NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

Transcription

1 bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest version of this pathway see: Pathway last updated: 10 January 2017 This document contains a single pathway diagram and uses numbering to link the boxes to the associated recommendations. All rights reserved

2 Page 2 of 10

3 1 Person aged 18 or over with lung cancer No additional information 2 Providing supportive and palliative care Supportive and palliative care of the patient should be provided by general and specialist palliative care providers in accordance with the NICE cancer service guideline on improving supportive and palliative care for adults with cancer. Patients who may benefit from specialist palliative care services should be identified and referred without delay. Other symptoms, including weight loss, loss of appetite, depression and difficulty swallowing, should be managed by multidisciplinary groups that include supportive and palliative care professionals. NICE has produced pathways on opioids for pain relief in palliative care and nutrition support in adults. See also the NICE guideline on care of dying adults in the last days of life. 3 Palliative radiotherapy Patients who cannot be offered curative treatment, and are candidates for palliative radiotherapy, may either be observed until symptoms arise and then treated, or be treated with palliative radiotherapy immediately. Page 3 of 10

4 4 Bone metastases For patients with bone metastasis requiring palliation and for whom standard analgesic treatments are inadequate, single-fraction radiotherapy should be administered. Preventing skeletal-related events from bone metastases Denosumab The following recommendations are an extract from NICE technology appraisal guidance on denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours. Denosumab is recommended as an option for preventing skeletal-related events (pathological fracture, radiation to bone, spinal cord compression or surgery to bone) in adults with bone metastases from breast cancer and from solid tumours other than prostate if: bisphosphonates would otherwise be prescribed and the manufacturer provides denosumab with the discount agreed in the patient access scheme. Adults with bone metastases from solid tumours currently receiving denosumab for the prevention of skeletal-related events that is not recommended according to the criteria above should be able to continue treatment until they and their clinician consider it appropriate to stop. NICE has written information for the public explaining its guidance on denosumab. NICE has also produced a pathway on metastatic spinal cord compression. Page 4 of 10

5 5 Brain metastases Offer dexamethasone to patients with symptomatic brain metastases and reduce to the minimum necessary maintenance dose for symptomatic response. Consider palliative whole-brain radiotherapy for patients with symptomatic brain metastases with good performance status (WHO 0 or 1). 6 Breathlessness, cough and hoarseness Non-drug interventions based on psychosocial support, breathing control and coping strategies should be considered for patients with breathlessness. Non-drug interventions for breathlessness should be delivered by a multidisciplinary group, coordinated by a professional with an interest in breathlessness and expertise in the techniques (for example, a nurse, physiotherapist or occupational therapist). Although this support may be provided in a breathlessness clinic, patients should have access to it in all care settings. Opioids, such as codeine or morphine, should be considered to reduce cough. Patients with troublesome hoarseness due to recurrent laryngeal nerve palsy should be referred to an ear, nose and throat specialist for advice. Page 5 of 10

6 7 Endobronchial obstruction When patients have large airway involvement, monitor (clinically and radiologically) for endobronchial obstruction to ensure treatment is offered early. Offer external beam radiotherapy and/or endobronchial debulking or stenting to patients with impending endobronchial obstruction. NICE has published a medtech innovation briefing on ERBE flexible cryoprobes for bronchoscopic diagnosis and treatment. Interventional procedures NICE has published guidance on the following procedures with normal arrangements for consent, audit and clinical governance: cryotherapy for malignant endobronchial obstruction photodynamic therapy for advanced bronchial carcinoma. 8 Pleural effusion Pleural aspiration or drainage should be performed in an attempt to relieve the symptoms of a pleural effusion. Patients who benefit symptomatically from aspiration or drainage of fluid should be offered talc pleurodesis for longer-term benefit. Page 6 of 10

7 9 Superior vena cava obstruction Patients who present with superior vena cava obstruction should be offered chemotherapy and radiotherapy according to the stage of disease and performance status. Stent insertion should be considered for the immediate relief of severe symptoms of superior vena caval obstruction or following failure of earlier treatment. Stent placement for vena caval obstruction NICE has published interventional procedures guidance on stent placement for vena caval obstruction with normal arrangements for consent, audit and clinical governance. 10 Treatment-resistant recurrent ascites PleurX peritoneal catheter drainage system The following recommendations are from NICE medical technologies guidance on the PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites. The case for adopting the PleurX peritoneal catheter drainage system in the NHS is supported by the evidence. The available clinical evidence suggests that the PleurX peritoneal catheter drainage system is clinically effective, has a low complication rate and has the potential to improve quality of life: it enables early and frequent treatment of symptoms of ascites, in the community, rather than waiting for inpatient treatment. The PleurX peritoneal catheter drainage system should be considered for use in patients with treatment-resistant, recurrent malignant ascites. The PleurX peritoneal catheter drainage system is associated with an estimated cost saving of 679 per patient when compared with inpatient large-volume paracentesis. Page 7 of 10

8 ALK anaplastic lymphoma kinase BIS Bispectral Index Consistent with the finding has characteristics that could be caused by many things, including cancer EBUS endobronchial ultrasound ECOG Eastern Cooperative Oncology Group EEG electroencephalography EGFR epidermal growth factor receptor EGFR-TK epidermal growth factor receptor tyrosine kinase EUS endoscopic ultrasound FNA fine needle aspiration Page 8 of 10

9 MDT multidisciplinary team NSCLC non-small-cell lung cancer Persistent The continuation of specified symptoms and/or signs beyond a period that would normally be associated with self-limiting problems. The precise period will vary depending on the severity of symptoms and associated features, as assessed by the healthcare professional. PET-CT positron emission tomography computed tomography SBRT stereotactic body irradiation SCLC small-cell lung cancer TBNA transbronchial needle aspiration Unexplained symptoms or signs that have not led to a diagnosis being made by the healthcare professional in primary care after initial assessment (including history, examination and any primary care investigations) Sources Lung cancer: diagnosis and management (2011) NICE guideline CG121 Page 9 of 10

10 Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours (2012) NICE technology appraisal guidance 265 The PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatmentresistant, recurrent malignant ascites (2012) NICE medical technologies guidance 9 Your responsibility The guidance in this pathway represents the view of NICE, which was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties. Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties. Copyright Copyright National Institute for Health and Care Excellence All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE. Contact NICE National Institute for Health and Care Excellence Level 1A, City Tower Piccadilly Plaza Manchester M1 4BT nice@nice.org.uk Page 10 of 10