Managing patients with lung cancer

New guidelines should improve standards of care

Lung cancer is the commonest cancer in the United Kingdom and also the commonest cause of death from cancer, with around 37 000 deaths each year.1 Despite this, it remains the Cinderella of common solid tumours, and because most patients are elderly and eventually succumb to the disease the management of patients is often afflicted by an unjustified sense of therapeutic nihilism. Both within and between countries there is greater variation in clinical practice and outcomes for patients with lung cancer than can be justified by factors such as case mix alone,2 3 suggesting that clinicians use different information to inform treatment decisions. Evidence based clinical practice guidelines such as those recently published by the Royal College of Radiologists' clinical oncology information network (COIN) for the non-surgical management of lung cancer,4 and similar guidelines produced by other organisations,5 6 should help clinicians make better decisions, thereby reducing inappropriate variation and improving patient care.

The COIN guidelines identify the most important clinical questions in the management of patients with lung cancer and make recommendations about these as well as the process of patient care. They are not prescriptive, but should guide clinicians in making relevant interventions. The strength of the evidence for the effectiveness of given interventions is summarised, making the rationale behind recommendations understandable. The guidelines identify those patients who are most likely to benefit from a particular intervention and indicate where …