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Management

​The Lung Tumour Group of the BC Cancer Agency is a multi-disciplinary committee charged with the development of management policy for lung cancer, mesothelioma and thymoma. This policy results from the deliberations of the group that include literature review of published practice guidelines, experience with prior policy with outcome analysis where possible, and results of clinical trials performed at BCCA or in co-operation with communities oncology investigators and other cancer centres. It is recognized that management of the individual patient must take into consideration such additional factors as ability to withstand the proposed therapy.

The Lung Tumour Group is committed to the improvement of the results of cancer treatment by participation in a broad clinical research effort. Practitioners with a special interest in lung cancer are encouraged to become a member of the International Association for the Study of Lung Cancer (IASLC). Detailed protocols are available on the internet. Investigational trials are often complex and frequently change. It is recommended that the principal investigator be contacted directly regarding patients who may be eligible.

Careful documentation before, during, and after treatment is an integral component of clinical research. Problematic toxicity, cancer relapse and patient death (from any cause) are particularly important. The participation of the patient's referring and family physician in this process is essential and appreciated.

Levels of Evidence 

  1. Evidence obtained from meta-analysis of multiple, well-designed, controlled studies. Randomized trials with low false-positive and low false-negative errors (high power).  
  2. Evidence obtained from at least one well-designed experimental study. Randomized trials with high false-positive and/or negative errors (low power).  
  3. Evidence obtained from well-designed, quasi-experimental studies such as non-randomized, controlled single-group, pre-post, cohort, time, or matched case-control series.  
  4. Evidence from well-designed, non-experimental studies such as comparative and correlational descriptive and case studies.  
  5. Evidence from case reports and clinical examples.

Grades of Recommendations 

  1. There is evidence of type I or consistent findings from multiple studies of types II III, or IV.  
  2. There is evidence of types II, III, or IV and findings are generally consistent.  
  3. There is evidence of types II, III or IV but findings are inconsistent.  
  4. There is little or no systematic empirical evidence.

Key References:

  1. Sackett DL: Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95:2S-4S, 1989 (suppl 2)  

  2. Cook DL, Guyatt GH, Laupacis A, et al: Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102:S305-S311, 1992 (suppl 4)

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