Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

The American College of Chest Physicians (ACCP) proposes to update the following guideline topics from the 2007 publication on the Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition).1

1. Solitary Pulmonary Nodules
2. Stage I and II
3. Stage IIIA
4. Stage IIIB
5. Stage IV
6. Diagnosis and Management of Lung Cancer: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (2nd Edition) CHEST 2007; 132(suppl): 1S-422S http://www.chestjournal.org/content/vol132/3_suppl/

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

There are a variety of treatment choices that are dependent on the stage, patients' genomic profile, and values and preferences. In addition to the major treatment modalities (surgery, radiation, and chemotherapy), the selection of chemotherapeutics is growing rapidly. Comparisons should include the modalities and specific treatment options for various subgroups of patients, based on biomarkers, location and spread of tumors, and other defining characteristics.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Patients with non-small cell lung cancer (NSCLC) at the various stages (I, II, IIIA, IIIB, and IV), as well as patients for whom a single nodule has been detected by chest radiograph or CT scan

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Subgroups analyses could include nodule size (for unconfirmed nodules) and for diagnosed NSCLC should include cell type, pathologic stage, tumor location, nodal involvement, presence and location of metastatic disease, presence or absence of specific biomarkers, and physical status.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improved cure rates, recurrence-free or overall survival rates, symptom palliation, and improvement in quality of life

Describe any health-related risks, side effects, or harms that you are concerned about.

For the SPN topic, the risk of missed or delayed diagnoses. For the treatment topics, there is a risk of side effects related to chemotherapy or radiation therapy (eg, nausea, vomiting, fatigue, hair loss, radiation toxicity), surgical site bleeding, lung puncture, reduced pulmonary function, or operative mortality.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

None

Importance

Describe why this topic is important.

Lung cancer is a leading cause of cancer deaths in both men and women in the US resulting in more deaths than those attributable to the next four most common cancers combined (colon, breast, pancreas, and prostate). Despite continuing advances, survival rates are poor. However, promising new evidence shows significant mortality benefit in select clinical situations and treatment options that have advanced since the last edition of these guidelines was published.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The ACCP published the Diagnosis and management of lung cancer: ACCP evidence-based clinical practice guidelines in 2007. Since that time, a number of new studies have been published that impact on the main areas which are being proposed for updating. A complete and systematic evidence review would inform the development of these updated evidence-based recommendations.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Physicians cannot keep abreast of the research that is advancing the field so rapidly with increasing treatment options at each stage of the disease. Selection of therapies can now be based on personal genetic markers.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The ACCP intends to develop evidence-based clinical practice guidelines on this topic, which will be submitted to the journal CHEST for consideration for publication. Additional dissemination efforts will facilitate implementation of these recommendations in various media and venues.

Describe the timeframe in which an answer to your question is needed.

ACCP has begun the updating of these guidelines and we are targeted to have the first draft manuscripts and recommendations for the other PICO questions completed by late fall 2011. If the new evidence tables or profiles could be made available to the guideline panel members by October 1, 2012, it would facilitate the progress of the entire set of guidelines.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Lung cancer incidence rates are high among African-American men and have become a major health issue for women. Patients with lung cancer who are not able to obtain care from experienced clinicians, (whether due to geographic location, mobility restrictions, costs, or access) may not receive the latest evidence-based treatments resulting in disparities and inequities.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The ACCP intends to develop evidence-based clinical practice guidelines on this topic, which will be submitted to the journal CHEST for consideration for publication. Additional dissemination efforts will facilitate implementation of these recommendations in various media and venues.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

ACCP has partnered with the AHRQ Effective Health Care Program many times

previously. This particular topic was discussed with the Duke Evidence-Based Practice Center, who has been selected by AHRQ to complete pulmonary and cardiovascular CERs.