BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPEregional discrepancies by establishing national benchmarks. A high-quality, evidence-based clinical
guideline will cover the continuum of care, ranging from screening and early detection through to
diagnosis, treatment and psychological support, as well as supportive and palliative care. Ideally,
guidelines will also describe the working of multidisciplinary care teams and ensure that there is a role
for patient involvement, for example through shared decision-making. To this end, including patient
organisations in the development of clinical guidelines can help to prioritise what matters to the
patient and identify issues that may otherwise be overlooked by health professionals.
Our analysis of national lung cancer guidelines revealed significant variation in both quality and
coverage. Recognition of the mental burden and ways to access psychological support were often
lacking. Similarly, although lung cancer is a disease that needs to be addressed with urgency, many
guidelines did not adequately describe fast-tracking of suspected patients or set out a specific
timeframe within which a diagnostic referral should be made. Also, guidelines often did not include a
pathway for rapid referral for patients to obtain secondary or tertiary care.
A 2014 review of 56 European lung cancer guidelines found that, while the guidelines covered
showed some areas of duplication, they differed markedly in scope and content.^26 Five years later, we
draw a similar conclusion. Each country we analysed uses lung cancer clinical guidelines and all of these
discuss diagnosis and treatment. However, only seven countries’ guidelines discuss shared decision-
making: Austria, France, the Netherlands, Norway, Romania, Sweden and the UK. Ten of eleven
countries’ guidelines discuss supportive and palliative care; Belgium’s does not. Screening is only
discussed in guidelines produced by six of the eleven countries—Finland, the Netherlands, Norway,
Poland, Romania and Sweden—although discussion of screening in the guidelines does not necessarily
mean that the country has a national screening programme.
Fresh thinking: opportunities for
improvementKeeping plans up to date. Lung cancer is a
complex, fast-moving area of research, with new
technologies constantly coming on-line. Although
drawing up a high-quality plan may seem a
substantial investment, to be effective plans need
to be kept up to date and periodically refreshed or
replaced.
Implementation of plans. Most countries
did not discuss how their plans were going to be
funded. Such an omission puts implementation atrisk, particularly during times of austerity. Funding
for a national cancer control plan should be both
sufficient and ring-fenced to ensure that the plan
can meet its objectives. An implementation and
evaluation framework should also be included.
The patient voice in the development of
guidelines. The fact that shared decision making
and psychological support was missing in many
countries’ guidelines suggest that the patient voice
is not being heard. Patient involvement in the
development of guidelines will help ensure they
remain focussed on their primary goal: the delivery
of high-quality, patient-centred care.