Lung cancer: diagnosis and management

Provide palliative radiotherapy, either as symptoms arise or immediately, for people who are eligible and cannot have curative treatment. [2005]

When people have large airway involvement, monitor (clinically and radiologically) for endobronchial obstruction to ensure treatment is offered early. [2011]

Offer external beam radiotherapy and/or endobronchial debulking or stenting to people with impending endobronchial obstruction. [2011]

Every cancer alliance should ensure that people have rapid access to a team capable of providing interventional endobronchial treatments. [2011]

Perform pleural aspiration or drainage in an attempt to relieve the symptoms of a pleural effusion. [2005]

Offer talc pleurodesis to people who would experience long-term symptomatic benefit from aspiration or drainage of fluid. [2005]

Consider non-pharmacological interventions that are based on psychosocial support, breathing control and coping strategies for people with breathlessness. [2005]

Non-pharmacological interventions for breathlessness should be delivered by a multidisciplinary group, coordinated by a professional with an interest in breathlessness and expertise in the techniques (for example, a nurse, physiotherapist or occupational therapist). Although this support may be provided in a breathlessness clinic, people should have access to it in all care settings. [2005]

Consider opioids, such as codeine or morphine, to reduce cough. [2005]

Refer people with troublesome hoarseness due to recurrent laryngeal nerve palsy to an ear, nose and throat specialist for advice. [2005]

For people who present with superior vena cava obstruction, offer chemotherapy and radiotherapy based on the stage of disease and performance status. [2005]

Consider stent insertion for the immediate relief of severe symptoms of superior vena caval obstruction or following failure of earlier treatment. [2005]

Offer dexamethasone to people with symptomatic brain metastases and reduce to the minimum necessary maintenance dose for symptomatic response. [2011]

For guidance on management of brain metastases, see the section on management of confirmed brain metastases in the NICE guideline on brain tumours. [2019]

Offer single-fraction radiotherapy to people with bone metastasis who need palliation and for whom standard pain relief is inadequate. [2005]

Denosumab is recommended as an option for preventing skeletal-related events in adults with bone metastases from breast cancer and from solid tumours other than prostate if bisphosphonates would otherwise be prescribed. For full details, see NICE's technology appraisal guidance on denosumab (TA265, 2012).

Other symptoms, including weight loss, loss of appetite, depression and difficulty swallowing, should be managed by multidisciplinary groups that include supportive and palliative care professionals. [2005]