Cancer Guidelines Database

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of these patients. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This is a clinical practice guideline for patients with limited-stage (LS) and extensive-stage (ES) small cell lung cancer (SCLC). The guideline examines thoracic radiation therapy (RT) and prophylactic cranial irradiation (PCI) for these patients, including indications, appropriate dose-fractionation schedules, techniques and timing. Stereotactic body radiation therapy (SBRT) for stage I and II node-negative SCLC is also discussed.

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of these patients. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This is a clinical practice guideline for patients with neuroendocrine or adrenal tumours. The guideline discusses the diagnosis, staging, treatment, and follow-up of patients with sporadic neuroendocrine tumours, originating from organs such as the lungs, thymus, and gastrointestinal (GI) tract. The guideline also examines the role of the genetic syndrome, multiple endocrine neoplasia (MEN), in developing parathyroid, pituitary, and pancreatic tumours.

This is a clinical practice guideline on the role of bronchoscopy during the COVID-19 pandemic, including for the diagnosis, staging, or characterization of known or suspected lung cancer. The guideline focuses on the optimal protection of patients and healthcare workers in these settings. The use of personal protective equipment by healthcare workers, and COVID-19 testing in patients undergoing bronchoscopy, are discussed, as is the timing of bronchoscopy in patients with a high suspicion of lung cancer. The impact of delayed care on the survival of lung cancer patients is also considered.

This is a clinical practice guideline for patients with stage IV non-small cell lung cancer (NSCLC) without effectively targeted driver alterations. The guideline examines systemic therapy treatment options that are available for this patient population, taking into consideration the subtype of cancer. Treatment options discussed include single-agent pembrolizumab, pembrolizumab/carboplatin/pemetrexed, and atezolizumab/carboplatin/nab-paclitaxel.

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of these patients. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This clinical practice guideline is an endorsement of the National Institute for Health and Care Excellence and the Society for Immunotherapy of Cancer's guidelines for the treatment of patients with non-small cell lung cancer (NSCLC). The guideline specifically examines different treatment options for patients with clinical stage III N2 NSCLC. Primary outcomes of interest include overall survival and quality of life.

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of lung cancer. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This is a clinical practice guideline for patients with stage IV non-small cell lung cancer. The guideline provides recommendations for the treatment of these patients using chemotherapy, including first-line and second-line options. Recommendations are separated based on the patient's level of programmed death-ligand 1 (PD-1) expression, and whether or not they are driver oncogene-positive.

This is a clinical practice guideline for adult patients with lung cancer. Key areas discussed include screening and early detection, diagnostic procedures for non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), staging, and management strategies. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.

This is a clinical practice guideline for patients with non-small cell or small cell lung cancer. The guideline provides recommendations on diagnosis, management, follow-up, and palliative care for these patients. Outcomes of interest include length of stay in hospital and intensive care units, quality of life, and overall survival.

This is a clinical practice guideline for patients with lung cancer, especially adenocarcinoma. The guideline examines low-dose CT (LDCT) screening of these patients, including the accuracy of LDCT protocols and imaging modalities, and the benefits and risks of LDCT. Risk factors, nonsolid nodules, cost-effectiveness, and the selection of individuals for screening based on risk factors are also discussed.

This is a clinical practice guideline for pediatric and adult patients with primary lung cancer. The guideline provides recommendations regarding various radiological procedures used in initial clinical staging of non-small cell lung cancer and small cell lung cancer. The appropriateness of procedures indicated in specific clinical scenarios (measured by validity, reliability/reproducibility, clinical applicability, relative radiation levels, etc.) is examined.

This clinical practice guideline is an endorsement of the National Institute for Health and Care Excellence's 2019 guideline titled Lung cancer: diagnosis and management. The guideline provides recommendations on prophylactic cranial irradiation and consolidative radiation for patients with small cell lung cancer.

This is a clinical practice guideline for lung cancer screening in adult patients. The guideline discusses the risk factors for lung cancer, selection of individuals for screening based on level of risk, and the benefits and risks of lung cancer screening. The accuracy of low-dose computed tomography (LDCT), multiple nonsolid nodules, and the concept of shared decision-making are also considered, along with the cost-effectiveness of screening.

This is a clinical practice guideline for malignant pleural mesothelioma (MPM). The guideline examines the clinical management options for these patients, which include surgery, radiation therapy (RT), and chemotherapy. The potential for multimodal therapy is also addressed.

This is a clinical practice guideline for patients with neuroendocrine or adrenal tumours. The guideline discusses the diagnosis, staging, treatment, and follow-up of patients with sporadic neuroendocrine tumours, originating from organs such as the lungs, thymus, and gastrointestinal (GI) tract. The guideline also examines the role of the genetic syndrome, multiple endocrine neoplasia (MEN), in developing parathyroid, pituitary, and pancreatic tumours.

This is a clinical practice guideline for patients with thymomas and thymic carcinomas. The guideline examines the diagnosis, staging, and treatment these mediastinal tumours. Surgical resection and radiation therapy are discussed as treatment options.

This is a clinical practice guideline for patients who have exposure to occupational conditions that are associated with the development of lung disease, including thoracic neoplasms. The guideline examines the appropriateness of various imaging techniques for the purposes of screening and diagnosing these patients. In addition to thoracic neoplasms, specific diseases addressed include interstitial lung disease and airway disease.

This is a clinical practice guideline on the routine follow-up and surveillance patients with stage I - III non-small cell lung cancer (NSCLC) who have completed treatment (with curative intent), are asymptomatic, and have no physical findings or laboratory abnormalities to suggest metastatic disease. The guideline examines follow-up intervals at years 1, 2, 3 and beyond, the optimal imaging surveillance modalities, recurrence, long-term side effects of curative-intent therapy, and quality of life.

This is a clinical practice guideline for patients with small cell lung cancer. The guideline examines the diagnosis, staging, prognostic factors, treatment, and surveillance of these patients. Treatment options discussed include systemic therapy, radiotherapy, and surgical resection. Systemic therapy is further examined in elderly patients, and as a second-line (and beyond) treatment. Radiotherapy treatments considered include thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy.

This is a clinical practice guideline for adults with curatively treated stage I-III non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). The guideline examines radiographic imaging and biomarker surveillance strategies for these patients. The frequency of surveillance imaging, optimal imaging modalities, patient factors that would preclude surveillance, the role of circulating biomarkers in surveillance, and the appropriateness of using magnetic resonance imaging (MRI) for NSCLC and SCLC are all specifically discussed.

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of lung cancer. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This is a clinical practice guideline for patients presenting to primary care services with signs and/or symptoms of lung cancer. The guideline examines the referral process for this patient population. Topics of interest include factors that have been shown to increase the risk of lung cancer, symptoms that should be present in a person before referral, indications for chest computed tomography (CT) scan, and follow-up to diagnostic investigations.

This is a clinical practice guideline for patients with thymomas and thymic carcinomas. The guideline examines the diagnosis, staging, and treatment these mediastinal tumours. Surgical resection and radiation therapy are discussed as treatment options.

This is a clinical practice guideline for adult patients with non-small cell lung cancer (NSCLC). The guideline examines appropriate invasive mediastinal staging of NSCLC stratified by normal sized mediastinal lymph nodes (MLNs) and enlarged discrete MLNs. Outcomes of interest include sensitivity, specificity and overall diagnostic accuracy.

This is a clinical practice guideline for patients with non-small cell lung cancer (NSCLC). The guideline provides recommendations on the use of immunotherapy as treatment for these patients, using the immune checkpoint inhibitors pembrolizumab, nivolumab and atezolizumab. Specific topics discussed include appropriate patient selection, sequencing of therapies, response monitoring, adverse event management, and biomarker testing.

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of lung cancer. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This is a clinical practice guideline for adult patients with symptomatic endobronchial disease in non-small cell lung cancer. The guideline examines the use of high dose rate endobronchial brachytherapy (HDREB) for the palliation of respiratory symptoms in these patients. Specific topics discussed include the appropriate dose of HDREB, toxicity, and fatal hemoptysis.

This is a clinical practice guideline for patients with malignant pleural mesothelioma (MPM). The guideline provides recommendations on the investigation of suspected MPM, and the subsequent care and management of individuals with proven MPM. Topics of interest include the preferred investigation pathway of suspected cases of MPM, biomarkers, and the role of different treatments including chemotherapy.

This is a clinical practice guideline for patients with small cell lung cancer. The guideline examines the diagnosis, staging, prognostic factors, treatment, and surveillance of these patients. Treatment options discussed include systemic therapy, radiotherapy, and surgical resection. Systemic therapy is further examined in elderly patients, and as a second-line (and beyond) treatment. Radiotherapy treatments considered include thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy.

This is a clinical practice guideline for patients who are at risk of developing lung cancer. The guideline examines the appropriateness of screening for lung cancer in patient populations based on their smoking history and other risk factors, including radon exposure, occupational exposure to asbestos or other carcinogens, personal history of cancer, family history of lung cancer, history of chronic obstructive pulmonary disease (COPD), and history of pulmonary fibrosis. Screening procedures discussed include chest computed tomography (CT), chest magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography / computed tomography (FDG-PET/CT) from the skull base to mid-thigh, and chest radiography. Information on relevant radiation levels for these procedures is also provided.

This is a clinical practice guideline for patients with small cell lung cancer. The guideline examines the diagnosis, staging, prognostic factors, treatment, and surveillance of these patients. Treatment options discussed include systemic therapy, radiotherapy, and surgical resection. Systemic therapy is further examined in elderly patients, and as a second-line (and beyond) treatment. Radiotherapy treatments considered include thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy.

This is a clinical practice guideline for the optimal preoperative management of patients undergoing thoracic surgery, and primarily, lung resection. Topics covered in the guideline include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anesthetics to facilitate early emergence, regional anesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery.

This is a clinical practice guideline for lung cancer screening in adult patients. The guideline discusses the risk factors for lung cancer, selection of individuals for screening based on level of risk, and the benefits and risks of lung cancer screening. The accuracy of low-dose computed tomography (LDCT), multiple nonsolid nodules, and the concept of shared decision-making are also considered, along with the cost-effectiveness of screening.

This is a clinical practice guideline for patients who have been diagnosed with or are suspected of having malignant pleural mesothelioma. Recommendations are provided on diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodal therapy. Outcomes of interest include overall survival, progression-free survival, response rate, toxicity, quality of life (QoL), surgical complications, and diagnostic accuracy.

This is a clinical practice guideline for patients with a malignant pleural effusion (MPE). The guideline provides recommendations for the management of these patients, and specifically discusses the use of thoracic ultrasound to guide pleural interventions, pleural drainage, large-volume thoracentesis and pleural manometry, among other topics. Recommendations for asymptomatic and symptomatic patients are addressed, as well as recommendations for patients with expandable lung.

This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of lung cancer. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.

This is a clinical practice guideline for patients with non-small cell lung cancer (NSCLC). The guideline examines the use of concurrent chemotherapy (CC) with palliative thoracic external beam radiation (EBRT). Patients with incurable stage 3 NSCLC and stage 4 NSCLC are considered. Outcomes of interest include overall survival, local and regional control, distant failure, toxicity, and quality of life.

This is a clinical practice guideline for asymptomatic adults. The guideline discusses the screening of lung cancer using computed tomography (CT) scans. Different recommendations are provided based on age, as well as smoking status.

This is a clinical practice guideline for adults with advanced-stage lung cancer. Recommendations are provided for the molecular analysis of lung cancers to guide treatment decisions with targeted inhibitors. The guideline examines the genes that should be tested for lung cancer patients, the methods that should be used to perform molecular testing, the appropriateness of molecular testing for lung cancers that do not have an adenocarcinoma component, the testing that is indicated for patients with targetable mutations who have relapsed on targeted therapy, and the role of testing for circulating cell-free DNA in lung cancer patients.

This is a clinical practice guideline for lung cancer screening in adult patients. The guideline discusses the risk factors for lung cancer, selection of individuals for screening based on level of risk, and the benefits and risks of lung cancer screening. The accuracy of low-dose computed tomography (LDCT), multiple nonsolid nodules, and the concept of shared decision-making are also considered, along with the cost-effectiveness of screening.

This is a clinical practice guideline for patients with neuroendocrine or adrenal tumours. The guideline discusses the diagnosis, staging, treatment, and follow-up of patients with sporadic neuroendocrine tumours, originating from organs such as the lungs, thymus, and gastrointestinal (GI) tract. The guideline also examines the role of the genetic syndrome, multiple endocrine neoplasia (MEN), in developing parathyroid, pituitary, and pancreatic tumours.

This is a clinical practice guideline for malignant pleural mesothelioma (MPM). The guideline examines the clinical management options for these patients, which include surgery, radiation therapy (RT), and chemotherapy. The potential for multimodal therapy is also addressed.

This guideline provides recommendations on use of vertebroplasty or kyphoplasty as treatment options for cancer patients with vertebral compression fractures. The guideline outlines clinical criteria for when vertebroplasty, kyphoplasty, or focal tumour ablation (FTA) assisted vertebroplasty/kyphoplasty should be performed, and provides recommendations on selecting the most appropriate procedure. The role of radiation treatment, absolute contraindications, and service provider requirements are also discussed.

This is a clinical practice guideline for the use of stereotactic body radiation therapy (SBRT) for patients with early-stage non-small cell lung cancer (NSCLC). The guideline examines the evidence for SBRT for early-stage NSCLC and offers guidance towards its use in challenging clinical scenarios. Outcomes of interest include survival, quality of life, toxicity, pain, and other adverse events.

This is a clinical practice guideline discussing adjuvant therapy for adult patients with non-small cell lung cancer (NSCLC). The guideline specifically examines the appropriateness of adjuvant systemic therapy versus adjuvant radiation therapy in adults with completely resected stage I-IIIA NSCLC. Recommendations are made based on disease stage, as well as other factors such as tumour size, genetics, and histology.

This is a clinical practice guideline for adult patients with clinical or pathological stage III non-small cell lung cancer (NSCLC). The guideline provides recommendations for the treatment of NSCLC by comparing treatment options such as chemotherapy, radiotherapy, and surgery. Outcomes of interest include adverse effects, overall survival, progression-free survival, quality of life, and local control.

This clinical practice guideline is an endorsement of the American Society for Radiation Oncology's 2017 guideline titled Evidence-Based Guideline for Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer. The endorsement examined new evidence and modified the guideline recommendations on the use of SBRT. Shared decision-making and implementation are discussed. Outcomes of interest include survival, quality of life, toxicity, pain and other adverse events.

This is a clinical practice guideline for adult patients with lung cancer who have been treated with surgery or systemic anti-cancer treatment such as chemotherapy or (external-beam) radiotherapy. The guideline provides recommendations for the symptomatic management of persistent, bothersome cough among theses patients. Multiple options for reducing cough are discussed, based on the etiology of the cough and the patient's response to various treatments.

This is a clinical practice guideline for patients with lung cancer. The guideline examines techniques used in high-precision thoracic radiotherapy for treating these patients. Topics of interest include fractionation for stereotactic body radiotherapy (SBRT), reproducibility of patient positioning and tumour position, computed tomography (CT) scanning, and treatment planning.

This is a clinical practice guideline for patients with stage IV non-small-cell lung cancer (NSCLC). The guideline provides recommendations on systemic therapy options for NSCLC such as standard chemotherapy, immune checkpoint therapy, antibody therapy and other drug classes and treatment settings. Outcomes of interest include therapeutic efficacy, adverse effects, overall survival and quality of life. The guideline also discusses health disparities and multiple chronic conditions and provides recommendations on managing these barriers.

This is a clinical practice guideline for lung cancer screening in adult patients. The guideline reviews risk factors for lung cancer and provides recommendations on selecting high-risk individuals for screening, guidance on choice of screening modalities with specific review of low dose computed tomography (LDCT), and recommendations on the evaluation and follow-up of nodules found during screening. Additionally, the benefits and risks of screening are discussed.

A clinical practice guideline for the treatment of small cell and non-small cell lung cancer. The guideline examines treatment options for multiple stages of these two cancer modalities, including surgical and non-surgical procedures. Palliative, supportive, and psychological care for lung cancer patients are also discussed. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of April 23, 2018.

This is a clinical practice guideline for adults with non-resected limited stage and extensive stage small cell lung cancer who can safely receive definitive radiation. The guideline examines thoracic radiotherapy and first-line chemotherapy as treatment options for these patients. The recommendations are tailored to patients' stage of cancer, and consider optimal timing of each treatment option, whether treatment should be sequential or concurrent, and appropriate dose or treatment regimen.

This is a clinical practice guideline for adults (aged 18 and older) at any phase of the cancer care continuum regardless of cancer type, stage (including metastatic) or treatment plan, with some components of the guideline also applicable to the patient's family and/or caregivers. Recommendations are provided on implementation of the brief tobacco intervention using the evidence-based AAR Brief Tobacco Intervention Model which includes screening, education and assessment, treatment plan, and referral, monitoring, and follow-up. The 2015 guideline was revised in June 2016 to abbreviate the cessation intervention model to best support adoption across all CCA clinics and settings. Clinical considerations and contraindications of treatment options for cancer patients are discussed including nicotine replace therapy (NRT), bupropion, varenicline, and e-cigarettes, and the impact of tobacco use on cancer treatment is reviewed with a specific focus on erlotinib and irinotecan.

This is a clinical practice guideline for the use of myeloid growth factors in adult patients with solid tumours and non-myeloid malignancies. Benefits and risks are reviewed, the role of biosimilars is discussed, and recommendations are provided for prophylactic and therapeutic uses of both granulocyte and granulocyte-macrophage colony stimulating factors (CSFs). Recommendations are also given regarding the use of CSFs in the hematopoietic cell transplant setting. Outcomes of interest include efficacy of CSFs, mortality, length of hospitalization, toxicity, and adverse effects.

This is a clinical practice guideline for adult patients with non-small cell lung cancer. The guideline provides updated recommendations around prevention and screening, evaluation and staging, treatment, and follow up care. Areas of focus are discussed with recognition that much progress has been made in regards to screening, minimally invasive techniques for diagnosis and treatment, advances in radiation therapy (RT) including stereotactic ablative radiotherapy (SABR), and targeted therapies.

This is a clinical practice guideline for patients undergoing endobronchial ultrasound (EBUS) for the real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The guideline discusses the technical aspects of linear EBUS-TBNA, including patient factors (e.g. sedation), procedural aspects (e.g. ultrasonographic features of lymph nodes, needle size, number of needle passes, use of suction, and presence of rapid on-site cytologic evaluation), and proceduralists' aptitude (i.e. training) are specifically addressed.

A clinical practice guideline for lung cancer screening of adults at high risk. The guideline examines computed tomography screening and screening intervals, and criteria for high risk screening. Outcomes of interest include reduction in harms from chest radiography and improved screening economy.

This is a clinical practice guideline for the investigation and diagnosis of suspected lung cancer and referral for treatment, particularly for patients residing in Nova Scotia. The guideline reviews the investigation process from initial presentation to treatment referral. Topics include principles of communication between patient-provider and among providers throughout the diagnostic process, standards for initial investigation, appropriate use of imaging (CT, MRI, PET, bone scan) and biopsy and laboratory testing, as well as recommendations regarding treatment referral upon diagnosis. Referrals to diagnostic specialists (thoracic surgery or respirology) and to psychosocial and supportive care are also reviewed.

This is a clinical practice guideline for the treatment of advanced non-small cell lung cancer (NSCLC). The guideline examines the efficacy of different therapies including chemotherapy and immune checkpoint inhibitors. Outcomes of interest include overall survival, progression-free survival, quality of life, toxicity, and response rate.

This is a clinical practice guideline for small cell lung cancer and lung neuroendocrine tumours. Diagnosis, staging, prognostic factors, treatment and surveillance are reviewed. Treatment options include chemotherapy, with special topics of discussion including elderly patients and second- and third-line therapies, radiotherapy (thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy), and surgery. Outcomes of interest include survival (disease free, overall, progression-free), response rates, and treatment toxicity.

The guideline provides recommendations for management and treatment of patients 18 years of age and older who have malignant superior vena cava obstruction (SVCO) or airway obstruction, compression, or invasion, or those experiencing hemoptysis. The course of management is dependent on symptoms, primary histology, urgency of histology, previous treatment, and access to resources. External beam radiotherapy (EBRT), endobronchial brachytherapy, chemotherapy, radiotherapy, bronchoscopic debulking, surgical resection, photodynamic therapy, and Neodymium-doped yttrium aluminum garnet (Nd:YAG) are discussed as treatment options. For superior vena cava obstruction, external beam radiation EBRT, RT dose fractionation, SVC stent insertion, steroids, and palliative intent chemotherapy are discussed.

This is a clinical practice guideline for adult patients with potentially curable, early stage (Stage I or II) NSCLC (without nodal involvement or metastases), and who are deemed medically inoperable or refuse surgery. The guideline provides discusses the use of stereotactic body radiation therapy (SBRT)/stereotactic ablative radiation therapy with curative intent and provides recommendations on fractionation schemes. Outcomes of interest include tumour control and survival as well as toxicity.