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New Lung Cancer Guidelines Recommends Offering Screening To High-Risk Individuals

"Lung cancer screening offers a potential benefit for select individuals, but it is not a substitute for stopping smoking," said Frank Detterbeck, MD, FCCP, Yale University, New Haven, CT, and Vice-Chair of the Guidelines Panel. "However, screening is not a scan, it is a process. We have much to learn as we embark upon implementation of screening. Education on screening is the key to overcoming misconceptions and misguided fears. The guidelines include recommendations that help the patient and physician with the decision process. It provides a structure that gives a clearer interpretation of what we know and what we can only speculate."

ADVANCES IN TREATMENTTreatment of lung cancer is progressing rapidly, with significant advances in all modalities, including surgery, radiation, and chemotherapy. Treatment procedures detailed in the guidelines include the benefits of minimally invasive surgery whenever possible, as well as the benefit of treatment at specialized centers. Today, patients with limited lung function also have treatment options such as stereotactic body radiosurgery, which is similar to using a GPS system to deliver a laser-accurate strike to a tumor. Molecular-based targeted chemotherapy can also shut down the cellular engine driving a tumor's growth as dramatically as flipping a switch. The guidelines also make it clear that a sophisticated approach to symptom control and palliative care can markedly improve both quality and quantity of life for individuals with lung cancer.

However, the data presented in the guidelines also underscore the importance of an integrated collaborative team of individuals, each with lung cancer expertise within his or her own specialty.

"All stages of non-small cell lung cancer involve complex factors," said Darcy Marciniuk, MD, FCCP, Royal University Hospital, Saskatoon, Saskatchewan, and ACCP President. "In the guidelines, we highlight these factors throughout all stages, including symptom management, special treatment, complementary or alternative therapies, and end-of-life care."

TREATMENT OF TOBACCO USEAn ounce of prevention is still best; and the science behind treatment of tobacco dependency has matured tremendously. This edition of the guidelines outlines how to select the right interventions for someone who smokes and improve the rate of successful abstinence from smoking.

"Smoking is a difficult addiction to overcome; however, significant advances have increased our understanding of the physiological and biological changes that make this chronic medical condition so challenging. Today, we have multiple treatment options to help these patients," said Frank Leone, MD, FCCP, University of Pennsylvania, Philadelphia, PA, and topic editor of "Treatment of Tobacco Use in Lung Cancer," in Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. "The guidelines include a detailed summary of the scientific basis and management strategies for an up-to-date, sophisticated, and evidence-based treatment program for tobacco use."

SYMPTOM MANAGEMENT AND PALLIATIONFor patients with advanced lung cancer, a major concern is palliation, easing the severity of pain and symptoms. In the past, the approach to palliative care was largely empiric, but as summarized in the guidelines, a large body of research has led to the development of a more formal evidence-based process. Many tools are available that provide an effective structure for both symptom management and for facilitating the process of end-of-life care. The data also demonstrate that early inclusion of a palliative care team in the management of advanced lung cancer has meaningful quality of life benefits for the patient.

"The scope of this chapter is very large," said Michael J. Simoff, MD, FCCP, Henry Ford Hospital, Detroit, MI, and topic editor of "Symptom Management in Patients With Lung Cancer," in Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. "Few classic double-blind, randomized studies exist to give guidance in many of the areas covered in the chapter. Experts in many specialties were brought together to ask the questions necessary and get the best answers possible from the literature to guide physician management of the symptoms encountered in lung cancer patients."

The guidelines also devote attention to complementary therapies and integrative medicine in lung cancer. This includes interventions such as acupuncture, nutrition, and mind-body therapies. The guidelines outline which treatments and situations are scientifically supported for integration with standard treatments for lung cancer.

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