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Endocrine cancers

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What is covered

This interactive flowchart covers NICE guidance on endocrine cancers.

Updates

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on endocrine cancers in an interactive flowchart

What is covered

This interactive flowchart covers NICE guidance on endocrine cancers.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Cabozantinib for treating medullary thyroid cancer (2018) NICE technology appraisal guidance 516
Minimally invasive video-assisted thyroidectomy (2014) NICE interventional procedures guidance 499
Interstitial photodynamic therapy for malignant parotid tumours (2008) NICE interventional procedures guidance 259
Intraoperative nerve monitoring during thyroid surgery (2008) NICE interventional procedures guidance 255

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Cabozantinib

Cabozantinib and vandetanib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Both drugs are currently available through the Cancer Drugs Fund for progressive and symptomatic disease. Best supportive care is the only other available option for people who cannot have cabozantinib or vandetanib.
Clinical trial evidence suggests that cabozantinib is effective in delaying disease progression compared with best supportive care, but may not prolong survival. Without reliable comparative data, it was considered that cabozantinib and vandetanib are likely to be similarly effective.
The cost-effectiveness estimates for cabozantinib compared with best supportive care and vandetanib are less than £30,000 per quality-adjusted life year gained. Therefore, cabozantinib can be recommended as a cost-effective use of NHS resources.
For more information see the committee discussion in the NICE technology appraisal guidance on cabozantinib for treating medullary thyroid cancer.

Everolimus and sunitinib

NETs can affect the pancreas, gastrointestinal tissue and lungs and are difficult to diagnose and treat. They can significantly affect emotional health and often mean that people are unable to work. There is particularly high unmet need for people with NETs that affect the lungs.
Clinical trial evidence shows that everolimus and sunitinib are effective for treating pancreatic NETs compared with current treatment (best supportive care). Everolimus is effective for treating gastrointestinal and lung NETs compared with current treatment (best supportive care).
For treating pancreatic NETs, everolimus and sunitinib were recommended because they met NICE's end-of-life criteria. The cost effectiveness estimates varied, from below £20,000 up to £30,000 per quality-adjusted life year (QALY) gained.
For treating gastrointestinal NETs, everolimus did not meet the end-of-life criteria but was recommended because it is cost effective, at below £20,000 per QALY gained.
For treating lung NETs, everolimus did not meet the end-of-life criteria. The cost-effectiveness estimates for everolimus varied, from below £20,000 up to £30,000 per QALY gained. It was recommended because of the cost-effectiveness estimates and the limited treatment options available for people with lung NETs.
NICE's end-of-life criteria are that life expectancy for people with the condition should be less than 24 months and that treatment should extend life by more than 3 months.
For more information see the committee discussion in the NICE technology appraisal guidance on everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease.

Glossary

neuroendocrine tumours

Paths in this pathway

Pathway created: March 2018 Last updated: April 2018

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