The U.S. Preventive Services Task Force states that there is insufficient evidence to recommend for or against lung cancer screening.
'The evidence isn't available to show that low-dose CT screening provides a mortality benefit.' DR. ALBERTS
Other Points Covered by the Guidelines
In addition to the three recommendations on lung cancer screening, the ACCP has issued 257 recommendations on the prevention, diagnosis, and treatment of lung cancer.
The ACCP classifies its evidence-based guidelines as strong (grade 1) or weak (grade 2) based on a balance of risks, benefits, burdens, and costs. The college also classifies the quality of evidence as high (grade A), moderate (grade B), or low (grade C) based on study design, consistency of results, and directness of the evidence.
The following are among the most notable of the other recommendations:
▸ Fifteen of the guidelines deal with complementary therapies and integrative oncology. The guidelines recommend mind-body modalities to reduce anxiety, mood disturbances, or chronic pain (grade 1B); massage therapy for anxiety or pain (grade 1C), as long as it does not involve deep or intense pressure near cancer lesions or anatomical distortions (grade 2C); and acupuncture for poorly controlled pain or for side effects such as neuropathy or xerostomia (grade 1A) and for nausea and vomiting (grade 1B).
However, the guidelines recommend against therapy based on putative manipulation of bioenergy fields (grade 1C); electrostimulation wristbands for nausea and vomiting (grade 1B); and botanical agents in patients who either fail or decline antitumor therapies except in the context of clinical trials (grade 1C).
In addition, physicians should specifically ask all patients with lung cancer about their use of complementary and alternative therapies (grade 1C).
▸ In terms of lung cancer chemoprevention, the guidelines recommend against supplementation with β-carotene, vitamin D, retinoids, N-acetylcysteine, and aspirin (grade 1A). The guidelines further state that even for individuals at risk of lung cancer or with a history of lung cancer, there are insufficient data to recommend any agent—either alone or in combination—for chemoprevention, except in the context of a clinical trial (grade 1B).
▸ Solitary pulmonary nodules are addressed in 29 guidelines. The guidelines direct physicians to estimate the pretest probability of malignancy (grade 1C), and to perform specific imaging and diagnostic tests based on that probability and other characteristics of the nodule (various grades). They also recommend a number of surgical approaches, including thorascopic wedge resection and lobectomy, depending on the results of these tests and patient preference (various grades).
▸ For the first time, the guidelines address bronchioloalveolar carcinoma. They recommend surgical biopsy for establishing a diagnosis (grade 1C); follow-up diagnostic testing after a negative PET scan (grade 1C); and sublobar resection for patients who are good surgical candidates, provided the CT scan shows a pure ground-glass appearance and there's no evidence of invasive disease (grade 1B).
▸ Palliative care is addressed in 35 guidelines. Patients should be reassured that pain can be treated safely and effectively, and all patients should be questioned regularly about their pain (grade 1A). Patients with mild to moderate pain should be managed first with acetaminophen or an NSAID, and then with an opioid when pain becomes more severe (grade 1B). Those with pain unresponsive to standard methods should be referred to a specialized pain clinic or a palliative care consultant (grade 1C).
External radiation therapy and bisphosphonates are recommended for patients who have pain from bone metastases (grade 1A). Patients with malignant tracheoesophageal or bronchoesophageal fistula should be considered for stenting of the esophagus, airway, or both for symptomatic relief, but attempts at curative resection or esophageal bypass are not recommended (grade 1C).
▸ All patients with lung cancer should be evaluated for the presence of depression and treated appropriately (grade 1C).