Authors explain rationale behind ‘controversial’ new VTE and lung cancer screening recommendations

Members of the committees that authored CHEST’s clinical practice guidelines on venous thromboembolism (VTE) therapy and lung cancer screening gathered during CHEST 2021 to discuss the rationale behind some recommendations that might be considered controversial.

The plenary session ‘You Recommended WHAT?’ Controversies in the Newest CHEST VTE and Lung Cancer Screening Guidelines is available on demand for registered CHEST 2021 attendees through October 1, 2022.

“Both of these guidelines are clearly high-impact in terms of patient care,” said CHEST Guideline Oversight Committee Chair Kevin M. O’Neil, MD, MHA, FCCP, who chaired and moderated the session. “They’re new, and some of the recommendations are different than what has been recommended in the past, and some of them may be controversial or surprising in terms of what people have been doing.”

Joining Dr. O’Neil on the panel for the session were Peter J. Mazzone, MD, MPH, FCCP; and Gerard A. Silvestri, MD, MS, FCCP, chair and panelist, respectively, of the lung cancer screening guideline; and Scott M. Stevens, MD, FCCP; and Scott C. Woller, MD, FCCP, co-chairs of the VTE therapy guideline.

Panelists discussed recommendations for which the guideline authors had prolonged discussions and perhaps could have gone in a different direction, recommendations that had been upgraded or downgraded, as well as recommendations that differ from other societies’ guidelines. The panelists explained their rationale for those differences and described the factors that led to their final recommendations.

“Everything is not always black and white, and there are often factors beyond the evidence that influence clinical practice guideline recommendations,” Dr. O’Neil said. “So understanding how the guideline committees got to the decisions they made will help people understand why some of these recommendations are so important.

“It’s also important to understand that some of these areas are still unsettled, with ongoing discussion and research that needs to be completed in order to really have a full picture of what the best options for care are.”

Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report

The second update of this CHEST guideline and expert panel report on venous thromboembolism contains 29 recommendations on aspects of all phases of antithrombotic management of VTE, including whether to treat, choice of antithrombotic therapy, duration of therapy, and secondary prevention and risk reduction of post-thrombotic syndrome.

Screening for Lung Cancer: CHEST Guideline and Expert Panel Report

These new guidelines provide 16 recommendations on updated patient selection criteria for lung cancer screening, approach to the evaluation of screen-detected findings, and incorporation of tobacco cessation treatment in lung cancer screening programs.