Targeted screening for lung cancer with low radiation dose computed tomography.
|Source and Topic||Recommendations|
|NOLCP: community CXR||CXRs reported within 24 h of image acquisition; preferably before patient leaves|
|NOLCP: CT imaging||CT within 72 h of CXR suggestive of lung cancer or GP referral for suspected lung cancer; preferably on the same day. CT results should be triaged on the same day|
|NOLCP: test bundles||To use groups of tests, requested simultaneously, that provide the required diagnostic, staging, and physiological information relevant to the stage and pattern of disease to ensure complete MDT discussion and treatment recommendations can be made|
|NICE: nodal staging with EBUS||Patients with suspected lung cancer with no evidence of distant metastases and any intrathoracic lymph node >1 cm should undergo staging EBUS|
|NICE: brain imaging||Patients with stage II lung cancer should undergo contrast-enhanced CT brain followed by contrast-enhanced MRI brain when positive for brain metastases.|
Patients with stage III lung cancer should undergo contrast-enhanced MRI brain
|NICE: physiological assessment||For patients with lung cancer and a possible treatment option of surgery, assess risk of mortality (e.g., Thoracoscore), cardiac risk, postoperative predicted lung function (FEV1 and DLCO by means of segment counting), and functional ability (ISWT, CPET)|
|NICE: ISWT||Use a distance walked of >400 m as a cutoff for good function|
|NICE: CPET||Use a VO2max of >15 ml/kg/min as a cutoff for good function|
Pathology and Molecular Diagnostics
Standards and datasets for reporting cancers: dataset for histopathological reporting of lung cancer.
Challenges and Unique Features
|Staff Member||Median Number of Staff Per Unit||Range of Number of Staff Per Unit||NHS England Commissioning Guidance||% of Units Meeting Commissioning Guidance in 2019|
|Pulmonologists||4||0–14||10 sessions per week for direct clinical care per 200 new diagnoses per year||16|
|Clinical oncologists||1||0–27||At least 1/3 of job plan devoted to lung cancer||70|
|Medical oncologists||1||0–18||At least 1/3 of job plan devoted to lung cancer||60|
|Thoracic surgeons||3||0–7||At least 1/3 of clinical time dedicated to lung cancer||75|
|Thoracic radiologists||2||0–14||At least 1/3 of job plan devoted to lung cancer||83|
|Lung cancer nurse specialists||N/A||N/A||One whole time equivalent per 80 new cases per year||32|
CRediT Authorship Contribution Statement
- National Lung Cancer Audit annual report.
- A randomized trial of e-cigarettes versus nicotine-replacement therapy.N Engl J Med. 2019; 380: 629-637
- Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation.Health Technol Assess. 2018; 22: 1-276
- Targeted screening for lung cancer with low radiation dose computed tomography.https://www.england.nhs.uk/wp-content/uploads/2019/02/targeted-lung-health-checks-standard-protocol-v1.pdfDate accessed: September 30, 2021
- Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial.Lancet Respir Med. 2015; 3: 282-289
- Implementation and outcomes of the RAPID programme: addressing the front end of the lung cancer pathway in Manchester.Clin Med (Lond). 2020; 20: 401-405
- Standards and datasets for reporting cancers: dataset for histopathological reporting of lung cancer.https://www.rcpath.org/uploads/assets/265cdf74-3376-40b0-b7d0e3ed8a588398/G048-Dataset-for-histopathological-reporting-of-lung-cancer.pdfDate accessed: September 30, 2021
- NHS, GIRFT (Getting It Right First Time). Cardiothoracic surgery—GIRFT Programme National Speciality Report.https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/04/GIRFT-Cardiothoracic-Report-1.pdfDate accessed: September 30, 2021
- Stage III non-small cell lung cancer management in England.Clin Oncol (R Coll Radiol). 2019; 31: 688-696
- Current status of stereotactic ablative body radiotherapy in the UK: six years of progress.BJR Open. 2019; 1: 20190022
Disclosure: Dr. Navani reports receiving personal fees from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Janssen, Eli Lilly, Olympus , OncLive, PeerVoice, Pfizer , and Takeda and personal fees and nonfinancial support from Merck Sharp & Dohme , all outside of the submitted work. Dr. Baldwin reports receiving personal fees from Merck Sharp & Dohme, Bristol-Myers Squibb, Roche , and AstraZeneca , all outside of the submitted work. Dr. McDonald reports receiving personal fees from AstraZeneca and Elekta , outside of the submitted work. Dr. Nicholson reports receiving personal fees from Merck , Boehringer Ingelheim, Novartis , AstraZeneca, Bristol-Myers Squibb, Roche, AbbVie, Oncologica, UptoDate, European Society of Oncology, Liberum, Takeda UK Ltd., and Daiichi Sankyo and grants and personal fees from Pfizer , outside of the submitted work. Dr. Popat reports receiving personal fees and other fees from Amgen and personal fees from AstraZeneca , Bayer , BeiGene, Blueprint, Bristol-Myers Squibb , Boehringer Ingelheim , Daiichi Sankyo, GlaxoSmithKline , Guardant Health, Incyte, Janssen, Eli Lilly , Merck Serono, Merck Sharp & Dohme , Novartis , Roche , Takeda , Pfizer , Seattle Genetics , Turning Point Therapeutics, and Xcovery, outside of the submitted work. The remaining authors declare no conflict of interest.