Quality standards in lung cancer care

This page explains the recommendations in the European Respiratory Society (ERS) clinical guidelines for the quality of care for lung cancer. It is for people with lung cancer, or their family or carers.

Last Update 06/03/2024
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Who is this document for and what is it about?
This document explains the recommendations in the European Respiratory Society (ERS) clinical guidelines for the quality of care for lung cancer. It is for people with lung cancer, or their family or carers.

What are clinical guidelines?
Clinical guidelines are produced after a scientific process used to gather the latest evidence on a condition or symptom. Guidelines also take into account the opinions of experts and the priorities of patients and carers who have experience of a condition. Clinical guidelines are written for healthcare professionals. They use them as a best practice document on how to diagnose, manage and treat a condition.

What does this document include?
This document summarises the key points from the clinical guidelines on quality of care for lung cancer. It explains them in a way that is easier to understand for people who do not work in a medical field. It will explain what lung cancer is and what care should be given for people with the condition. It includes information on the what standards this care should meet to be most effective.

By providing this information in an accessible way, this document aims to help people with lung cancer understand more about the standard of care they should receive. This can help them to feel informed when making decisions about their treatment options.

What is lung cancer?

Lung cancer is cancer of the trachea (windpipe), bronchus (airway) or lung air sacs (alveoli). Lung cancer is now the leading cause of cancer deaths worldwide in both men and women. Survival rates vary depending on the type of the cancer and at what stage the disease was diagnosed.

There are wide differences in care for people with lung cancer across Europe. There is also a lack of evidence on the quality of this care. This guideline aims to provide recommendations on the best way to deliver lung cancer services in Europe.

How should lung cancer care be delivered?

Diagnosis and treatment times

Treatments can work better if lung cancer is found early. Yet, lung cancer symptoms often do not appear until a later stage in the disease. Lung cancer screening programmes are beginning to take place across Europe. These programmes will help to identify people with lung cancer before any symptoms appear.

The guideline recommends reducing delays between diagnosis and starting treatment. This is another method that can help improve outcomes, including how long a person can survive the disease (known as survival rate). It is important to confirm the diagnosis as it could be harmful to begin treatment before giving an accurate diagnosis. Additionally, healthcare professionals should assess how well a person is. A person may need to receive treatment for other conditions before lung cancer treatment begins. After this has taken place, the guideline states that treatment should start as soon as possible.

Patient decision tools

A patient decision tool helps someone think about their treatment options. The tools explain any benefits and risks of the different decisions they need to make.

The guideline recommends using a patient decision tool for lung cancer treatment. Evidence shows that the tools can help increase understanding about a condition and its treatment. They can also help improve discussions between patients and healthcare professionals. This can lead to a person feeling more satisfied with the treatments they then receive.

Finding out what type of lung cancer a person has

Lung cancer treatment options have grown over the last few years. Additionally, we know more about the different kinds of lung cancer and how it affects the body. Studies have shown that matching the right treatment option to the type of lung cancer a person has can improve survival rates. However, the procedures that determine the type of lung cancer a person has are not widely available.

The guideline recommends that when people have suspected lung cancer, healthcare professionals should aim to analyse a sample from a tumour to find out how it is growing. This is known as pathological diagnosis. It provides a more accurate picture of the type of lung cancer a person has.

In people who have a confirmed diagnosis of lung cancer, healthcare professionals should also find out the specific type of lung cancer they have. They should do this using the World Health Organization (WHO)’s Classification of Tumours of the Lung as a reference. Further analysis of cells can also identify what part of the lung cancer can be targeted to achieve the best results.

Multidisciplinary teams 

A multidisciplinary team is a group of professionals from different areas of healthcare that work together to support a person during their care. For people with lung cancer, their team could include a surgeon, a cancer doctor, a lung health doctor, a specialist nurse or a radiologist. These professionals bring different expertise to the team and work together to offer the best care.

These teams are widely established in Europe for the care of people with lung cancer. The guideline confirms that multidisciplinary teams are needed to offer the best form of care. It additionally suggests that there needs to be processes and structures in place to ensure successful teamwork throughout a person’s treatment journey.

Lung cancer surgery and alternative lung cancer treatment procedures

Evidence suggests people survive cancer longer and there are a lower number of deaths from lung cancer, when operations and procedures take place in specialist hospitals. To achieve this, services often need to be grouped into a central hospital within a region. This can mean that people living with lung cancer have to travel further to receive this care.

The guideline recommends that lung cancer surgery and other procedures should take place in a hospital that has experience of these procedures and operations. A specialist surgeon or professional should also perform them.

Palliative care

Palliative care is care that manages pain and other distressing symptoms. It focuses on making a person as comfortable as possible throughout their treatment. It could include support that is psychological, social or spiritual. Palliative care is often associated with end-of-life care, when a person is in the last few months or years of life. It can also be given in the earlier stages of treatment to help manage symptoms.

The evidence suggests that if palliative care is started early, there is a positive effect on patients with lung cancer, for example better quality of life. The guideline recommends including palliative care at an early stage, based on how severe a person’s symptoms are.

Guidelines and standard operating procedures

Guidelines summarise the research available and give recommendations on the best way to deliver care. There are large numbers of international and national lung cancer guidelines available. These can differ in quality and sometimes contain outdated information. It is also not always clear if guidelines have been successfully shared and followed by professionals.

The evidence suggests that there are a number of benefits for people with lung cancer when the guidelines are easily available and followed by healthcare professionals. These include surviving the disease for longer, an increased chance of receiving treatment to cure the cancer and healthcare professionals having a better understanding of what stage the cancer is at.

This guideline recommends the use of good-quality guidelines and standards.  It recommends that experts from across the world meet to agree on guidelines. These can then be adapted to fit with the healthcare systems in each country.

Measuring the effectiveness of lung cancer care 

Gathering information on the kind of lung cancer care available and how effective it is, is key to keep improving the quality of care.

The guideline recommends the use of national lung cancer registries to collect this information. These registries are set up in each country to collect information on how many people have lung cancer and how they are treated. This information can provide feedback for future lung cancer guidelines and help improve lung cancer services.

The guideline also recommends other ways to improve the quality of care for lung cancer. These include making sure that treatment and care is the same within countries, and meetings between lung cancer experts to review their work.

Further reading

This guideline was produced by the European Respiratory Society and the European Lung Foundation. You can find out more about these organisations and access the full professional guideline using the links below:

Full clinical guideline – published in the European Respiratory Journal:
European Respiratory Society Guideline on various aspects of quality in lung cancer care

Further resources for patients and carers:

Lung cancer factsheet

Lung cancer screening factsheet

Rare lung cancers factsheet

Smoking when you have a lung condition factsheet

About ERS

The European Respiratory Society (ERS) is an international organisation that brings together physicians, healthcare professionals, scientists and other experts working in respiratory medicine. It is one of the leading medical organisations in the respiratory field, with a growing membership representing over 140 countries. The ERS mission is to promote lung health in order to alleviate suffering from disease and drive standards for respiratory medicine globally. Science, education and advocacy are at the core of everything it does. ERS is involved in promoting scientific research and providing access to high-quality educational resources. It also plays a key role in advocacy – raising awareness of lung disease amongst the public and politicians.

About ELF

The European Lung Foundation (ELF) was founded by ERS to bring together patients and the public with professionals. ELF produces public versions of ERS guidelines to summarise the recommendations made to healthcare professionals in Europe, in a simple format for all to understand. These documents do not contain detailed information on each condition and should be used in conjunction with other patient information and discussions with your doctor.