The five commandments of efficient and effective care in the initial evaluation of lung cancer

Multiple recent studies have found an astounding lack of concordance with national guidelines in the workup of lung cancer in both community and academic settings. The resultant increase in complications and delays may potentially contribute to the overall dismal outcomes, as well as cost. This article aims to increase awareness among clinicians about the scope of this problem, and provides a simplified primer on the core concepts of how to perform an efficient and effective workup that is in-line with national guidelines.

Although the basic principles underlying lung cancer evaluation have not changed in the last decade, there are new areas of debate which are outlined and discussed in this article. These include: the value of brain and bone imaging in asymptomatic patients, the best initial site to biopsy in the era of genomics, and the use of biomarkers with low-dose chest tomography screening.

Given the huge stakes in lung cancer, the current national quality gap in initial evaluation is unacceptable. However, physician re-education can change this. This article provides a quick review of how to properly evaluate a patient with potential lung cancer, as well as an update on new and continuing controversies in the field.