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"Even in high risk populations, currently available research data do notshow that lung cancer screening alters mortality outcomes," said W. MichaelAlberts, MD, FCCP, chair of the ACCP lung cancer guidelines and Chief MedicalOfficer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. "Wehope that one day, we can find a useful and accurate tool for general lungcancer screening, but, at this time, the evidence does not support the use ofLDCT screening."
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In its second edition, Diagnosis and Management of Lung Cancer: ACCPEvidence-Based Clinical Practice Guidelines (2nd Edition) provides 260 of themost comprehensive recommendations related to lung cancer prevention,screening, diagnosis, staging, and medical and surgical treatments. Theguidelines also review complementary and integrative therapy for theprevention and treatment of lung cancer.
SCREENING
Due to the lack of supporting evidence, the guidelines recommend againstthe use of LDCT, chest radiographs, or single or serial sputum cytologicevaluation for lung cancer screening in the general population, includingsmokers or others at high risk, except in the context of a well-designedclinical trial.
"Population screening for lung cancer is not recommended and may,ultimately, put the patient at risk for further complications," said Gene L.Colice, MD, FCCP, vice chair of the ACCP lung cancer guidelines and Director,Pulmonary, Critical Care, and Respiratory Services, Washington HospitalCenter, Washington, DC. "Nodules are commonly found during screening; however,to determine whether they are cancerous requires additional testing, which isfairly invasive and extensive. This may cause the patient needless risk, bothphysically and psychologically."
PREVENTION
The guidelines also recommend against the preventive use of several of thefollowing common supplements and medications in at-risk patients or those witha history of lung cancer:
INTEGRATIVE THERAPY
For the first time, the ACCP lung cancer guidelines have includedrecommendations on mind-body modalities as part of a multimodality approach toreduce the anxiety, mood disturbances, and chronic pain associated with lungcancer. Massage therapy is recommended for patients who are experiencinganxiety or pain, while acupuncture is recommended for patients experiencingfatigue, dyspnea, chemo-induced neuropathy, or in cases where pain ornausea/vomiting is poorly controlled. Electrostimulation wristbands are notrecommended for managing chemo-induced nausea/vomiting, as studies show thatthey do little to delay nausea/vomiting compared with placebo.
The recommendations were rigorously developed and reviewed by 100multidisciplinary panel members, including pulmonologists, medicaloncologists, radiation oncologists, thoracic surgeons, integrative medicinespecialists, oncology nurses, pathologists, health-care researchers, andepidemiologists. The guidelines were further reviewed and approved by the ACCPThoracic Oncology NetWork, the Health and Science Policy Committee, the Boardof Regents, and external reviewers from the journal CHEST. The guidelines havebeen endorsed by the Ame
