Niels Lyhne Christensen1,2, Antti Jekunen3, Sebastian Heinonen4, Susanne Oksbjerg Dalton5, Torben Riis Rasmussen2. 1. a Department of Documentation and Quality , Danish Cancer Society , Copenhagen Ø , Denmark. 2. b Department of Respiratory Diseases and Allergy , Aarhus University Hospital , Aarhus , Denmark. 3. c Oncology Clinic , Vaasa Central Hospital , Vaasa , Finland. 4. d Faculty of Health , Aarhus University , Aarhus C , Denmark. 5. e Danish Cancer Society Research Center , Copenhagen Ø , Denmark.
Abstract
BACKGROUND: The Nordic countries are similar in terms of demographics and health care organization. Yet there are marked differences in lung cancer mortality, for which Denmark historically has had the poorest outcome. One of several possible reasons for these differences could have to do with how lung cancer is diagnosed and treated in the different Nordic countries. However, among the four most populous Nordic countries: Sweden, Denmark, Norway and Finland, there is a paucity of knowledge about differences and similarities in recommendations in the national guidelines for non-small cell lung cancer (NSCLC) and the methodology by which the guidelines are developed. METHODS: We identified and evaluated the development and content of the available clinical care guidelines for NSCLC in the four countries. Moreover, we compared the integrated cancer pathways in these countries. We have used case examples to illustrate areas with clear differences in clinical care recommendations. RESULTS: There are notable differences in the methodology by which the guidelines are developed, published and updated to comply with international recommendations. The Norwegian guidelines are developed and updated according to the most rigorous methodology and have so far been updated most frequently. We found that on the basis of recommendations patients with NSCLC are treated differently with regard to bevacizumab therapy and radiation dosing regimens. Cerebral imaging practices in patients with locally advanced NSCLC also differ. There is, moreover, a marked difference with regard to efforts to help patients to quit smoking. All except Finland have integrated cancer pathways for fast track diagnosis and treatment. Guidelines for follow-up of lung cancer patients also differ, with the Danish follow-up regimen as the most comprehensive. To obtain consensus on optimal clinical care, areas with differences in recommendations or where recommendations are based on a low level of evidence should be subjected to further studies.
BACKGROUND: The Nordic countries are similar in terms of demographics and health care organization. Yet there are marked differences in lung cancer mortality, for which Denmark historically has had the poorest outcome. One of several possible reasons for these differences could have to do with how lung cancer is diagnosed and treated in the different Nordic countries. However, among the four most populous Nordic countries: Sweden, Denmark, Norway and Finland, there is a paucity of knowledge about differences and similarities in recommendations in the national guidelines for non-small cell lung cancer (NSCLC) and the methodology by which the guidelines are developed. METHODS: We identified and evaluated the development and content of the available clinical care guidelines for NSCLC in the four countries. Moreover, we compared the integrated cancer pathways in these countries. We have used case examples to illustrate areas with clear differences in clinical care recommendations. RESULTS: There are notable differences in the methodology by which the guidelines are developed, published and updated to comply with international recommendations. The Norwegian guidelines are developed and updated according to the most rigorous methodology and have so far been updated most frequently. We found that on the basis of recommendations patients with NSCLC are treated differently with regard to bevacizumab therapy and radiation dosing regimens. Cerebral imaging practices in patients with locally advanced NSCLC also differ. There is, moreover, a marked difference with regard to efforts to help patients to quit smoking. All except Finland have integrated cancer pathways for fast track diagnosis and treatment. Guidelines for follow-up of lung cancerpatients also differ, with the Danish follow-up regimen as the most comprehensive. To obtain consensus on optimal clinical care, areas with differences in recommendations or where recommendations are based on a low level of evidence should be subjected to further studies.
Authors: Astrid Kravdal; Øystein Olav Stubhaug; Anne Grete Wågø; Magnus Steien Sætereng; Dag Amundsen; Ruta Piekuviene; Annette Kristiansen Journal: ERJ Open Res Date: 2020-06-29
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Authors: John Milkovich; Tim Hanna; Carolyn Nessim; Teresa M Petrella; Louis Weatherhead; An-Wen Chan; Jonathan C Irish; Christian Murray; Grace Bannerman; Claire Holloway; Katharina Forster; Laura Pazzano; Frances C Wright Journal: Curr Oncol Date: 2021-03-12 Impact factor: 3.677