divided by stage of illness, small cell lung cancer, and special treatment issues. But the comprehensive and systematic evidence reviews have yielded the newest evidence on treatments for these patient populations.
This edition includes a comprehensive review with recommendations for managing the symptoms experienced by patients with lung cancer even before they approach the end of life.
Complementary and integrative oncology treatments are explored and held to the same evidence-based standards. A number of randomized controlled trials, meta-analyses, and systematic reviews were revealed, and many recommendations address the benefits of integration of approaches from pulmonary rehabilitation to acupuncture and massage and more.
Clinical resources, including slide sets for presentations to lay and professional audiences, and educational programs will be made available over the next several months and during CHEST 2013 in Chicago in October. Please watch for announcements in your inbox and on www.chestnet.org.
The ACCP is working hard to produce the very best evidence-based clinical guidelines in chest medicine. You can access the LC III guidelines at journal.publications.chestnet.org.
For more information, please contact Sandra Zelman Lewis, PhD, slewis@chestnet.org.
References
1. Lewis SZ, Addrizzo-Harris D. Methodology for Development of guidelines for lung cancer in diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2013;143(5):41S-50S.
2. Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307(22):2418-2429.
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