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

Sindhu Bhaarrati Naidu; Amyn Bhamani; Charlotte Murray; Katharina Beyer; Rebecca C Rancourt; Thorben Witte; Wouter H van Geffen; Ilona Tietzova; Armin Frille; Adrien Costantini; Monika Schäfer; Steven MacLennan; Hagen Krüger; Solveiga Žibaitė; James N'Dow; Sara Jane MacLennan; Monique J Roobol; Sam M Janes; Neal Navani; Muhammad Imran Omar; Torsten Blum; OPTIMA Consortium

doi:10.1016/j.lungcan.2025.108610

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

Lung Cancer. 2025 Jun 3:205:108610. doi: 10.1016/j.lungcan.2025.108610. Online ahead of print.

Authors

Sindhu Bhaarrati Naidu¹, Amyn Bhamani², Charlotte Murray³, Katharina Beyer⁴, Rebecca C Rancourt⁵, Thorben Witte⁶, Wouter H van Geffen⁷, Ilona Tietzova⁸, Armin Frille⁹, Adrien Costantini¹⁰, Monika Schäfer⁶, Steven MacLennan³, Hagen Krüger¹¹, Solveiga Žibaitė³, James N'Dow¹², Sara Jane MacLennan¹³, Monique J Roobol⁴, Sam M Janes², Neal Navani², Muhammad Imran Omar¹⁴, Torsten Blum¹⁵; OPTIMA Consortium

Affiliations

¹ Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom. Electronic address: s.naidu@ucl.ac.uk.
² Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.
³ Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
⁴ Erasmus University Medical Centre, Cancer Institute, Rotterdam, Netherlands.
⁵ Medical School Berlin, Berlin, Germany.
⁶ Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany.
⁷ Frisius MC, Department of Respiratory Medicine, Leeuwarden, Netherlands.
⁸ Department of Respiratory Diseases, First Faculty of Medicine, Charles University, Thomayer University Hospital, Czech Republic; Department of Palliative Medicine, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic.
⁹ Leipzig University, Department of Respiratory Medicine, Leipzig, Germany.
¹⁰ Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, UVSQ-Universite Paris Saclay, Boulogne Billancourt, France.
¹¹ Pfizer Pharma GmbH, Berlin, Germany.
¹² Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Clinical Research Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
¹³ Clinical Research Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
¹⁴ Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom; European Association of Urology, Arnhem, the Netherlands.
¹⁵ Medical School Berlin, Berlin, Germany; Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany.

PMID: 40480014
DOI: 10.1016/j.lungcan.2025.108610

Abstract

Introduction: 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.

Methods: 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.

Results: 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%).

Conclusion: 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.

Keywords: AGREE-II; Clinical practice guidelines; Lung cancer management; Multi-disciplinary team; Patient and public involvement.