title: Systematic review of guidelines for the management of suspected lung cancer in primary care.
abstract: OBJECTIVE
  To systematically review the literature and provide an update and integration of existing peer-reviewed guidelines with recent systematic reviews and with primary studies related to the early recognition and management of lung cancer in primary care.
  
  
  METHODS
  MEDLINE and EMBASE were searched for relevant articles. The quality of the evidence to support existing guideline recommendations, and the consistency of recommendations with updated evidence, were assessed. Applicability in a Canadian primary care setting was also evaluated.
  
  
  METHODS
  All studies that explored signs or symptoms of or risk factors for lung cancer in the primary care setting were included. All diagnostic studies in which symptomatic primary care patients underwent 1 or more investigations were also searched.
  
  
  RESULTS
  Recommendations were consistent among guidelines despite a paucity of supporting evidence. Updated evidence provided further support for the recommendations. Recommendations for identifying signs and symptoms of lung cancer presenting in primary care and for initial management can be adopted and applied within a Canadian primary care setting.
  
  
  CONCLUSIONS
  This updated review of recommendations might help promote evidence-based practice and, ultimately, more timely management and improved prognosis for lung cancer patients. It might also assist in the development of lung cancer diagnostic assessment programs.
authors.affiliation: Physician with the Sunnybrook Academic Family Health Team in Toronto, Ont, and is Regional Primary Care Cancer Lead for the Toronto Central Local Health Integration Network. ccopgi@mcmaster.ca.
authors.forename: M Elisabeth
authors.initials: ME
authors.lastname: Del Giudice
authors.affiliation: Family physician in Lindsay, Ont.
authors.forename: Sheila-Mae
authors.initials: SM
authors.lastname: Young
authors.affiliation: Health Research Methodologist in the Department of Oncology at McMaster University in Hamilton, Ont, and for Cancer Care Ontario's Program in Evidence-based Care. ccopgi@mcmaster.ca.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Vella
authors.affiliation: Family physician with the North York Family Health Team in Ontario.
authors.forename: Marla
authors.initials: M
authors.lastname: Ash
authors.affiliation: Family physician in Brampton, Ont.
authors.forename: Praveen
authors.initials: P
authors.lastname: Bansal
authors.affiliation: Assistant Professor in the Department of Oncology at Queen's University in Kingston, Ont.
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Respirologist in Toronto, Ont.
authors.forename: Roland
authors.initials: R
authors.lastname: Skrastins
authors.affiliation: Associate Professor in the Department of Radiation Oncology at the University of Toronto and a staff radiation oncologist at Sunnybrook Odette Cancer Centre.
authors.forename: Yee
authors.initials: Y
authors.lastname: Ung
authors.affiliation: Associate Professor in the Division of Thoracic Surgery at the University of Toronto and Medical Director of Surgical Oncology at the Toronto East General Hospital.
authors.forename: Robert
authors.initials: R
authors.lastname: Zeldin
authors.affiliation: Professor in the Department of Family Medicine at McMaster University and Past Provincial Primary Care Lead at Cancer Care Ontario.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Levitt
mesh_terms: D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*