AGREE-II appraisal of lung cancer management clinical practice guidelines by the OPTIMA consortium

Amongst all cancers, lung cancer is the leading cause of mortality worldwide and has the highest economic burden in the European Union. With rapidly evolving treatments, clinicians must keep up-to-date with the latest recommendations to ensure their patients receive the best care. Clinical practice guidelines support decision-making and improve care. The OPTIMA consortium aimed to identify and critically appraise relevant lung cancer clinical practice guidelines commonly used in Europe.

Clinical practice guidelines were identified through expert consensus and cross-checked against the International Guidelines Library. Two assessors independently appraised each guideline using the AGREE-II tool. Guideline contents including guideline characteristics and composition of panel were also reviewed.

We identified 21 guidelines. National UK and German lung cancer guidelines received the highest overall scores (7/7). Guidelines scored highest on clarity (median score 80.6%) while stakeholder involvement and applicability were the lowest scoring domains (median 50.0% each). The median intraclass correlation coefficient for all guidelines was 0.95 (interquartile range (IQR) 0.92-0.99), representing excellent inter-rater agreement. Differences between guidelines included number of specialties involved in development and guideline recommendations. Five (23.8%) included a patient or public representative and only one specified patient-reported outcome measures. Few guidelines considered how to optimise patients for treatment such as through nutrition assessment (n = 4, 19.0%) and prehabilitation (n = 3, 14.3%).

We identified and critically appraised 21 European lung cancer guidelines published between 2009 and 2025. Key recommendations for improvement include inclusion of diverse specialities and patient representatives in guideline development and addressing barriers to implementation.