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NICE acts to speed lung cancer diagnosis and treatment

Published on 02/03/05 at 11:33am

Patients showing symptoms of lung cancer should be offered an urgent referral to a chest physician, according to NICE recommendations for improving NHS services for the disease.

The institute also wants to see an increase in the number of nurse specialists, more use being made of early diagnosis clinics and improved access to screening services.

Lung cancer is the most common form of cancer in men in the UK and the third most common in women, but it causes more cancer deaths than any other form of the disease.

Andrea Sutcliffe, planning and resources director at NICE and executive lead for the guideline, said: "[This guideline] aims to improve the length and quality of life for people with lung cancer by ensuring that a diagnosis is made promptly and correctly and that, from the patient and their carer's perspective, the experience of care from the NHS is good."

The guideline says the NHS should make it a priority for all cancer units to have at least one trained lung cancer nurse specialist to see patients before and after their diagnosis to provide them with continuing support.

In order to improve lung cancer screening services, NICE says every cancer network must be able to gain rapid access to PET scanning services, though to manage this will require a significant increase in the existing capacity for such diagnostic services.

Although NICE's recommendations were welcomed by cancer charities, they sounded a note of caution as to whether there were sufficient resources to put some of them in place.

Peter Cardy, chief executive of Macmillan Cancer Relief, said: "We are concerned that, while all patients need good quality supportive and palliative care, none of these improvements will happen unless the government makes additional money available to back up the recommendations."

He also questioned whether the NHS had enough specialist nurses and said that improving scanning services would require appropriate resources for both the technology and the people to operate it.

In addition to offering patients who show signs of lung cancer an urgent referral for a chest X-ray, the guidance recommends that specific note be taken of patients with breathlessness, a common symptom of lung cancer.

It recommended that non-drug interventions for breathlessness be co-ordinated by a professional with an interest in the area and expertise in the techniques such as a nurse, physiotherapist or occupational therapist.

The new guideline recommended that medically inoperable patients at stage I and II non-small cell lung cancer (NSCLC) should be treated with CHART (continuous hyperfractionated accelerated radiotherapy) radiotherapy rather than standard radiotherapy.

When they reach stages III and IV, patients with NSCLC who have good performance status should be offered chemotherapy to improve their chances of survival, disease control and quality of life.

NICE now recommends four first-line treatments for advanced NSCLC in combination with a platinum drug in an update of its 2001 guidance that adds Sanofi-Aventis' Taxotere (docetaxel) to a list of BMS' Taxol (paclitaxel), Lilly's Gemzar (gemcitabine) and Pierre Fabre's Navelbine (vinorelbine).

Taxotere continues to be the only NICE-recommended second-line treatment for patients with locally advanced or metastatic NSCLC in whom relapse has occurred after previous chemotherapy.



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