Lung cancer: diagnosis and management

Supportive and palliative care of the person should be provided by general and specialist palliative care providers in line with the NICE guidance on improving supportive and palliative care for adults with cancer. [2005]

Identify and refer people who may benefit from specialist palliative care services without delay. [2005]

Provide palliative radiotherapy, either as symptoms arise or immediately, for eligible people who cannot be offered curative treatment. [2005]

When people have large airway involvement, monitor (clinically and radiologically) for endobronchial obstruction to ensure treatment is offered early. [2011]

Offer external beam radiotherapy and/or endobronchial debulking or stenting to people with impending endobronchial obstruction. [2011]

Every cancer alliance should ensure that people have rapid access to a team capable of providing interventional endobronchial treatments. [2011]

Perform pleural aspiration or drainage in an attempt to relieve the symptoms of a pleural effusion. [2005]

Patients who benefit symptomatically from aspiration or drainage of fluid should be offered talc pleurodesis for longer-term benefit. [2005]

Consider non-drug interventions based on psychosocial support, breathing control and coping strategies for people with breathlessness. [2005]

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, people should have access to it in all care settings. [2005]

Consider opioids, such as codeine or morphine, to reduce cough. [2005]

Refer people with troublesome hoarseness due to recurrent laryngeal nerve palsy to an ear, nose and throat specialist for advice. [2005]

Offer people who present with superior vena cava obstruction chemotherapy and radiotherapy according to the stage of disease and performance status. [2005]

Consider stent insertion for the immediate relief of severe symptoms of superior vena caval obstruction or following failure of earlier treatment. [2005]

Offer dexamethasone to people with symptomatic brain metastases and reduce to the minimum necessary maintenance dose for symptomatic response. [2011]

For guidance on management of brain metastases, see the section on management of confirmed brain metastases in the NICE guideline on brain tumours. [2019]

Administer single-fraction radiotherapy to people with bone metastasis who need palliation and for whom standard analgesic treatments are inadequate. [2005]

For more guidance on preventing complications from bone metastases, see the NICE technology appraisal guidance on denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours. [2019]

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. [2005]