Background Empowering nurses to discuss clinical trials with patients can increase recruitment rates. Clinical trials are essential for improving lung cancer patient outcomes; in the short term, they provide individuals access to new treatments and care regimens which, longer term, have the potential to advance clinical care. However, recruitment into lung cancer clinical trials is as low as 5%, and lung cancer nurses feel ill-equipped to signpost clinical trial opportunities to patients. This study aimed to pilot and assess the acceptability and utility of the ‘Lung I-ACT tool’: a newly developed resource comprising a patient-facing leaflet and a nurse-facing poster, designed to help lung cancer nurses initiate clinical trial discussions with patients. Methods A 6-month, mixed methods, pilot study was conducted at seven NHS hospital sites in the UK; four were intervention sites, three were control sites. Data on self-efficacy, knowledge, confidence, awareness and current practice were collected using online surveys for nurses at baseline, 3 and 6 months, and online interviews with lung cancer nurses and patients from intervention sites. Survey data were analysed using descriptive and inferential statistics, and interview data were thematically analysed via Framework Method. Results Thirty-four nurse respondents were recruited to the survey. Survey findings indicated increased frequency of clinical trial discussions at the intervention sites, and increased nurse awareness, confidence and knowledge to navigate these discussions. Eleven nurses and four patients were interviewed; these data comprised five themes regarding lung cancer nurses’ and patients’ views of the Lung I-ACT tool: (1) content and format of the tool, (2) application and utility of the tool in practice, (3) perceived changes to practice, (4) knowledge, awareness and confidence to discuss clinical trials, (5) contextual and situational factors impacting the presentation of clinical trials. Conclusion The Lung I-ACT tool improves nurses’ confidence in discussing trials with patients through increasing their awareness of clinical trial opportunities and helping them to structure conversations.

Purpose Clinical research trials are needed to enhance the medical care and treatment for lung cancer, which remains the leading cause of cancer-related deaths worldwide. While clinical trials allow for the development of novel therapies to treat cancer, the recruitment of lung cancer patients to trials is low. This review aimed to identify and synthesise the available literature concerning barriers and facilitators affecting lung cancer patients’ decisions to enrol in clinical trials to guide future cancer research efforts. Methods Four databases were systematically searched: Academic Search Complete, CINHAL, PubMed, and PsycINFO in August 2023. A supplemental grey literature search was also conducted alongside this. Articles were quality appraised using CASP and JMI checklists, and results were narratively synthesised. Results Eighteen articles of varied design met the inclusion criteria, and results were mapped onto the Capability, Opportunity, and Motivation Behaviour (COM-B) Model to help structure and conceptualise review findings. Evidence suggests that the decision to enrol in a trial is multifaceted and informed by: when and how study information is presented, travel and trial eligibility, and altruistic hopes and fears. Conclusions There is need to address the many different concerns that lung cancer patients have about participating in a clinical trial through the supply of accessible and timely trial information, and via the reduction of travel, expansion of study eligibility criteria, and recognition of a person's altruistic wishes, hopes, fears, and family-oriented concerns. Future research should aim to work alongside lung cancer patients, clinicians, and other stakeholders to increase research accessibility.

Lung cancer is the lead cause of cancer related mortality both nationally and internationally; and is estimated to have been responsible for the deaths of around 1.8 million people globally in 2020. Clinical trials have the potential to improve patients' survival outcomes and their experiences of care. Despite this however, it is estimated that only 8% of lung cancer patients participate in a clinical study. In view of the low enrolment, and need for further research, this study aimed to explore stakeholders' perspectives regarding the barriers and enablers to clinical trials and how to increase the literacy and accessibility of trials.

This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.

BACKGROUND Patients with malignant pleural mesothelioma (MPM) have a life-limiting illness and short prognosis and experience many debilitating symptoms from early in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer. OBJECTIVE This study aimed to determine the feasibility and acceptability of using an ASyMS adapted for use by patients with MPM, called ASyMSmeso, enabling the remote monitoring of symptoms using a smartphone. METHODS This was a convergent mixed methods study using patient-reported outcome measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC), Technology Acceptance Model (TAM) measure for eHealth, and Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study, semistructured interviews with 11 health professionals, 8 patients, and 3 carers were conducted to collect their experience with using ASyMSmeso. RESULTS Eighteen patients with MPM agreed to participate in the study (33.3% response rate). The completion rates of study PROMs were high (97.2%-100%), and completion rates of the daily symptom questionnaire were also high, at 88.5%. There were no significant changes in quality of life, as measured by LCSS-Meso. There were statistically significant improvements in the SPARC psychological need domain (P=.049) and in the “Usefulness” domain of the TAM (P=.022). End-of-study interviews identified that both patients and clinicians found the system quick and easy to use. For patients, in particular, the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable, and areas that were mentioned included the early management of symptoms and connectivity between patients and clinicians, leading to enhanced communication. CONCLUSIONS This study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone are feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home.

Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared with other cancer populations. Lung cancer stigma (LCS) may in part explain these findings.

This presentation will discuss the clinical patient care and management of patients receiving immunotherapies. A team approach to patient management including patient education, pre asessment, toxicity management and follow up will be presented. This team consists of Oncologists, specialist nurses and cancer care pharmacists, who work together in a dedicated clinic. The benefits to patients will be presented as well as demonstrating efficient use of clinical time. immunotherapy, management, teamworking

The NHS Lanarkshire Lung Cancer Project is part of the Transforming Care after Treatment (TCAT) programme. During phase one 58 patients participated in the project. 88% of patients opted for a telephone consultation, which was more time effective taking only on average 20 minutes compared to 48 minutes for a face to face consultation. 90% of patients rated the service as excellent and a review of additional Patient Reported Outcome Measures demonstarted an improvement in overall quality of life. Further funding was secured as part of Phase 3 of the TCAT programme allowing for continued testing. Between November 2017 – May 2018 lung cancer patients living in Lanarkshire were offered two monthly SPARC assessments on completion of treatment . This was followed up with and a telephone consultation from a lung cancer clinical nurse specialist, the provision of a personalised care plan and access to self-management information. The choice of an electronic or paper SPARC assessment was offered. To support the evaluation a Functional Assessment of Cancer Therapy – Lung (FACT-L), Memorial Symptoms Assessment Scale (MSAS) and Supportive Care Needs Survey Long-Form 59 (SCNS) were completed prior to their first and after their final assessment. A patient experience questionnaire was also provided on completion of their final assessment. 24 patients participated in phase 3. 53% opted to complete their assessment electronically with 47% preferring the paper option. 15 patients (63%) completed both assessments resulting in a total of 582 concerns being identified. Data analysis of these patients shows a 27% reduction in concerns with the number of high concerns falling by 62% between the first and second assessment. The average length of time for telephone review remained similar phase one at 22 minutes ranging from 7 minutes to 55 minutes. Patient satisfaction in the project continued to be high with 82% rating the service as excellent and 18% as good.. Data analysis for 15 patients' who had completed 2 FACT-L, MSAS and SCNS yielded a significant reduction in symptom burden and psychological distress with a significant improvement in quality of life. Findings from this project are encouraging that this model of working is not only acceptable to patients but time efficient and clinically effective. However, a limitation of this project is its small sample size. Therefore, further work is needed to explore its transferability and cost effectiveness to allow it to be considered for implementation in standard practice.

The European Respiratory Society (ERS) task force for harmonised standards for lung cancer registration and lung cancer services in Europe recognised the need to create a single dataset for use in pan-European data collection and a manual of standards for European lung cancer services.The multidisciplinary task force considered evidence from two different sources, reviewing existing national and international datasets alongside the results of a survey of clinical data collection on lung cancer in 35 European countries. A similar process was followed for the manual of lung cancer services, with the task force using existing guidelines and national or international recommendations for lung cancer services to develop a manual of standards for services in Europe.The task force developed essential and minimum datasets for lung cancer registration to enable all countries to collect the same essential data and some to collect data with greater detail. The task force also developed a manual specifying standards for lung cancer services in Europe.Despite the wide variation in the sociopolitical landscape across Europe, the ERS is determined to encourage the delivery of high-quality lung cancer care. Both the manual of lung cancer services and the minimum dataset for lung cancer registration will support this aspiration.

Purpose Developing new supportive/palliative care services for lung cancer should encompass effective ways to promptly identify and address patients’ healthcare needs. We examined whether an in-clinic, nurse-led consultation model, which was driven by use of a patient-reported outcomes (PRO) measure, was feasible and acceptable in the identification of unmet needs in patients with lung cancer. Methods A two-part, repeated-measures, mixed-methods study was conducted. Part 1 employed literature reviews and stakeholder focus group interviews to inform selection of a population-appropriate needs assessment PRO measure. In Part 2, lung cancer nurse specialists (CNS) conducted three consecutive monthly consultations with patients. Recruitment/retention data, PRO data, and exit interview data were analysed. Results The Sheffield Profile for Assessment and Referral to Care was the PRO measure selected based on Part 1 data. Twenty patients (response rate: 26%) participated in Part 2; 13 (65%) participated in all three consultations/assessments. The PRO measure helped patients to structure their thinking and prompted them to discuss previously underreported and/or sensitive issues, including such topics as family concerns, or death and dying. Lung CNS highlighted how PRO-measures-driven consultations differed from previous ones, in that their scope was broadened to allow nurses to offer personalised care. Small-to-moderate reductions in all domains of need were noted over time. Conclusions Nurse-led PRO-measures-driven consultations are acceptable and conditionally feasible to holistically identify and effectively manage patient needs in modern lung cancer care. PRO data should be systematically collected and audited to assist in the provision of supportive care to people with lung cancer.

Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared to other cancer populations (Hewitt et al, 2013). Lung cancer stigma (LCS) may in part explain these findings. Evidence from studies in the Unites States has shown associations between LCS and lower QoL, higher symptom burden and higher levels of anxiety and depression (Cataldo et al, 2013). Whether these associations exist in people diagnosed with LC in the United Kingdom is unknown. Therefore this study explored the prevalence of LCS and its relationship with patient outcomes as well as QoL in a Scottish population. This study was a cross-sectional study. Patients (n=201) diagnosed with LC were recruited by health care professionals at follow-up clinics at four hospitals in Scotland. Participants completed questionnaires to collect demographic data and assess perceived LCS, QoL, symptom severity and level of depression. Clinical data was collected by case note review. Bivariate correlations were performed to investigate the relationships between stigma, demographics, and patient outcomes. Multiple regression further explored the individual contributions of LCS on symptom burden and quality of life. Participants had a mean age of 69 years (range 41-89 years), 46.8% were males, 92.0% were ever smokers, 17.9% current smokers. The mean LCS score was 53.1 (SD=14.1, range 31-124,). There were significant correlations between higher LCS and age (r= -0.28, p<0.001), being a current smoker (r= 0.17, p<0.05), deprivation index (r=0.15, p<0.05) depression (r=0.40, p<0.001), symptom burden (r=2.60, p<0.001), and QoL (r= - 0.52, p<0.001). Multiple regression revealed an overall model that explained 30.6% of the total variance of stigma (F=14.82, p<0.001). Perceived stigma also accounted for significant unique variance in QoL (4.3%, p<0.001) and depression (3.6%, p<0.001) above and beyond that accounted for by relevant variables. No contribution of stigma on symptom burden was found. Stigma was correlated with depression, and QoL. Therefore, it is expected that depression and stigma share some of the explanation of variance of QoL. Nevertheless, stigma was found to have a unique contribution on QoL, and on depression. With this in mind, management of patients with LC could determine the patients' experience of stigma to tailor treatment plans to improve QoL and psychosocial outcomes. Being younger was correlated with higher LCS. This might reflect changed attitudes toward smoking due to changed marketing strategies in the 1960s.

The National Lung Cancer Audit 2015 reported 40% of patients with Lung cancer are diagnosed following an emergency admission. The National Lung Cancer Forum for Nurses Workshop 2016 undertook a review of how the Lung Cancer CNS's (LCNS) early intervention can have a positive impact on the reduction in the length of stay for those patients admitted via the emergency route at their first presentation. A prospective and a retrospective review of a cohort of patients admitted by the emergency route was undertaken, n=51 in both cohorts, across 13 UK sites over a 2 month period. A standardised Data Collection Tool was developed to ensure consistency and avoid bias. In the prospective cohort the LCNS actively identified patients at an early stage following their admission, whereas the retrospective cohort was a random sample of patients admitted and diagnosed via the emergency route irrespective of the LCNS involvement. Demographics and baseline characteristics were found to be similar in both cohorts. 31% of patients were never seen by the LCNS in the retrospective cohort whereas all patients were seen in the prospective cohort 76% of patients in the prospective cohort were seen within 0-5 days following admission by a LCNS compared with 43% in the retrospective cohort Average length of stay in the prospective cohort was 9.7 days V 17.6 days in the retrospective cohort. This review suggests the early intervention of a LCNS is associated with a reduced length of stay following an emergency admission when Lung Cancer/Mesothelioma is diagnosed.

The NHS Lanarkshire Lung Cancer Project is part of the Transforming Care after Treatment programme, a partnership between the Scottish Government, Macmillan Cancer Support, NHS Scotland and local authorities, to support a redesign of care following active treatment for cancer. More people are living with lung cancer, but it continues to have a poor prognosis, therefore followup care is vital and all patient needs, not just medical, must be addressed appropriately. This article outlines a two-year project that aims to influence changes in follow up for patients with lung cancer, through the testing of digital health technology. The article reports the interim results of the project, which suggest that using electronic patient reported outcome measures, combined with telephone consultations, are acceptable methods of identifying and supporting patients’ needs.