Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

The importance of early diagnosis

  • The public needs to be better informed of the symptoms and signs that are characteristic of lung cancer, through coordinated campaigning to raise awareness. [2005]


  • Ensure that a lung cancer clinical nurse specialist is available at all stages of care to support patients and carers. [new 2011]

Diagnosis and staging

  • Choose investigations that give the most information about diagnosis and staging with the least risk to the patient. Think carefully before performing a test that gives only diagnostic pathology when information on staging is also needed to guide treatment. [new 2011]

  • Offer PET-CT, or EBUS-guided TBNA, or EUS-guided FNA, or non-ultrasound-guided TBNA as the first test for patients with an intermediate probability of mediastinal malignancy (lymph nodes between 10 and 20 mm maximum short axis on CT) who are potentially suitable for treatment with curative intent. [new 2011]

Surgery with curative intent for non-small-cell lung cancer

  • Offer patients with NSCLC who are medically fit and suitable for treatment with curative intent, lobectomy (either open or thoracoscopic) as the treatment of first choice. For patients with borderline fitness and smaller tumours (T1a–b, N0, M0), consider lung parenchymal-sparing operations (segmentectomy or wedge resection) if a complete resection can be achieved. [new 2011]

Radiotherapy with curative intent for non-small-cell lung cancer

  • Radical radiotherapy is indicated for patients with stage I, II or III NSCLC who have good performance status (WHO 0, 1) and whose disease can be encompassed in a radiotherapy treatment volume without undue risk of normal tissue damage[1]. [2005]

Combination treatment for non-small-cell lung cancer

  • Ensure all patients potentially suitable for multimodality treatment (surgery, radiotherapy and chemotherapy in any combination) are assessed by a thoracic oncologist and by a thoracic surgeon. [new 2011]

Assessing patients with small-cell lung cancer

  • Arrange for patients with small-cell lung cancer (SCLC) to have an assessment by a thoracic oncologist within 1 week of deciding to recommend treatment. [new 2011]

Managing endobronchial obstruction

  • Every cancer network should ensure that patients have rapid access to a team capable of providing interventional endobronchial treatments. [new 2011]

Follow-up and patient perspectives

  • Offer all patients an initial specialist follow-up appointment within 6 weeks of completing treatment to discuss ongoing care. Offer regular appointments thereafter, rather than relying on patients requesting appointments when they experience symptoms. [new 2011]

[1] The GDG recognised that radiotherapy techniques have advanced considerably since the 2005 guideline and centres would reasonably wish to offer these techniques (including SBRT and 4-D planning) to patients. These treatments have the advantage of reducing the risk of damage to normal tissue (estimated by using measurements such as V20).

  • National Institute for Health and Care Excellence (NICE)