Department of Surgery, University of Washington, Seattle, Washington, USA.
Division of Pulmonary and Critical Care Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Cancer. 2024 Dec 15;130(24):4167-4176. doi: 10.1002/cncr.34627. Epub 2024 Sep 30.
Accurate staging improves lung cancer survival by increasing the chances of delivering stage-appropriate therapy. However, there is underutilization of, and variability in, the use of guideline-recommended diagnostic tests used to stage lung cancer. Consequently, the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) convened the Triage for Appropriate Treatment Task Group-a multidisciplinary expert and stakeholder panel-to identify knowledge and/or resource gaps contributing to guideline-discordant staging and make recommendations to overcome these gaps. The task group determined the following: Gap 1: facilitators of and barriers to guideline-concordant staging are incompletely understood; Recommendation 1: identify facilitators of and barriers to guideline-concordant lung cancer staging; Gap 2: the level of evidence supporting staging algorithms is low-to-moderate; Recommendation 2: prioritize comparative-effectiveness studies evaluating lung cancer staging; Gap 3: guideline recommendations vary across professional societies; Recommendation 3: harmonize guideline recommendations across professional societies; Gap 4: existing databases do not contain sufficient information to measure guideline-concordant staging; Recommendation 4: augment existing databases with the information required to measure guideline-concordant staging; Gap 5: health systems do not have a performance feedback mechanism for lung cancer staging; Recommendation 5: develop and implement a performance feedback mechanism for lung cancer staging; Gap 6: patients rarely self-advocate for guideline-concordant staging; Recommendation 6: increase opportunities for patient self-advocacy for guideline-concordant staging; and Gap 7: current health policies do not motivate guideline-concordant lung cancer staging; Recommendation 7: organize a representative working group under the ACS NLCRT that promotes policies that motivate guideline-concordant lung cancer staging. PLAIN LANGUAGE SUMMARY: Staging-determining the degree of cancer spread-is important because it helps clinicians choose the best cancer treatment. Receiving the best cancer treatment leads to the best possible patient outcomes. Practice guidelines are intended to help clinicians stage patients with lung cancer. However, lung cancer staging in the United States often varies from practice guideline recommendations. This report identifies seven opportunities to improve lung cancer staging.
准确的分期可以通过增加提供适合分期的治疗的机会来提高肺癌患者的生存率。然而，指南推荐的用于分期肺癌的诊断检测的应用不足且存在差异。因此，美国癌症协会国家肺癌圆桌会议（ACS NLCRT）召集了适当治疗分类任务组 - 一个多学科专家和利益相关者小组 - 以确定导致与指南不一致的分期的知识和/或资源差距，并提出克服这些差距的建议。该任务组确定了以下内容：差距 1：不完全了解促进和阻碍与指南一致的分期的因素；建议 1：确定促进和阻碍与指南一致的肺癌分期的因素；差距 2：支持分期算法的证据水平低至中等；建议 2：优先进行评估肺癌分期的比较效果研究；差距 3：专业协会之间的指南建议存在差异；建议 3：协调专业协会之间的指南建议；差距 4：现有数据库不包含足够的信息来衡量与指南一致的分期；建议 4：用衡量与指南一致的分期所需的信息来扩充现有数据库；差距 5：卫生系统没有肺癌分期的绩效反馈机制；建议 5：为肺癌分期开发和实施绩效反馈机制；差距 6：患者很少自行倡导与指南一致的分期；建议 6：增加患者自行倡导与指南一致的分期的机会；差距 7：现行卫生政策不能激励与指南一致的肺癌分期；建议 7：在 ACS NLCRT 下组织一个代表工作组，促进激励与指南一致的肺癌分期的政策。
