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Journal of Thoracic Oncology:
doi: 10.1097/01.JTO.0000283174.88857.1c
Profferred Paper Abstracts: Session B6: Health Services, Supportive Care & QOL: Tuesday, September 4: Health Services, Supportive Care & QOL, Tue, 13:45 - 15:30

Developing clinical guidelines on lung cancer for limited resource settings: an international collaboration supported by the International Atomic Energy Agency (IAEA): B6-01

MacBeth, Fergus1; Cho, Kwan2; Abratt, Raymond3; Stephens, Richard4; Jeremic, Branislav5

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1 Velindre Cancer Centre, CARDIFF, UK 2 National Cancer Centre, Goyang, Korea 3 Groote Schurr Hospital, Cape Town, South Africa 4 MRC Cancer Trials Unit, London, UK 5 International Atomic Energy Agency, Vienna, Austria

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Introduction:

Lung cancer is an increasing problem in developing countries, where access to medical resources may be limited. It is crucial that care in these settings makes most effective and cost effective use of those resources, based on good evidence. Clinical guideline recommendations from developed countries are not likely to be always (or ever) appropriate and so a different approach is needed.

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Methods:

An international panel, with a special interest in lung cancer, was invited to a meeting organised by the IAEA in March 2006, at which the main approaches were drafted. Reference was made to recent English language evidence-based clinical guidelines and to other recent systematic reviews, meta-analyses and research. Drafts were then circulated sequentially around the group members, a telephone conference held and a final version approved. We assumed that baseline resources for diagnosis (including CT scanning), radical surgery, radiotherapy (RT) with at least 60Co and 2D planning and IV cisplatin-based combination chemotherapy (CT) would be available. Tables were constructed that showed a baseline standard treatment for different patient groups and the additional benefits, risks and resource use from additional treatment options. Accompanying text summarised the evidence and justification for these options.

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Results:

Six tables were devised entitled:

1. Options for patients with limited disease SCLC and good prognosis

2. Options for patients with operable NSCLC

3. RT options for patients with medically inoperable NSCLC (Stage I and II)

4. Options for patients with inoperable ‘small' volume NSCLC (‘Favourable' Stage III)

5. Options for palliative thoracic RT

6. Options for patients with ‘unfavourable' Stage III and Stage IVdisease and WHO PS 0 or 1.

A comprehensive list of 65 relevant references to current clinical guidelines, systematic reviews and primary research was included.

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Discussion:

We believe that this is an innovative approach to guideline development because it not only summarises the research evidence but makes clear the additional resource use and risks as well as benefits of treatment options. This would enable people to make local decisions about best use of their resources or to develop more sophisticated cost effectiveness models for their local health services. It will also allow those without even the baseline resources to lobby for their provision.

Copyright © 2007 by the European Lung Cancer Conference and the International Association for the Study of Lung Cancer.

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