American lung cancer

The American College of Chest Physicians (ACCP) has released new guidelines on lung cancer treatment, calling for a coordinated team approach to the continuum of care for patients with lung cancer. "Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Guidelines" appears in the January 2003 edition of Chest and is available online at www.chestjournal.org.

Lung cancer is currently the leading cause of cancer deaths in men and women in the United States. Despite the less than optimal survival rate of patients with lung cancer, there are many treatment options that can extend and increase the quality of a patient's life, such as using a balanced approach to patient care that provides multidisciplinary expertise and treatment appropriate for the individual patient. The multidisciplinary team approach reflects a growing trend in the medical field, according to the ACCP.

Among the ACCP guidelines are the following recommendations:

* All cancer units, treatment facilities, and centers should have a multidisciplinary lung cancer conference that meets on a regular basis.

* All patients with known or suspected lung cancer should be referred to a multidisciplinary team of physicians or a physician with experience in the management of lung cancer.

* For patients in whom tissue diagnosis or staging remains incomplete, referral should be made to a subspecialist with expertise in these areas. When completed, the choice of referral may vary with the interventions(s) proposed.

* A multidisciplinary group is particularly valuable for management of patients who may be offered multimodality therapy.

* Management decisions emanating from the multidisciplinary conference should be guided by locally agreed-on adaptations of clinical practice guidelines or other evidence.

* All patients should be evaluated as potential candidates for clinical trials, and enrollment should be encouraged.

* A specific coordinator of care should be identified to the patient and caregivers.

* For patients with suspected lung cancer, evaluation, diagnosis, and treatment planning should be expedited.

* Patients with lung cancer should receive clear, understandable information about their diagnosis, treatment, and possible outcomes. Patients and their families should be offered clear, full, prompt, and culturally appropriate information, preferably in both verbal and written form.

* All health care professionals involved in the care of the patient should be aware of the management plan. This communication should include the clinical staging, what the patient has been told, and the proposed treatment plan.

* For all patients with lung cancer, explicit guidelines for follow-up and surveillance after the initial treatment should be developed. It should be clear to the patients who will be supervising their ongoing care and surveillance. Patients should know how to access assistance for urgent problems.

* For patients with lung cancer in whom death or a significant change in clinical status occurs, the primary care physician and all management team members should be advised. Likewise, the primary care physician should notify the management team and all interested parties if a change in clinical status of the patient should occur at home.