肺癌患者初始评估的临床和组织学因素：肺癌的诊断和治疗，第 3 版：美国胸科医师学会循证临床实践指南。
Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
机构信息
Department of Pulmonary Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX.
Department of Emergency Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX; Department of Endocrine, Neoplasia & Hormonal Disorders, MD Anderson Cancer Center, The University of Texas, Houston, TX.
出版信息
Chest. 2013 May;143(5 Suppl):e121S-e141S. doi: 10.1378/chest.12-2352.
BACKGROUND
This guideline is intended to provide an evidence-based approach to the initial evaluation of patients with known or suspected lung cancer. It also includes an assessment of the impact of timeliness of care and multidisciplinary teams on outcome.
METHODS
The applicable current medical literature was identified by a computerized search and evaluated using standardized methods. Recommendations were framed using the approach described by the Guidelines Oversight Committee of the American College of Chest Physicians. Data sources included MEDLINE and the Cochrane Database of Systematic Reviews.
RESULTS
Initial evaluation should include a thorough history and physical examination; CT imaging; pulmonary function tests; and hemoglobin, electrolyte, liver function, and calcium levels. Additional testing for distant metastases and paraneoplastic syndromes should be determined on the basis of these results. Paraneoplastic syndromes may have an adverse impact on cancer treatment, so they should be controlled rapidly with the goal of proceeding with definitive cancer treatment in a timely manner. Although the relationship between timeliness of care and survival is difficult to quantify, efforts to deliver timely care are reasonable and should be balanced with the need to attend to other dimensions of health-care quality (eg, safety, effectiveness, efficiency, equality, consistency with patient values and preferences). Quality care will require multiple disciplines. Although it is difficult to assess the impact, we suggest that a multidisciplinary team approach to care be used, particularly for patients requiring multimodality therapy.
CONCLUSIONS
The initial evaluation of patients with lung cancer should include a thorough history and physical examination, pulmonary function tests, CT imaging, basic laboratory tests, and selective testing for distant metastases and paraneoplastic syndromes.
背景
本指南旨在提供一种基于循证医学的方法，用于评估已知或疑似肺癌患者。它还包括评估及时性护理和多学科团队对结果的影响。
方法
通过计算机搜索确定适用的当前医学文献，并使用标准化方法进行评估。建议采用美国胸科医师学院指南监督委员会描述的方法制定。数据源包括 MEDLINE 和 Cochrane 系统评价数据库。
结果
初始评估应包括全面的病史和体格检查；CT 成像；肺功能检查；以及血红蛋白、电解质、肝功能和钙水平。应根据这些结果确定对远处转移和副肿瘤综合征的进一步检测。副肿瘤综合征可能对癌症治疗产生不利影响，因此应迅速控制，以便及时进行确定性癌症治疗。虽然及时性护理与生存之间的关系难以量化，但及时护理的努力是合理的，并且需要与关注医疗保健质量的其他方面（例如安全性、有效性、效率、公平性、一致性与患者价值观和偏好）相平衡。高质量的护理将需要多个学科。尽管评估其影响具有挑战性，但我们建议采用多学科团队的方法进行护理，特别是对于需要多模式治疗的患者。
结论
肺癌患者的初始评估应包括全面的病史和体格检查、肺功能检查、CT 成像、基本实验室检查以及对远处转移和副肿瘤综合征的选择性检测。
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