- Describe your topic.
- We are suggesting the following PICO questions pertaining to Methods for Staging Non-small Cell Lung Cancer. 1. In patients with (non-small cell) lung cancer, how accurate is CT scanning for staging the mediastinum? 2. In patients with (non-small cell) lung cancer, how accurate is PET scanning for staging the mediastinum? 3. In patients with (non-small cell) lung cancer, how accurate is EUS-NA for staging the mediastinum? 4. In patients with (non-small cell) lung cancer, how accurate is EBUS-NA for staging the mediastinum? 5. In patients with (non-small cell) lung cancer, how accurate is mediastinoscopy (cervival and extended cervival mediastinoscopy, and anterior mediastinotomy) for staging the mediastinum? 6. In patients with NSCLC, how accurate is VATS for stating the mediastinum? 7. In patients with NSCLC, how accurate is TBNA for stating the mediastinum? 8. In patients with NSCLC, how accurate is TTNA for stating the mediastinum?
- Describe why this topic is important.
- In patients in whom non-small cell lung cancer (NSCLC) has been demonstrated or is strongly suspected, consideration must turn toward determining the extent of the disease, or its stage, because this will impact directly on the management and prognosis. The first step is to identify whether the patient has distant metastatic disease or tumor confined to the chest, to determine whether treatment should be aimed at palliation or at potential cure. Clinical evaluation and CT scan provide an initial presumptive definition of the clinical stage, but in most cases the initial clinical stage must be confirmed with further tests. Many different tests are available, and selection of the right tests and their sequence has a major impact on how accurately and efficiently the patient’s true clinical stage is determined. Accurate staging of lung cancer is of paramount importance given the markedly different treatment options and prognosis for any given stage. Despite this, data have shown that the staging evaluation has often been carried out very poorly, as it has been reported that only 30% of patients receive bimodality staging (CT scan plus PET scan or CT scan plus invasive staging), and 5% receive trimodality staging (CT, PET, and invasive staging).1-3 This is in spite of the fact that guidelines for many years have called for bimodality or trimodality staging in the majority of patients. Lack of using the appropriate staging modality has resulted in adverse health outcomes as evidence by those who underwent bimodality and trimodality staging having a significantly lower risk of death (hazard ratio, 0.58; 99% CI, 0.56-0.60; tri- vs single-modality: hazard ratio, 0.49; 99% CI, 0.45-0.54). Because of this, there can be little doubt that basing treatment decisions on poorly executed staging evaluations may well lead to suboptimal treatment and worse outcomes. 1Farjah F , Flum DR , Ramsey SD , Heagerty PJ , Symons RG , Wood DE . Multi-modality mediastinal staging for lung cancer among medicare benefi ciaries . J Thorac Oncol . 2009 ; 4 ( 3 ): 355 - 363 . 2Little AG , Rusch VW , Bonner JA , et al . Patterns of surgical care of lung cancer patients . Ann Thorac Surg . 2005 ; 80 (6): 2051 - 2056 . 3Tsang GM , Watson DC . The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer . Thorax . 1992 ; 47 ( 1 ): 3 - 5.
- Tell us why you are suggesting this topic.
- Lung Cancer Staging has been the focus of 3 editions of evidence-based guidelines developed by the American College of Chest Physicians (CHEST), the last of which was published in 2013 and accepted by the National Guideline Clearinghouse. CHEST aims to update its guidelines every 5 years per the National Academy of Medicine (formerly IOM) and AHRQ standards, but due to increased demand for guidelines, has fallen short on this objective. Development of an evidence review on at least some, if not all, of the PICO’s described above would serve as the source document to facilitate the update of these guidelines.
- Target Date.
- 2019-09-01
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- Evidence reports form the basis of all CHEST clinical practice guidelines. If this topic is selected for an AHRQ evidence report, the results of that report will directly inform an update of the guideline on Methods for Staging Non-small Cell Lung Cancer. The original selection of this topic was due to professional demand based on inconsistent or lack of clear guidance based on current evidence. CHEST guidelines have been touted as a useful tool to assist in clinical decision-making, resulting in improved concordance between practice and the larger body of published evidence. In order to meet the National Academy of Medicine (formerly IOM) standards, it is imperative that an updated evidence report be developed to update the guidelines.
- How will you or your group use the information from a new evidence report?
- The evidence report will be directly used to inform the update of evidence-based guidelines on this topic.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The report will be disseminated in the following ways: 1) communications to CHEST membership (nearly 19,000 healthcare providers) via electronic (ie eNews Alerts), print (ie CHEST Physician Newsletter), and social media. There will also be opportunities to inform providers about the report through our eLearning and Live Learning platforms, including our Annual Conference. Finally, the report will be referenced as the source document for the subsequent update of the guideline, furthering dissemination of the report as well as use of its contents in clinical practice.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- CHEST serves as the primary organization that will directly use this evidence report to update our clinical practice guideline on Methods for Staging Non-small Cell Lung Cancer. Such guidelines have the opportunity to change clinical practice by improving clinical decisions in concordance with current evidence. Other organizations that would also benefit from this evidence report include: the American Thoracic Society, the American Society for Clinical Oncology and the American Lung Association.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- The American College of Chest Physicians (CHEST) is a professional society, and is the global leader in advancing best patient o
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- American College of CHEST Physicians
- Please tell us how you heard about the Effective Health Care Program.
- CHEST has collaborated with AHRQ in the past on evidence reviews, most recently the Venous Thromboembolism Prophylaxis in Orthop
