Guidance
Introduction
|
The addendum to NICE clinical guideline 81 has added recommendations on exercise in people with or at risk of breast-cancer-related lymphoedema to section 1.5 of the NICE guideline. The addendum also contains details of the methods and evidence used to update these recommendations. The recommendations on exercise in lymphoedema are also relevant for people with early or locally advanced breast cancer. |
This 2014 update assesses exercise in people with or at risk of breast-cancer-related lymphoedema. Because of the variation between the exercise programmes in the included studies, it was not possible to define the frequency and intensity of the exercise programmes that may be undertaken. The exercise programmes that were included could reasonably be completed at gyms or similar facilities, or at home.
The 2009 guideline updated and replaced the following technology appraisals:
-
'Guidance on the use of capecitabine for the treatment of locally advanced or metastatic breast cancer' (NICE technology appraisal guidance 62)
-
'Guidance on the use of vinorelbine for the treatment of advanced breast cancer' (NICE technology appraisal guidance 54)
-
'Taxanes for the treatment of breast cancer' (NICE technology appraisal guidance 30).
Breast cancer is the most common cancer affecting women in England and Wales, with about 40,500 new cases diagnosed and 10,900 deaths recorded in England and Wales each year. In men breast cancer is rare, with about 260 cases diagnosed and 68 deaths in England and Wales each year.[1],[2] Of these new cases in women and men, a small proportion is diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, there are a significant number of women who have been previously treated with curative intent who subsequently develop either a local recurrence or metastases. Over recent years there have been important developments in the investigation and management of patients with advanced breast cancer, including new chemotherapy, and biological and hormonal agents. There is some evidence of practice variation across the country and of patchy availability of certain treatments and procedures. This clinical guideline helps to address these issues and offers guidance on best practice.
Drug recommendations
The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.
This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information. Where recommendations have been made for the use of drugs outside their licensed indications ('off-label use'), these drugs are marked with a footnote in the recommendations.
[1] Office for National Statistics (2008) Cancer statistics registrations: registrations of cancer diagnosed in 2005, England. Series MB1 number 36. London: Office for National Statistics.
[2] Welsh Cancer Intelligence and Surveillance Unit (2008) Cancer incidence in Wales 1992−2002. Cardiff: Welsh Cancer Intelligence and Surveillance Unit.