{"cancerId":"lung-cancer","aliases":["nsclc","sclc","lung-adenocarcinoma","lung-squamous-cell-carcinoma","large-cell-lung-carcinoma","egfr-mutant-nsclc","alk-positive-nsclc","ros1-positive-nsclc","ret-fusion-nsclc","kras-g12c-nsclc","met-altered-nsclc","braf-v600e-nsclc","her2-mutant-nsclc","ntrk-fusion-nsclc","pdl1-high-nsclc","resectable-nsclc","stage-iii-unresectable-nsclc","limited-stage-sclc","extensive-stage-sclc"],"cancerName":"Lung cancer","asOf":"2026-09-25","intro":"Around 50,200 people a year are diagnosed with lung cancer in the UK and around 32,800 die of it: the third most common cancer and the most common cause of cancer death. It is also the cancer where the gap between rich and poor is widest, by a distance. Mortality rates are 102 percent higher for women and 93 percent higher for men in the most deprived fifth of the UK than in the least, around 13,400 lung cancer deaths a year are linked with deprivation, and in Scotland the incidence rate in the most deprived fifth is more than three times the rate in the least. The National Cancer Plan says lung cancer alone accounts for almost a year of the nine-year life expectancy gap between richer and poorer parts of England. Against that, this is also the cancer where the NHS has changed most: England is building a national screening programme, the proportion of English cases found at stage 1 or 2 rose from 32 percent in 2022 to 40 percent in 2024, and the number of people given treatment with curative intent rose from 5,561 to 8,936 between 2019 and 2024. This page follows the NHS route from the lung health check invitation through the chest X-ray rules, the 49-day optimal pathway and the 28, 31 and 62 day standards, to the lung multidisciplinary team, the thoracic surgery units, reflex molecular testing and the drugs. It lists every NICE, Scottish Medicines Consortium and Welsh decision on a lung cancer medicine with its reference and date, and says plainly where a figure could not be found.","presentation":[{"title":"A letter inviting you to a lung health check","share":"7,329 cancers found in people aged 55 to 74 invited between April 2019 and March 2025 (England)","detail":"The planned route, and the one that is changing the disease. If your GP record shows you have ever smoked and you are between 55 and 74, you are invited to a lung health check: a telephone, online or face-to-face risk assessment, and if your risk is high enough a low-dose CT scan, usually in a mobile unit in a car park rather than a hospital. Of the people staged through screening in England, 76.2 percent had stage 1 or 2 disease, against 40.2 percent of everyone diagnosed; the range between cancer alliances was 63 to 81 percent. Around 70 percent of screening is delivered in mobile units, deliberately placed where people are four times more likely to smoke. Coverage was about 40 percent of the country at the time of the 2026 audit.","sources":[{"label":"NHS: lung cancer (page last reviewed 20 August 2026)","url":"https://www.nhs.uk/conditions/lung-cancer/","date":"2026-08-20"},{"label":"NHS: lung cancer screening (the lung health check: who is invited, the telephone or online risk assessment, the scan in a mobile unit, the result letter within four weeks, and the cancer alliance areas where checks are live; page last reviewed 27 March 2023)","url":"https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/","date":"2023-03-27"},{"label":"GOV.UK: new lung cancer screening roll out to detect cancer sooner (Department of Health and Social Care, 26 June 2023): ages 55 to 74 with a GP record of smoking, 270 million pounds a year once fully implemented, up to 9,000 cancers a year and almost a million scans, 76 percent of cancers found at an earlier stage in the first phase, around 70 percent of screening delivered in mobile units in areas where people are four times more likely to smoke","url":"https://www.gov.uk/government/news/new-lung-cancer-screening-roll-out-to-detect-cancer-sooner","date":"2023-06-26"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"}]},{"title":"A cough that did not go away, and a chest X-ray","detail":"The commonest symptomatic route. NICE NG12 recommendation 1.1.2 tells GPs to offer an urgent direct-access chest X-ray to anyone aged 40 or over with two or more of cough, fatigue, shortness of breath, chest pain, weight loss or appetite loss, or with only one of those if they have ever smoked. Recommendation 1.1.3 adds a persistent or recurrent chest infection, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or a raised platelet count. Recommendation 1.1.1 says refer on a suspected cancer pathway straight away for chest X-ray findings that suggest lung cancer, or for unexplained coughing of blood at 40 or over. The National Optimal Lung Cancer Pathway asks for the X-ray to be reported before the patient leaves the department or within 24 hours, and a CT within 72 hours if it is suspicious. It also allows a direct-to-CT route, without an X-ray first, for people at high risk.","sources":[{"label":"NICE NG12: suspected cancer, recommendations by site (lung and pleural cancers 1.1.1 to 1.1.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"}]},{"title":"An emergency admission","share":"30.2% of diagnoses (England, 2024); 41.2% (Northern Ireland, 2018-2022)","detail":"Nearly one in three lung cancers in England still comes to light through an emergency admission. The share has fallen slowly, from 33 percent in 2022 to 31.9 percent in 2023 and 30.2 percent in 2024, and the audit notes bluntly that the screening programme's effect has not yet translated into fewer emergency presentations. Wales is lower at 26.4 percent; Northern Ireland is much higher, and its registry compared itself directly with England: 40.5 percent against 33.7 percent for 2018 to 2020. Northern Ireland's routes analysis also shows what the route costs: one-year net survival was 22.9 percent after an emergency presentation against 61.6 percent for people who came through an ordinary outpatient appointment, and 56.8 percent of stage IV cases came this way against 20.8 percent of stage I cases.","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"Northern Ireland Cancer Registry 2026: routes to diagnosis 2018 to 2022 (lung: 41.2 percent of diagnoses through an emergency presentation, 40.5 percent in Northern Ireland against 33.7 percent in England for 2018 to 2020)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/pdf/Routes%20to%20diagnosis%202018-2022.pdf","date":"2026"},{"label":"Cancer Research UK: lung cancer statistics (key stats, early diagnosis and routes by nation, treatment shares)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer","date":"2026-09-25"}]},{"title":"Never smoked, and told it cannot be lung cancer","detail":"Macmillan's page says around 15 in 100 people diagnosed with lung cancer in the UK have never smoked; the audit found that 10.0 percent of English patients with smoking status recorded had never smoked, though that field was complete for only 45.7 percent of records. University College London Hospitals is running an observational study of lung cancer in never-smokers whose own summary says more than a quarter of adults diagnosed with lung cancer have never smoked. The British group that runs TRACERx supplied the mechanism: fine particulate air pollution promotes EGFR-driven lung adenocarcinoma, and ultradeep sequencing of histologically normal lung tissue from 295 people found oncogenic EGFR variants in 18 percent of samples. Roy Castle Lung Cancer Foundation campaigns on exactly this under the name Let Go of the Labels, arguing that the words smoker and never-smoker distort what is going on and deny people an earlier diagnosis.","sources":[{"label":"Macmillan Cancer Support: lung cancer (support line 0808 808 00 00, 8am to 8pm every day)","url":"https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer","date":"2026-09-25"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NIHR Be Part of Research: observational study of lung cancer in never-smokers (University College London Hospitals, recruiting; the record carries only a portfolio number, no registry identifier)","url":"https://bepartofresearch.nihr.ac.uk/trial-details/trial-detail?trialId=61184","date":"2026-07-23"},{"label":"Hill W and others, lung adenocarcinoma promotion by air pollutants, Nature 2023 (particulate matter and EGFR-driven lung cancer across 32,957 cases; oncogenic EGFR variants found in 18 percent of histologically normal lung samples)","url":"https://europepmc.org/article/MED/37020004","date":"2023"},{"label":"Roy Castle Lung Cancer Foundation: campaigns (Let Go of the Labels, This is Lung Cancer, and the policy ask that no one should wait longer than 14 days for genomic testing)","url":"https://roycastle.org/about-us/campaigns/","date":"2026-09-25"}]}],"timeline":[{"id":"screening","label":"Before any symptoms: the lung health check","standard":"Aged 55 to 74, registered with an English GP and have ever smoked: a risk assessment, then a low-dose CT scan if either risk model puts you over its threshold, then a scan every two years","target":"Scan within 56 days of the lung health check; outcome letters within 28 days; national coverage of England by 2030","detail":"The UK National Screening Committee recommended targeted screening in June 2022 for people aged 55 to 74 at high risk, with integrated smoking cessation, and the government approved the recommendation on 26 June 2023. The operating document is NHS England's standard protocol, version 3 of 3 February 2025. Eligibility is age 55 to 74 years and 364 days, registered with a GP practice in England, and having ever smoked, with no baseline scan more than three months after a 75th birthday; because GP smoking records are poor, the protocol says that once the programme is fully rolled out everyone in the age band should be given the opportunity irrespective of their recorded smoking history. GP records are re-queried at least every two years.\n\nWho gets a scan is decided by risk models, not by age and pack-years alone. The programme uses PLCOm2012, adapted for UK ethnic groups, at a six-year risk of 1.51 percent or more, and the Liverpool Lung Project model version 2 at a five-year risk of 2.5 percent or more; satisfying either is enough. The Yorkshire Lung Screening Trial is why: at those thresholds PLCOm2012 identified 91.1 percent of the cancers against 62.8 percent for the 2013 United States categorical rule. People are excluded if they are beyond the scanner's weight or size limits, cannot lie flat, are too unwell for treatment with curative intent, are on a palliative care register or are severely frail.\n\nThe scan is usually in a mobile unit in a car park, should happen within 56 days of the lung health check, and the result letter should arrive within 28 days. A clear scan means a return in 24 months from the last stable or negative scan; an indeterminate nodule means surveillance at three and twelve months first, so a person can be 36 months from their baseline before their next routine round. Nodules are managed on the British Thoracic Society ladder with volumetry preferred, characterised at 5 mm or 80 cubic millimetres, and referred at 300 cubic millimetres or 8 mm with a Brock risk of 10 percent or more. The programme is expected to cost 270 million pounds a year once fully implemented; its modelling assumes 63 percent uptake and that 43.3 percent of completed risk assessments lead to a scan.","sources":[{"label":"UK National Screening Committee: lung cancer recommendation (June 2022 review): targeted screening with low-dose computed tomography is recommended for people aged 55 to 74 at high risk, with integrated smoking cessation, and the Targeted Lung Health Checks programme is a feasible starting point in England","url":"https://view-health-screening-recommendations.service.gov.uk/lung-cancer/","date":"2022-06"},{"label":"NHS England: targeted screening for lung cancer with low radiation dose computed tomography, the standard protocol prepared for the Lung Cancer Screening Programme, publication reference PR1646, version 3 of 3 February 2025 (eligibility, the two risk models and their thresholds, the invitation route, the exclusions, the scan interval and the nodule ladder). The publication page itself answers HTTP 202 with an empty body","url":"https://www.england.nhs.uk/wp-content/uploads/2019/02/2502-B1646-standard-protocol-prepared-for-the-lung-cancer-screening-programme.pdf","date":"2025-02-03"},{"label":"NHS England: quality assurance standards prepared for the Lung Cancer Screening Programme, publication reference PR1647, version 3 of 3 February 2025 (the scan within 56 days of the lung health check, and outcome letters within 28 days)","url":"https://www.england.nhs.uk/wp-content/uploads/2019/02/2502-B1647-quality-assurance-standards-prepared-for-the-lung-cancer-screening-programme.pdf","date":"2025-02-03"},{"label":"Department of Health and Social Care: equality impact assessment for screening for lung cancer (published 24 July 2025), which records that the government approved the UK National Screening Committee's recommendation on 26 June 2023 and that people with no nodules are reinvited every two years","url":"https://www.gov.uk/government/publications/lung-cancer-screening-equality-impact-assessment","date":"2025-07-24"},{"label":"NHS: lung cancer screening (the lung health check: who is invited, the telephone or online risk assessment, the scan in a mobile unit, the result letter within four weeks, and the cancer alliance areas where checks are live; page last reviewed 27 March 2023)","url":"https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/","date":"2023-03-27"},{"label":"GOV.UK: new lung cancer screening roll out to detect cancer sooner (Department of Health and Social Care, 26 June 2023): ages 55 to 74 with a GP record of smoking, 270 million pounds a year once fully implemented, up to 9,000 cancers a year and almost a million scans, 76 percent of cancers found at an earlier stage in the first phase, around 70 percent of screening delivered in mobile units in areas where people are four times more likely to smoke","url":"https://www.gov.uk/government/news/new-lung-cancer-screening-roll-out-to-detect-cancer-sooner","date":"2023-06-26"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Department of Health and Social Care: National Cancer Plan technical annex (published 4 February 2026), which gives the programme's operating assumptions: a 63 percent uptake rate, 43.3 percent conversion from risk assessment to scan, a 0.9 percent cancer rate at the first scan and 0.6 percent at later rounds, and a 76 percent early diagnosis rate against 29 percent before the programme","url":"https://www.gov.uk/government/publications/national-cancer-plan-technical-annex","date":"2026-02-04"},{"label":"Gabe R and others, comparing eligibility criteria in the Yorkshire Lung Screening Trial, Journal of Thoracic Oncology 2025 (the PLCOm2012 risk model at 1.51 percent found 91.1 percent of cancers against 62.8 percent for the 2013 US Preventive Services Task Force rule)","url":"https://europepmc.org/article/MED/39709114","date":"2025"}]},{"id":"referral","label":"Day 0: the chest X-ray decides the referral","standard":"Urgent direct-access chest X-ray within two weeks under NG12; suspected cancer pathway referral on a suspicious film or on unexplained haemoptysis at 40 or over; chest X-ray reported within 24 hours and CT within 72 hours under the optimal pathway","detail":"NG12's lung rules are unchanged since 2015 and are unusually permissive: two unexplained symptoms at 40 or over, or one if you have ever smoked. The National Optimal Lung Cancer Pathway then tries to compress what follows: the X-ray reported before the patient leaves or within 24 hours, CT the same day or within 72 hours, triage by radiology or respiratory medicine by day 3. Version 4 of the pathway, published 1 January 2024, added a direct-to-CT route for people at high risk of symptomatic lung cancer, clarified the other urgent presentation routes, and added blood-based tumour diagnostics and a molecular testing pathway. The National Cancer Plan says the artificial intelligence diagnostic fund has already put chest X-ray analysis tools into almost half of trusts and will extend them to all, and that self-referral for chest X-ray will be expanded; Roy Castle hosts the standard operating procedures of the three established self-request programmes, in Leeds, Greater Manchester and Leicester.","sources":[{"label":"NICE NG12: suspected cancer, recommendations by site (lung and pleural cancers 1.1.1 to 1.1.6), published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Roy Castle Lung Cancer Foundation: self-request chest X-ray services, a resource hub carrying the standard operating procedures of the Leeds, Greater Manchester and Leicester programmes","url":"https://roycastle.org/for-healthcare-professionals/self-request-chest-x-ray-services/","date":"2026-09-25"},{"label":"NICE HTG696: artificial-intelligence-derived software to analyse chest X-rays for suspected lung cancer in primary care referrals, early value assessment (28 September 2023, last updated 10 February 2025)","url":"https://www.nice.org.uk/guidance/htg696","date":"2025-02-10"}]},{"id":"fds","label":"28 days: diagnosis or all-clear","standard":"Faster Diagnosis Standard: told you have cancer, or that you do not, within 28 days of the referral","target":"75%, with 80% in the 2025/26 planning guidance and by March 2029","detail":"England measures the time from an urgent suspected cancer referral, an urgent screening referral or a consultant upgrade to the day the patient is told. In July 2026 the NHS achieved 79.3 percent across all cancers; for suspected lung cancer it was 77.8 percent, made up of 82.2 percent on the urgent suspected cancer route and only 58.9 percent on the national screening programme route. The National Cancer Plan commits to 80 percent by March 2029. For lung cancer the constraint is diagnostic capacity: GIRFT's lung cancer report asked for a three working day turnaround from abnormal chest X-ray to CT report, key diagnostic investigations within 21 calendar days, PET-CT reported within five calendar days, image-guided biopsy within five working days and endobronchial ultrasound within five calendar days, and found that in the 2019 organisational audit only 46 percent of services met the three-day target. NHS England's cancer waiting times web pages answer HTTP 202 with an empty challenge to automated readers; the figures here were read from the statistical release and the monthly data file, which do resolve.","sources":[{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"NHS England: cancer waiting times statistical release for July 2026, provider based, provisional (released 10 September 2026): 79.3 percent on the 28-day standard, 92.5 percent on the 31-day and 71.2 percent on the 62-day","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Cancer-Waiting-Times-Statistical-Release-July-2026-Provider-based-Provisional.pdf","date":"2026-09-10"},{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional (the lung rows for July 2026: 77.8 percent on the 28-day standard and 60.9 percent on the 62-day, and 35.9 percent at 62 days for referrals from the screening programme)","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/01/Lung-Cancer-National-Report-07-10j-FINAL.pdf","date":"2021-10"},{"label":"NHS England: cancer waiting times statistics (the page answered HTTP 202 with an empty AWS web application firewall challenge to OnCo on 25 September 2026)","url":"https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/"}]},{"id":"mdt","label":"Staging and the lung multidisciplinary team","standard":"Contrast-enhanced CT of chest, liver, adrenals and lower neck before biopsy; PET-CT for everyone who could have treatment with curative intent; every case discussed by a lung cancer multidisciplinary team","detail":"NICE NG122 recommendation 1.2.2 asks for contrast-enhanced CT including the liver, adrenals and lower neck, and 1.2.14 says do it before any biopsy. Recommendation 1.2.4 says ensure everyone who could potentially have treatment with curative intent is offered PET-CT before treatment, and 1.2.5 asks every cancer alliance to have a system of rapid access to it. Recommendation 1.2.8 offers endobronchial ultrasound-guided transbronchial needle aspiration for paratracheal and peribronchial lesions, and 1.2.9 asks every cancer alliance to have at least one centre with endobronchial or endoscopic ultrasound. Recommendations 1.2.31 to 1.2.33 require every suspected case to be referred to a member of a lung cancer multidisciplinary team, every working diagnosis to be discussed at that team's meeting, and fast-track lung cancer clinics to exist. The optimal pathway asks that a surgeon be present at more than 95 percent of meetings and that the full team meeting happen by day 21. NHS England's timed lung cancer diagnostic pathway names the core membership, which NG122 itself does not: lead clinician, radiologist, pathologist, oncologist, clinical nurse specialist and a relevant allied health professional, working with a pathway navigator, with a named clinical lead for every team. Its day-by-day audit tool runs from the chest X-ray at day minus three to triage at day 3, the fast-track clinic at day 6, a test bundle including at least PET-CT and spirometry at day 14, the multidisciplinary team meeting at day 21 and follow-up at day 28. Staging in NG122 still uses the seventh edition of the American Joint Committee on Cancer system; brain imaging is not offered in clinical stage 1 disease without neurological symptoms, is CT in stage 2 and MRI in stage 3.","sources":[{"label":"NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging","date":"2026-02"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"NHS England: implementing a timed lung cancer diagnostic pathway, publication reference PRN1346 (12 October 2023, last modified 25 June 2024), by Peter Johnson and David Baldwin: the day-by-day audit tool and the core membership of the lung cancer multidisciplinary team","url":"https://www.england.nhs.uk/long-read/implementing-a-timed-lung-cancer-diagnostic-pathway/","date":"2024-06-25"},{"label":"GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/01/Lung-Cancer-National-Report-07-10j-FINAL.pdf","date":"2021-10"}]},{"id":"genomics","label":"Reflex molecular testing, and what happens when the sample is too small","standard":"Comprehensive next-generation sequencing through a Genomic Laboratory Hub, requested reflexly by the pathologist; a full molecular report within 14 calendar days of the sample being taken","detail":"NG122 recommendation 1.2.11 says samples must be adequate to allow tumour subtyping and the assessment of molecular markers, and 1.2.12, amended in February 2026, now points directly at the National Genomic Test Directory for the next-generation sequencing panels, having previously described single-mutation testing. The National Optimal Lung Cancer Pathway sets the clock: tissue acquired on day 0, morphology and slide preparation for reflex testing by day 3, PD-L1 immunohistochemistry and slide preparation locally, then reflex sequencing, with a full molecular report no more than 14 calendar days after the sample was taken and the treating specialist seeing the patient within three working days of the result. Both DNA and RNA sequencing should be done in any histological subtype of non-small-cell disease. If there is not enough tissue, the pathologist emails or telephones the lung multidisciplinary team the same day, and the team decides between repeat sampling (allowed to day 21) and a salvage route: a limited DNA panel, fluorescence in situ hybridisation for ALK and ROS1, and a blood predictive biomarker. Circulating tumour DNA testing for non-small-cell lung cancer was added to the National Genomic Test Directory in May 2025 after an NHS pilot in which results came back on average 16 days faster than tissue genotyping. GIRFT asked for a maximum ten calendar day turnaround, and Roy Castle campaigns for 14 days as a patient right.","sources":[{"label":"NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging","date":"2026-02"},{"label":"NICE NG122: update information (February 2026 amended recommendation 1.2.12 from single-mutation testing to comprehensive next-generation sequencing panels through genomic laboratory hubs, and added links to the technology appraisals; March 2024 removed the mobocertinib pathways after that guidance was withdrawn)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Update-information","date":"2026-02"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/01/Lung-Cancer-National-Report-07-10j-FINAL.pdf","date":"2021-10"},{"label":"Roy Castle Lung Cancer Foundation: campaigns (Let Go of the Labels, This is Lung Cancer, and the policy ask that no one should wait longer than 14 days for genomic testing)","url":"https://roycastle.org/about-us/campaigns/","date":"2026-09-25"}]},{"id":"cns","label":"The lung cancer clinical nurse specialist","standard":"A lung cancer clinical nurse specialist available at all stages of care, and contact around the time of diagnosis","target":"More than 90% (National Lung Cancer Audit)","detail":"NG122 recommendation 1.1.1 says a lung cancer clinical nurse specialist should be available at all stages of care, and 1.2.34 says every cancer unit or centre should have one or more, seeing people before, at and after diagnosis. The audit's problem is not the number but the record: among English patients who had the field filled in, 93.1 percent had contact with a nurse specialist, comfortably above the 90 percent target, but the field was complete for only 64.2 percent of records and no English trust met the completeness target. Only 56 trusts exceeded 70 percent completeness. Wales records it for 97.5 percent of patients and reports 94.9 percent contact. The audit launched a quality improvement initiative on this indicator in autumn 2025.","sources":[{"label":"NICE NG122 recommendation 1.1.1: a lung cancer clinical nurse specialist should be available at all stages of care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Support-from-clinical-nurse-specialists","date":"2026-02"},{"label":"NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging","date":"2026-02"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"}]},{"id":"smoking","label":"Stopping smoking, as part of the treatment","standard":"Advise stopping as soon as lung cancer is suspected; an opt-out tobacco dependence service in hospital; do not postpone surgery to allow someone to stop","detail":"NG122 recommendations 1.3.1 to 1.3.3 are short and specific: tell people that smoking increases the risk of pulmonary complications after lung cancer surgery, advise them to stop as soon as the diagnosis is suspected and say why, and do not postpone surgery to allow them to stop. The National Cancer Plan commits hospitals to integrating opt-out cessation support into all routine care and to including smoking status in clinical assessments for non-urgent operations, with 70 million pounds more for local authority stop smoking services. Inside screening the evidence is British and good: in the Yorkshire Lung Screening Trial 89 percent of eligible smokers accepted an immediate consultation with a cessation practitioner at the same appointment, 75 percent took ongoing support and 12.4 percent were carbon-monoxide-validated quitters at four weeks. The UK National Screening Committee's recommendation was explicitly for screening with integrated smoking cessation, not screening alone. Outside screening, NICE NG209 section 1.14 asks secondary care to offer behavioural support during the current outpatient visit or inpatient stay, to provide it immediately at the outpatient site including at preoperative assessment, and to send people home with at least a week of stop-smoking medicine. The NHS Long Term Plan commitment that NHS England publishes covers inpatients, maternity and mental health settings rather than outpatient clinics.","sources":[{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Murray RL and others, a co-located stop-smoking service inside lung screening, European Respiratory Journal 2024 (89 percent of eligible smokers accepted an immediate consultation; 12.4 percent were carbon-monoxide-validated quitters at four weeks)","url":"https://europepmc.org/article/MED/38636970","date":"2024"},{"label":"UK National Screening Committee: lung cancer recommendation (June 2022 review): targeted screening with low-dose computed tomography is recommended for people aged 55 to 74 at high risk, with integrated smoking cessation, and the Targeted Lung Health Checks programme is a feasible starting point in England","url":"https://view-health-screening-recommendations.service.gov.uk/lung-cancer/","date":"2022-06"},{"label":"NICE NG209: tobacco, preventing uptake, promoting quitting and treating dependence (published 30 November 2021, last updated 4 February 2025), section 1.14 on secondary care, which asks for immediate behavioural support at the outpatient site and a week's pharmacotherapy on discharge","url":"https://www.nice.org.uk/guidance/ng209","date":"2025-02-04"},{"label":"NHS England: tobacco dependency programme (last modified 23 December 2024), which records the NHS Long Term Plan commitment to tobacco dependency treatment for all overnight inpatients by the end of 2023/24","url":"https://www.england.nhs.uk/ourwork/prevention/tobacco-dependency-programme/","date":"2024-12-23"}]},{"id":"dtt","label":"31 days: decision to first treatment","standard":"Treatment starts within 31 days of the decision to treat","target":"96% (England by March 2029); 95% (Scotland); 98% (Northern Ireland)","detail":"Scotland is the only nation that publishes a lung-specific split, and lung does well on this measure: 1,033 of 1,050 eligible referrals, or 98.4 percent, started treatment within 31 days in the quarter ending 31 March 2026, with a median wait of two days, against an all-cancer figure of 94.5 percent. The audit's equivalent internal measure is harsher: the median time from the decision to treat to the start of systemic anti-cancer therapy was 16 days in England, and in small-cell lung cancer, where the tumour doubles fastest, the audit's own standard is that at least 80 percent should start within 14 days of pathological diagnosis and only 44 percent did. England achieved 92.5 percent across all cancers in July 2026 and 94.3 percent for lung. Northern Ireland, whose target is 98 percent, treated 110 of 125 lung patients within 31 days in January 2026, 89 of 94 in February and 114 of 127 in March, with a median wait of eight to eleven days.","sources":[{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"NHS England: cancer waiting times statistical release for July 2026, provider based, provisional (released 10 September 2026): 79.3 percent on the 28-day standard, 92.5 percent on the 31-day and 71.2 percent on the 62-day","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Cancer-Waiting-Times-Statistical-Release-July-2026-Provider-based-Provisional.pdf","date":"2026-09-10"},{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional (the lung rows for July 2026: 77.8 percent on the 28-day standard and 60.9 percent on the 62-day, and 35.9 percent at 62 days for referrals from the screening programme)","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Northern Ireland Department of Health: cancer waiting times, January to March 2026 (published 2 July 2026, last updated 11 September 2026), whose tumour-site tables give the lung 31-day performance","url":"https://www.health-ni.gov.uk/publications/northern-ireland-waiting-time-statistics-cancer-waiting-times-january-march-2026","date":"2026-09-11"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"}]},{"id":"sixtytwo","label":"62 days: referral to first treatment, against a 49-day optimal pathway","standard":"First treatment within 62 days of the urgent referral; the National Optimal Lung Cancer Pathway asks for 49 days","target":"85% (England by March 2029); 95% (Scotland); 75% (Wales); 95% (Northern Ireland)","detail":"This is where lung cancer care in England fails most clearly, and the audit measures it against the tighter clinical standard rather than the national one. Of people with stage 1 or 2 non-small-cell lung cancer having surgery in England in 2024, the median time from referral to operation was 81 days and only 12 percent were treated within 49 days; for radical radiotherapy the median was 98 days and 3.2 percent met the target; for systemic therapy in stage 3B to 4 disease the median was 63 days and 27 percent met it. The audit's commentary says the growth in demand for surgery is lengthening the wait and that this will continue as screening expands, and it names thoracic surgery capacity as a priority. The national figures say the same thing: in July 2026, 71.2 percent of people across all cancers started treatment within 62 days, but only 60.9 percent of people with lung cancer, and only 35.9 percent of those referred through the screening programme. Lung cancer is about ten points worse than the average, and the screening route, which exists to catch cancer early, is the slowest door in the building. Scotland is the mirror image: it reported 83.6 percent of lung referrals treated within 62 days in the quarter to March 2026, well above its all-cancer figure of 72.2 percent though below its 95 percent standard, ranging from 67.7 percent in Greater Glasgow and Clyde to 94.1 percent in Lanarkshire. Wales publishes only an all-cancer figure, 60.1 percent in July 2026 against a 75 percent target. Northern Ireland republished its 62-day figures on 11 September 2026 after an error in the encompass patient administration system inflated them: the corrected all-cancer performance for the quarter to March 2026 is 29.6 percent.","sources":[{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional (the lung rows for July 2026: 77.8 percent on the 28-day standard and 60.9 percent on the 62-day, and 35.9 percent at 62 days for referrals from the screening programme)","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (published 17 September 2026): 60.1 percent of suspected cancer pathways started treatment within 62 days against a 75 percent target; no lung-specific figure is published","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},{"label":"Northern Ireland Department of Health: revised cancer waiting times against the 62-day target (published 11 September 2026), after an error in the encompass patient administration system's suspension logic inflated performance: 29.6 percent in the quarter to 31 March 2026","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"}]},{"id":"surgery","label":"Surgery","standard":"Lobectomy, open or thoracoscopic, for everyone well enough for treatment with curative intent; sublobar resection or stereotactic ablative radiotherapy if lobectomy is declined or contraindicated","target":"Surgical resection in at least 17% of people with non-small-cell lung cancer (audit); more than 20% (GIRFT)","detail":"NG122 recommendation 1.5.1 offers lobectomy, open or thoracoscopic, and 1.5.2 reserves more extensive surgery for clear margins; 1.5.3 requires hilar and mediastinal lymph node sampling or en bloc resection in every curative operation. Recommendation 1.5.5 offers stereotactic ablative radiotherapy or sublobar resection to people with stage 1 to 2A disease who decline lobectomy or in whom it is contraindicated. VIOLET, the UK trial, showed keyhole surgery leaves people with better physical function at five weeks and fewer serious adverse events after discharge, with the same survival at a year. In England in 2024, 7,878 people had surgery, 21.8 percent of everyone with non-small-cell disease, up from 6,547 and 19.6 percent in 2023; resection rates ranged from 15 to 37 percent between cancer alliances. Ninety-day survival after resection was 98.4 percent across England and Wales, on 8,559 operations in 28 thoracic units. Fitness still decides: among people with stage 1 or 2 disease, 75.3 percent with performance status 0 had surgery, 52.2 percent with performance status 1 and 19.2 percent with performance status 2.","sources":[{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"Lim E and others, VIOLET: video-assisted thoracoscopic or open lobectomy in early-stage lung cancer, NEJM Evidence 2022 (503 randomised; better physical function at five weeks and fewer serious adverse events after discharge with keyhole surgery, same survival at a year)","url":"https://europepmc.org/article/MED/38319202","date":"2022"},{"label":"GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/01/Lung-Cancer-National-Report-07-10j-FINAL.pdf","date":"2021-10"}]},{"id":"radiotherapy","label":"Radiotherapy with curative intent","standard":"Stereotactic ablative radiotherapy for stage 1 to 2A disease when surgery is declined or contraindicated; 55 Gy in 20 fractions or 60 to 66 Gy in 30 to 33 fractions when conventional radical radiotherapy is used","detail":"NG122 recommendation 1.5.8 offers stereotactic ablative radiotherapy to people with stage 1 to 2A disease who decline surgery or in whom it is contraindicated, and conventional or hyperfractionated radiotherapy if that too is contraindicated; 1.5.11 says follow the SABR Consortium guidance on fractionation; 1.5.12 sets the conventional doses. Recommendation 1.5.7 asks that everyone treated with curative intent be included in a national quality assurance programme. Britain's contribution here is CHART, invented at Mount Vernon, which gave the whole dose in twelve consecutive days and cut the relative risk of death by about a quarter; the schedule proved hard to run and modern practice uses the doses above, but the biological argument it settled, that tumour repopulation during a long course costs lives, is still the reason radiotherapy courses are kept short. In England in 2024 the median wait from referral to radical radiotherapy in stage 1 to 2 disease was 98 days, the longest interval the audit measures.","sources":[{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"Saunders M and others, continuous hyperfractionated accelerated radiotherapy against conventional radiotherapy in non-small-cell lung cancer, Lancet 1997 (563 patients, 24 percent reduction in the relative risk of death, two-year survival 20 to 29 percent)","url":"https://europepmc.org/article/MED/9250182","date":"1997"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"}]},{"id":"multimodality","label":"Stage 3 disease and the perioperative drugs","standard":"Assessment by both a thoracic oncologist and a thoracic surgeon for anyone potentially suitable for multimodality treatment; chemoradiotherapy with surgery considered in operable stage 3A N2","detail":"NG122 recommendation 1.6.1 requires assessment by both a thoracic oncologist and a thoracic surgeon; 1.6.3 to 1.6.5 offer chemoradiotherapy with surgery for operable stage 3A N2 disease, with the operation scheduled three to five weeks after the chemoradiotherapy finishes; 1.6.7 says centres performing lung resections should validate their data for the National Lung Cancer Audit. The guideline now also carries the perioperative appraisals directly: neoadjuvant nivolumab with chemotherapy (TA876), perioperative durvalumab (TA1030), perioperative pembrolizumab (TA1017) and perioperative nivolumab (TA1127), plus adjuvant osimertinib (TA1043), alectinib (TA1014), atezolizumab (TA1071) and pembrolizumab (TA1037). For unresectable stage 3 disease, durvalumab after concurrent chemoradiotherapy (TA798) and, for EGFR-mutant disease, osimertinib after chemoradiotherapy (TA1156). The audit's first recommendation for 2026 is about this step: only 59.1 percent of English patients with stage 3A disease and performance status 0 to 2 were given treatment with curative intent, and it asks cancer alliances to audit their multidisciplinary team decisions to find out why.","sources":[{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NICE TA1127: nivolumab with chemotherapy before surgery then alone after surgery for resectable non-small-cell lung cancer (4 February 2026; recommendation 1.2 says use the least expensive of nivolumab, pembrolizumab and durvalumab)","url":"https://www.nice.org.uk/guidance/ta1127","date":"2026-02-04"},{"label":"NICE TA798: durvalumab for maintenance treatment of unresectable non-small-cell lung cancer after platinum-based chemoradiation (22 June 2022, PD-L1 of 1 percent or more and only after concurrent chemoradiotherapy; the PACIFIC indication)","url":"https://www.nice.org.uk/guidance/ta798","date":"2022-06-22"}]},{"id":"systemic","label":"Systemic anti-cancer therapy in advanced disease","standard":"Molecular and PD-L1 results before treatment; platinum-based chemotherapy with or without immunotherapy, or a targeted drug where a driver is found","target":"More than 70% of fit people with stage 3B to 4 non-small-cell disease and more than 70% of people with small-cell disease to receive systemic therapy (audit)","detail":"The funding table below sets out what is available by biomarker. The audit's finding is that access, not availability, is the constraint: 63.4 percent of English patients with stage 3B to 4 non-small-cell disease and performance status 0 to 1 received systemic therapy in 2024, essentially unchanged since 2022, against a 70 percent standard that only 42 of 123 trusts met, with cancer alliance rates ranging from 42 to 84 percent. In small-cell disease 71.2 percent received systemic therapy, just over the standard but down from 73.8 percent in 2023. The audit concludes that the growing demand for systemic treatment is outpacing service provision and asks for a review of capacity, naming molecular pathology capacity specifically.","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"NHS England: national Cancer Drugs Fund list version 1.408, updated 24 September 2026, read in full (320 pages): four lung indications in the Cancer Drugs Fund section and 43 routinely funded lung indications in section B, each with its Blueteq form, appraisal reference and funding date","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"}]},{"id":"sclc","label":"Small-cell lung cancer, which runs on a shorter clock","standard":"Assessment by a thoracic oncologist within one week of the decision to recommend treatment; four to six cycles of platinum-based chemotherapy; twice-daily radiotherapy with concurrent chemotherapy in limited-stage disease; prophylactic cranial irradiation","detail":"Small-cell disease was 6.6 percent of English lung cancers in 2024, down from 8.6 percent in 2019, and 9.1 percent in Wales. NG122 recommendation 1.8.1 asks for assessment by a thoracic oncologist within one week of the decision to recommend treatment. In limited-stage disease, 1.10.1 offers four to six cycles of cisplatin-based chemotherapy, 1.10.2 offers twice-daily radiotherapy concurrent with it starting in cycle one or two, 1.10.5 offers prophylactic cranial irradiation at 25 Gy in ten fractions, and 1.10.6 now carries durvalumab after chemoradiotherapy (TA1099). In extensive-stage disease, 1.11.1 to 1.11.3 offer platinum chemotherapy with durvalumab (TA1041) or atezolizumab (TA638), and 1.11.4 and 1.11.5 consider thoracic radiotherapy and prophylactic cranial irradiation after a response. The twice-daily schedule survives because of CONVERT, a Manchester-led trial funded by Cancer Research UK across 73 centres in eight countries, which was designed to show the once-daily schedule was better and did not. In relapse, oral topotecan is the only recommended drug (TA184) and tarlatamab was refused (TA1091). The audit's fourth recommendation is about speed: the median time from diagnosis to treatment was 16 days against a 14-day standard, and only 44 percent were treated in time.","sources":[{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"Faivre-Finn C and others, CONVERT, Lancet Oncology 2017 (547 patients; median survival 30 months twice-daily against 25 months once-daily, hazard ratio 1.18, so twice-daily 45 Gy remained the standard)","url":"https://europepmc.org/article/MED/28642008","date":"2017"},{"label":"NICE TA1099: durvalumab for limited-stage small-cell lung cancer after platinum-based chemoradiotherapy (1 October 2025, the ADRIATIC indication)","url":"https://www.nice.org.uk/guidance/ta1099","date":"2025-10-01"},{"label":"NICE TA1091: tarlatamab for extensive-stage small-cell lung cancer after two or more treatments, not recommended (20 August 2025)","url":"https://www.nice.org.uk/guidance/ta1091","date":"2025-08-20"}]},{"id":"prehab","label":"Prehabilitation and exercise","standard":"Regular aerobic and resistance exercise during treatment with curative intent, including before surgery","detail":"The audit's fifth recommendation for 2026 asks that everyone diagnosed with stage 1 to 3 disease be recommended regular aerobic and resistance exercise during treatment with curative intent, including preoperative exercise before lung cancer surgery, citing the American Society of Clinical Oncology's 2022 guideline. It made this recommendation because the proportion of people with stage 1 to 2 disease having surgery falls so steeply with fitness. The National Optimal Lung Cancer Pathway asks teams to optimise comorbidities, smoking and nutrition as early as possible and to refer to local prehabilitation services, and the National Cancer Plan promises a digital-first prehabilitation offer through the NHS App. Fit 4 Surgery 2, a 902-patient NIHR trial run from Birmingham across 20 thoracic units, is testing whether an app-based programme actually reduces complications.","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}]}],"centres":[{"institutionId":"guys-st-thomas","name":"Guy's Hospital, Royal Brompton and Harefield","trust":"Guy's and St Thomas' NHS Foundation Trust","city":"London","nation":"England","offers":["The largest thoracic surgical service in the UK: 1,257 lung cancer resections in 2024","Sponsor of VIOLET, the trial that compared keyhole with open lobectomy","REFINE-Lung, PRINCE, QUARTZ LUNG, HALT and ADSCaN site"],"url":"https://www.guysandstthomas.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN13472721: VIOLET, video-assisted thoracoscopic lobectomy against open lobectomy (Royal Brompton and Harefield; 503 randomised)","url":"https://www.isrctn.com/ISRCTN13472721","date":"2026-09-25"},{"label":"ISRCTN70247820: REFINE-Lung, reduced-frequency pembrolizumab in first-line advanced non-small-cell lung cancer (Imperial College London, funded by the NIHR Health Technology Assessment Programme; target 1,750, 40 UK centres)","url":"https://www.isrctn.com/ISRCTN70247820","date":"2026-09-25"}],"institutionName":"Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre"},{"name":"Wythenshawe Hospital: the North West Centre for Lung Surgery and the North West Lung Centre","trust":"Manchester University NHS Foundation Trust","city":"Manchester","nation":"England","offers":["695 lung cancer resections in 2024, the second highest in England and Wales; the trust says its surgeons perform the highest proportion of surgery for lung cancer nationally","Home of the Manchester Lung Health Check pilot, the study that took CT scanners into supermarket car parks","SEARCH, MEDLEY, YorQuit, PROMINENT and Fit 4 Surgery 2 site"],"url":"https://mft.nhs.uk/wythenshawe/services/cardiology-and-cardiothoracic-surgery/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"Manchester University NHS Foundation Trust: cardiology and cardiothoracic surgery at Wythenshawe, home of the North West Centre for Lung Surgery, which says its surgeons perform the highest proportion of surgery for lung cancer nationally","url":"https://mft.nhs.uk/wythenshawe/services/cardiology-and-cardiothoracic-surgery/","date":"2026-09-25"},{"label":"Crosbie PA and others, implementing lung cancer screening: baseline results from a community Lung Health Check pilot in deprived areas of Manchester, Thorax 2019 (75 percent of attendees in the poorest fifth; 80 percent of the cancers found were early stage)","url":"https://europepmc.org/article/MED/29440588","date":"2019"}]},{"institutionId":"liverpool-heart-and-chest","name":"Liverpool Heart and Chest Hospital","trust":"Liverpool Heart and Chest Hospital NHS Foundation Trust","city":"Liverpool","nation":"England","offers":["568 lung cancer resections in 2024","One of the two hospitals that delivered the UK Lung Cancer Screening trial","Cheshire and Merseyside screening programme delivery; APPLIED-LUNG and P4-LHC site"],"url":"https://www.lhch.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN78513845: the UK Lung Cancer Screening pilot trial (Royal Liverpool and Broadgreen University Hospital Trust; 4,055 randomised, recruitment April 2011 to December 2012)","url":"https://www.isrctn.com/ISRCTN78513845","date":"2026-09-25"},{"label":"ISRCTN10688513: APPLIED-LUNG, a blood protein test to refine risk before the screening CT (University of Liverpool, NIHR; target 11,000, in the Cheshire and Merseyside screening programme)","url":"https://www.isrctn.com/ISRCTN10688513","date":"2026-09-25"}],"institutionName":"Liverpool Heart and Chest Hospital NHS Foundation Trust"},{"institutionId":"southampton-cancer","name":"University Hospital Southampton","trust":"University Hospital Southampton NHS Foundation Trust","city":"Southampton","nation":"England","offers":["384 lung cancer resections in 2024","Southampton Clinical Trials Unit coordinates PRINCE and QUARTZ LUNG","SEARCH, MEDLEY, REFINE-Lung and HALT site"],"url":"https://www.uhs.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN17123858: PRINCE, first-line systemic treatment with or without thoracic radiotherapy in stage 4 non-small-cell lung cancer (The Christie, NIHR; target 472, 29 centres across the four nations and Ireland)","url":"https://www.isrctn.com/ISRCTN17123858","date":"2026-09-25"},{"label":"ISRCTN11668189: SEARCH, low-dose CT lung screening for Hodgkin lymphoma survivors inside the NHS programme (University of Manchester, SBRI Healthcare; target 4,400, eight centres)","url":"https://www.isrctn.com/ISRCTN11668189","date":"2026-09-25"}],"institutionName":"University Hospital Southampton / Centre for Cancer Immunology"},{"institutionId":"bristol-haematology-oncology-centre","name":"Bristol Royal Infirmary and the Bristol Haematology and Oncology Centre","trust":"University Hospitals Bristol and Weston NHS Foundation Trust","city":"Bristol","nation":"England","offers":["332 lung cancer resections in 2024","PRINCE, QUARTZ LUNG, REFINE-Lung, HALT and ADSCaN site","Fit 4 Surgery 2 prehabilitation site"],"url":"https://www.uhbw.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN17123858: PRINCE, first-line systemic treatment with or without thoracic radiotherapy in stage 4 non-small-cell lung cancer (The Christie, NIHR; target 472, 29 centres across the four nations and Ireland)","url":"https://www.isrctn.com/ISRCTN17123858","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"Bristol Haematology and Oncology Centre"},{"institutionId":"newcastle-cancer-centre","name":"Freeman Hospital and the Northern Centre for Cancer Care","trust":"The Newcastle upon Tyne Hospitals NHS Foundation Trust","city":"Newcastle upon Tyne","nation":"England","offers":["324 lung cancer resections in 2024","Sir Bobby Robson Early Clinical Trials Centre; joint lead for the CONCORDE platform","ADSCaN site"],"url":"https://www.newcastle-hospitals.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"Newcastle University: Professor Alastair Greystoke","url":"https://www.ncl.ac.uk/medical-sciences/people/profile/alastairgreystoke.html","date":"2026-09-25"}],"institutionName":"Newcastle Cancer Centre / Northern Centre for Cancer Care"},{"institutionId":"weston-park-sheffield","name":"Northern General Hospital and Weston Park Cancer Centre","trust":"Sheffield Teaching Hospitals NHS Foundation Trust","city":"Sheffield","nation":"England","offers":["300 lung cancer resections in 2024","CONCORDE, PRINCE, QUARTZ LUNG, REFINE-Lung, HALT and ADSCaN site","Ran CHART-ED, the dose-escalated successor to CHART"],"url":"https://www.sth.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"ISRCTN47674500: ADSCaN, accelerated dose-escalated sequential chemoradiotherapy in stage 3 non-small-cell lung cancer (NHS Greater Glasgow and Clyde with Cancer Research UK; 18 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN47674500","date":"2026-09-25"}],"institutionName":"Weston Park Cancer Centre, Sheffield Teaching Hospitals"},{"institutionId":"barts-cancer-institute","name":"St Bartholomew's Hospital","trust":"Barts Health NHS Trust","city":"London","nation":"England","offers":["296 lung cancer resections in 2024","CONCORDE, HALT and REFINE-Lung site"],"url":"https://www.bartshealth.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"ISRCTN53398136: HALT, targeted therapy with or without stereotactic radiotherapy for oligoprogressive oncogene-addicted lung tumours (Institute of Cancer Research, Cancer Research UK; 113 enrolled, 19 centres)","url":"https://www.isrctn.com/ISRCTN53398136","date":"2026-09-25"}],"institutionName":"Barts Cancer Institute / Barts Health NHS Trust"},{"institutionId":"nottingham-cancer-centre","name":"Nottingham City Hospital","trust":"Nottingham University Hospitals NHS Trust","city":"Nottingham","nation":"England","offers":["293 lung cancer resections in 2024","Base of the NHS England lead clinician for lung cancer and chair of the UK clinical expert group","PRINCE, QUARTZ LUNG, REFINE-Lung, HALT, LION and ADSCaN site"],"url":"https://www.nuh.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"University of Nottingham: Professor David Baldwin","url":"https://www.nottingham.ac.uk/medicine/people/david.baldwin","date":"2026-09-25"},{"label":"ISRCTN17123858: PRINCE, first-line systemic treatment with or without thoracic radiotherapy in stage 4 non-small-cell lung cancer (The Christie, NIHR; target 472, 29 centres across the four nations and Ireland)","url":"https://www.isrctn.com/ISRCTN17123858","date":"2026-09-25"}],"institutionName":"Nottingham University Hospitals Cancer Centre (City Hospital)"},{"institutionId":"uclh","name":"University College Hospital","trust":"University College London Hospitals NHS Foundation Trust","city":"London","nation":"England","offers":["289 lung cancer resections in 2024","Home of TRACERx, PEACE and the SUMMIT lung health check study","LungVax, CONCORDE, PRINCE, QUARTZ LUNG and HALT site; the never-smoker observational study"],"url":"https://www.uclh.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"Bhamani A and others, the SUMMIT study baseline round, Lancet Oncology 2025 (12,773 participants from 329 London practices; 79.3 percent of the 261 cancers at stage 1 or 2)","url":"https://europepmc.org/article/MED/40154514","date":"2025"},{"label":"ISRCTN70717445: LungVax, a ChAdOx2 neoantigen vaccine to prevent recurrent or new non-small-cell lung cancer after resection (University of Oxford, funded by Cancer Research UK and the CRIS Cancer Foundation; phase 1, target 40)","url":"https://www.isrctn.com/ISRCTN70717445","date":"2026-09-25"}],"institutionName":"University College London Hospitals / UCL Cancer Institute"},{"institutionId":"birmingham-cancer-centre","name":"Queen Elizabeth Hospital Birmingham and Birmingham Heartlands","trust":"University Hospitals Birmingham NHS Foundation Trust","city":"Birmingham","nation":"England","offers":["289 lung cancer resections in 2024","Cancer Research UK Clinical Trials Unit runs the National Lung Matrix Trial; Birmingham Clinical Trials Unit runs Fit 4 Surgery 2","Birmingham Experimental Cancer Medicine Centre"],"url":"https://www.uhb.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN38344105: the National Lung Matrix Trial, a multi-drug, genetic-marker-directed multi-arm phase 2 trial (University of Birmingham with Cancer Research UK, AstraZeneca, Pfizer and Mirati; 423 enrolled, recruitment March 2015 to October 2021)","url":"https://www.isrctn.com/ISRCTN38344105","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"University Hospitals Birmingham / University of Birmingham Cancer Research Centre"},{"institutionId":"leicester-cancer-research-centre","name":"Glenfield Hospital and Leicester Royal Infirmary","trust":"University Hospitals of Leicester NHS Trust","city":"Leicester","nation":"England","offers":["289 lung cancer resections in 2024","REFINE-Lung, HALT and Fit 4 Surgery 2 site","One of the three established self-request chest X-ray programmes"],"url":"https://www.uhleicester.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN70247820: REFINE-Lung, reduced-frequency pembrolizumab in first-line advanced non-small-cell lung cancer (Imperial College London, funded by the NIHR Health Technology Assessment Programme; target 1,750, 40 UK centres)","url":"https://www.isrctn.com/ISRCTN70247820","date":"2026-09-25"},{"label":"Roy Castle Lung Cancer Foundation: self-request chest X-ray services, a resource hub carrying the standard operating procedures of the Leeds, Greater Manchester and Leicester programmes","url":"https://roycastle.org/for-healthcare-professionals/self-request-chest-x-ray-services/","date":"2026-09-25"}],"institutionName":"Leicester Cancer Research Centre / University Hospitals of Leicester"},{"institutionId":"derriford-plymouth","name":"Derriford Hospital","trust":"University Hospitals Plymouth NHS Trust","city":"Plymouth","nation":"England","offers":["283 lung cancer resections in 2024","SEARCH and Fit 4 Surgery 2 site"],"url":"https://www.plymouthhospitals.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN11668189: SEARCH, low-dose CT lung screening for Hodgkin lymphoma survivors inside the NHS programme (University of Manchester, SBRI Healthcare; target 4,400, eight centres)","url":"https://www.isrctn.com/ISRCTN11668189","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"Derriford Hospital, University Hospitals Plymouth"},{"institutionId":"leeds-cancer-centre","name":"St James's University Hospital","trust":"Leeds Teaching Hospitals NHS Trust","city":"Leeds","nation":"England","offers":["264 lung cancer resections in 2024","Home of the Yorkshire Lung Screening Trial and of the Leeds self-request chest X-ray programme","Leeds Clinical Trials Research Unit sponsors CONCORDE and MEDLEY"],"url":"https://www.leedsth.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN42704678: the Yorkshire Lung Screening Trial (University of Leeds, funded by Yorkshire Cancer Research; 8,847 enrolled, recruitment September 2018 to October 2024)","url":"https://www.isrctn.com/ISRCTN42704678","date":"2026-09-25"},{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"}],"institutionName":"Leeds Cancer Centre, St James's University Hospital"},{"name":"St George's Hospital","trust":"St George's University Hospitals NHS Foundation Trust","city":"London","nation":"England","offers":["264 lung cancer resections in 2024"],"url":"https://www.stgeorges.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"}]},{"name":"Basildon University Hospital","trust":"Mid and South Essex NHS Foundation Trust","city":"Basildon","nation":"England","offers":["249 lung cancer resections in 2024","Fit 4 Surgery 2 site"],"url":"https://mse.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}]},{"institutionId":"royal-papworth","name":"Royal Papworth Hospital","trust":"Royal Papworth Hospital NHS Foundation Trust","city":"Cambridge","nation":"England","offers":["236 lung cancer resections in 2024, with no deaths within 90 days","One of the two hospitals that delivered the UK Lung Cancer Screening trial","Fit 4 Surgery 2 site"],"url":"https://royalpapworth.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN78513845: the UK Lung Cancer Screening pilot trial (Royal Liverpool and Broadgreen University Hospital Trust; 4,055 randomised, recruitment April 2011 to December 2012)","url":"https://www.isrctn.com/ISRCTN78513845","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"Royal Papworth Hospital NHS Foundation Trust"},{"name":"James Cook University Hospital","trust":"South Tees Hospitals NHS Foundation Trust","city":"Middlesbrough","nation":"England","offers":["210 lung cancer resections in 2024","ADSCaN and Fit 4 Surgery 2 site"],"url":"https://www.southtees.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN47674500: ADSCaN, accelerated dose-escalated sequential chemoradiotherapy in stage 3 non-small-cell lung cancer (NHS Greater Glasgow and Clyde with Cancer Research UK; 18 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN47674500","date":"2026-09-25"}]},{"institutionId":"hull-castle-hill","name":"Castle Hill Hospital (Queen's Centre)","trust":"Hull University Teaching Hospitals NHS Trust","city":"Cottingham","nation":"England","offers":["209 lung cancer resections in 2024","TACTICAL1, MEDLEY, YorQuit, HALT and Fit 4 Surgery 2 site","CanBenefit 3 wellbeing study"],"url":"https://www.hey.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN87248310: MEDLEY, low-dose CT instead of chest X-ray for people referred from primary care with possible lung cancer symptoms (University of Leeds, NIHR; target 900, five centres)","url":"https://www.isrctn.com/ISRCTN87248310","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"Castle Hill Hospital, Hull (Queen's Centre)"},{"institutionId":"uhcw-coventry","name":"University Hospital Coventry","trust":"University Hospitals Coventry and Warwickshire NHS Trust","city":"Coventry","nation":"England","offers":["200 lung cancer resections in 2024","Fit 4 Surgery 2 site; a site of the robotic against video-assisted lobectomy comparison"],"url":"https://www.uhcw.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"University Hospital Coventry"},{"institutionId":"imperial-cancer-centre","name":"Hammersmith and Charing Cross Hospitals","trust":"Imperial College Healthcare NHS Trust","city":"London","nation":"England","offers":["199 lung cancer resections in 2024","Imperial College London sponsors REFINE-Lung and INSIGHT","Fit 4 Surgery 2 site"],"url":"https://www.imperial.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN70247820: REFINE-Lung, reduced-frequency pembrolizumab in first-line advanced non-small-cell lung cancer (Imperial College London, funded by the NIHR Health Technology Assessment Programme; target 1,750, 40 UK centres)","url":"https://www.isrctn.com/ISRCTN70247820","date":"2026-09-25"}],"institutionName":"Imperial College Healthcare NHS Trust / Imperial College London Cancer Research"},{"name":"Norfolk and Norwich University Hospital","trust":"Norfolk and Norwich University Hospitals NHS Foundation Trust","city":"Norwich","nation":"England","offers":["181 lung cancer resections in 2024, with the lowest unadjusted 90-day mortality of any high-volume unit"],"url":"https://www.nnuh.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"}]},{"institutionId":"royal-stoke-uhnm","name":"Royal Stoke University Hospital","trust":"University Hospitals of North Midlands NHS Trust","city":"Stoke-on-Trent","nation":"England","offers":["170 lung cancer resections in 2024","SEARCH site"],"url":"https://www.uhnm.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN11668189: SEARCH, low-dose CT lung screening for Hodgkin lymphoma survivors inside the NHS programme (University of Manchester, SBRI Healthcare; target 4,400, eight centres)","url":"https://www.isrctn.com/ISRCTN11668189","date":"2026-09-25"}],"institutionName":"Royal Stoke University Hospital"},{"name":"New Cross Hospital","trust":"The Royal Wolverhampton NHS Trust","city":"Wolverhampton","nation":"England","offers":["151 lung cancer resections in 2024","QUARTZ LUNG and Fit 4 Surgery 2 site"],"url":"https://www.royalwolverhampton.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN52137148: QUARTZ LUNG, palliative thoracic radiotherapy in stage 4 non-small-cell lung cancer for people not having systemic treatment (The Christie, NIHR; target 448, 18 centres)","url":"https://www.isrctn.com/ISRCTN52137148","date":"2026-09-25"}]},{"institutionId":"oxford-cancer","name":"Churchill and John Radcliffe Hospitals","trust":"Oxford University Hospitals NHS Foundation Trust","city":"Oxford","nation":"England","offers":["140 lung cancer resections in 2024","University of Oxford sponsors LungVax, the neoantigen prevention vaccine","PRINCE, HALT and Fit 4 Surgery 2 site"],"url":"https://www.ouh.nhs.uk/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN70717445: LungVax, a ChAdOx2 neoantigen vaccine to prevent recurrent or new non-small-cell lung cancer after resection (University of Oxford, funded by Cancer Research UK and the CRIS Cancer Foundation; phase 1, target 40)","url":"https://www.isrctn.com/ISRCTN70717445","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"}],"institutionName":"Oxford Cancer (Oxford University Hospitals and University of Oxford)"},{"institutionId":"the-christie","name":"The Christie","trust":"The Christie NHS Foundation Trust","city":"Manchester","nation":"England","offers":["Thoracic oncology and radiotherapy for Greater Manchester","Sponsor of CONVERT, PRINCE, QUARTZ LUNG, RAPID-RT and LION","Manchester Clinical Trials Unit; the base of the CONVERT and RAPID-RT programmes"],"url":"https://www.christie.nhs.uk/","sources":[{"label":"ISRCTN91927162: CONVERT, twice-daily against once-daily chemoradiotherapy in limited-stage small-cell lung cancer (The Christie, funded by Cancer Research UK; 547 enrolled, 73 centres in eight countries)","url":"https://www.isrctn.com/ISRCTN91927162","date":"2026-09-25"},{"label":"ISRCTN17123858: PRINCE, first-line systemic treatment with or without thoracic radiotherapy in stage 4 non-small-cell lung cancer (The Christie, NIHR; target 472, 29 centres across the four nations and Ireland)","url":"https://www.isrctn.com/ISRCTN17123858","date":"2026-09-25"},{"label":"University of Manchester: Professor Corinne Faivre-Finn","url":"https://research.manchester.ac.uk/en/persons/corinne.faivre-finn","date":"2026-09-25"}],"institutionName":"The Christie NHS Foundation Trust"},{"institutionId":"royal-marsden","name":"The Royal Marsden","trust":"The Royal Marsden NHS Foundation Trust","city":"London","nation":"England","offers":["Thoracic oncology; the base of the Institute of Cancer Research's thoracic oncology chair","Sponsor of HALT through the ICR Clinical Trials and Statistics Unit","CONCORDE, REFINE-Lung, ADSCaN and SEARCH site"],"url":"https://www.royalmarsden.nhs.uk/","sources":[{"label":"ISRCTN53398136: HALT, targeted therapy with or without stereotactic radiotherapy for oligoprogressive oncogene-addicted lung tumours (Institute of Cancer Research, Cancer Research UK; 113 enrolled, 19 centres)","url":"https://www.isrctn.com/ISRCTN53398136","date":"2026-09-25"},{"label":"The Royal Marsden: Professor Sanjay Popat, Chief Medical Officer and Consultant Medical Oncologist","url":"https://www.royalmarsden.nhs.uk/our-consultants-units-and-wards/consultant-directory/professor-sanjay-popat","date":"2026-09-25"},{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"}],"institutionName":"The Royal Marsden"},{"institutionId":"clatterbridge","name":"The Clatterbridge Cancer Centre","trust":"The Clatterbridge Cancer Centre NHS Foundation Trust","city":"Liverpool","nation":"England","offers":["Thoracic oncology for Cheshire and Merseyside","CONCORDE, PRINCE, QUARTZ LUNG, REFINE-Lung, HALT, LION and ADSCaN site","NEOVACC, the personalised DNA vaccine trial"],"url":"https://www.clatterbridgecc.nhs.uk/","sources":[{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"ISRCTN11752949: NEOVACC, personalised Doggybone DNA vaccines in PD-L1-high non-small-cell lung cancer (University of Liverpool with the Medical Research Council; phase 1, target 15)","url":"https://www.isrctn.com/ISRCTN11752949","date":"2026-09-25"},{"label":"ISRCTN70247820: REFINE-Lung, reduced-frequency pembrolizumab in first-line advanced non-small-cell lung cancer (Imperial College London, funded by the NIHR Health Technology Assessment Programme; target 1,750, 40 UK centres)","url":"https://www.isrctn.com/ISRCTN70247820","date":"2026-09-25"}],"institutionName":"The Clatterbridge Cancer Centre NHS Foundation Trust"},{"institutionId":"beatson-glasgow","name":"Beatson West of Scotland Cancer Centre","trust":"NHS Greater Glasgow and Clyde","city":"Glasgow","nation":"Scotland","offers":["Thoracic oncology for the West of Scotland; thoracic surgery for the region is at the Golden Jubilee National Hospital in Clydebank, which had 18,846 cardiothoracic episodes in 2024/25","NHS Greater Glasgow and Clyde sponsored ADSCaN, run from the Cancer Research UK Clinical Trials Unit at the Beatson","PRINCE, REFINE-Lung and HALT site; GALACTIC-1 case-finding feasibility study"],"url":"https://www.nhsggc.scot/","sources":[{"label":"ISRCTN47674500: ADSCaN, accelerated dose-escalated sequential chemoradiotherapy in stage 3 non-small-cell lung cancer (NHS Greater Glasgow and Clyde with Cancer Research UK; 18 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN47674500","date":"2026-09-25"},{"label":"NIHR Be Part of Research: GALACTIC-1, a Glasgow low-dose CT and artificial-intelligence case-finding feasibility study for lung cancer and other cardiorespiratory conditions (NHS Greater Glasgow and Clyde, recruiting, ages 55 to 74)","url":"https://bepartofresearch.nihr.ac.uk/trial-details/trial-detail?trialId=59789","date":"2026-06-18"},{"label":"Public Health Scotland open data: annual inpatient and daycase activity by location and specialty, cardiothoracic surgery in 2024/25 (Golden Jubilee National Hospital 18,846 episodes, Royal Infirmary of Edinburgh 16,539 and Aberdeen Royal Infirmary 4,900; Glasgow Royal Infirmary none)","url":"https://www.opendata.nhs.scot/dataset/annual-inpatient-and-daycase-activity","date":"2025-09-30"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"}],"institutionName":"Beatson West of Scotland Cancer Centre / CRUK Scotland Institute"},{"institutionId":"edinburgh-cancer-centre","name":"Western General Hospital, Edinburgh Cancer Centre","trust":"NHS Lothian","city":"Edinburgh","nation":"Scotland","offers":["Thoracic oncology for South East Scotland","The Royal Infirmary of Edinburgh is the region's cardiothoracic surgery centre, with 16,539 episodes in 2024/25, and a Fit 4 Surgery 2 site; Aberdeen Royal Infirmary is the third Scottish centre","CONCORDE, QUARTZ LUNG, REFINE-Lung and HALT site"],"url":"https://www.nhslothian.scot/","sources":[{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units)","url":"https://www.isrctn.com/ISRCTN40412033","date":"2026-09-25"},{"label":"Public Health Scotland open data: annual inpatient and daycase activity by location and specialty, cardiothoracic surgery in 2024/25 (Golden Jubilee National Hospital 18,846 episodes, Royal Infirmary of Edinburgh 16,539 and Aberdeen Royal Infirmary 4,900; Glasgow Royal Infirmary none)","url":"https://www.opendata.nhs.scot/dataset/annual-inpatient-and-daycase-activity","date":"2025-09-30"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"}],"institutionName":"Edinburgh Cancer Centre / CRUK Scotland Centre"},{"institutionId":"university-hospital-wales-cardiff","name":"Cardiff and Vale University Health Board","trust":"Cardiff and Vale University Health Board","city":"Cardiff","nation":"Wales","offers":["162 lung cancer resections in 2024, the larger of the two Welsh thoracic units, recorded against the health board by the national audit","A QuicDNA site: liquid biopsy folded into the routine diagnostic pathway"],"url":"https://cavuhb.nhs.wales/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN22734699: QuicDNA, liquid biopsy folded into the routine lung cancer diagnostic pathway across all six Welsh health boards (Aneurin Bevan University Health Board with Health and Care Research Wales; 763 enrolled)","url":"https://www.isrctn.com/ISRCTN22734699","date":"2026-09-25"}],"institutionName":"University Hospital of Wales, Cardiff"},{"institutionId":"morriston-swansea","name":"Morriston and Singleton Hospitals","trust":"Swansea Bay University Health Board","city":"Swansea","nation":"Wales","offers":["64 lung cancer resections in 2024, the smallest unit in England and Wales","South West Wales Cancer Centre at Singleton was an ADSCaN site","A QuicDNA site"],"url":"https://sbuhb.nhs.wales/","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"ISRCTN47674500: ADSCaN, accelerated dose-escalated sequential chemoradiotherapy in stage 3 non-small-cell lung cancer (NHS Greater Glasgow and Clyde with Cancer Research UK; 18 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN47674500","date":"2026-09-25"},{"label":"ISRCTN22734699: QuicDNA, liquid biopsy folded into the routine lung cancer diagnostic pathway across all six Welsh health boards (Aneurin Bevan University Health Board with Health and Care Research Wales; 763 enrolled)","url":"https://www.isrctn.com/ISRCTN22734699","date":"2026-09-25"}],"institutionName":"Morriston Hospital, Swansea"},{"institutionId":"velindre-cardiff","name":"Velindre Cancer Centre","trust":"Velindre University NHS Trust","city":"Cardiff","nation":"Wales","offers":["Thoracic oncology and radiotherapy for South East Wales","CONCORDE, PRINCE, REFINE-Lung and ADSCaN site","The QuicDNA principal investigator is based here"],"url":"https://velindre.nhs.wales/","sources":[{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"ISRCTN17123858: PRINCE, first-line systemic treatment with or without thoracic radiotherapy in stage 4 non-small-cell lung cancer (The Christie, NIHR; target 472, 29 centres across the four nations and Ireland)","url":"https://www.isrctn.com/ISRCTN17123858","date":"2026-09-25"},{"label":"ISRCTN22734699: QuicDNA, liquid biopsy folded into the routine lung cancer diagnostic pathway across all six Welsh health boards (Aneurin Bevan University Health Board with Health and Care Research Wales; 763 enrolled)","url":"https://www.isrctn.com/ISRCTN22734699","date":"2026-09-25"}],"institutionName":"Velindre Cancer Centre"},{"institutionId":"northern-ireland-cancer-centre","name":"Belfast City Hospital and the Royal Victoria Hospital","trust":"Belfast Health and Social Care Trust","city":"Belfast","nation":"Northern Ireland","offers":["Thoracic oncology at the Northern Ireland Cancer Centre and thoracic surgery for the whole of Northern Ireland, delivered across both sites","CONCORDE, PRINCE, HALT and ADSCaN site","The Northern Ireland Cancer Registry records the highest emergency presentation share of the five trusts, at 46.7 percent"],"url":"https://belfasttrust.hscni.net/service/thoracic-services/","sources":[{"label":"Belfast Health and Social Care Trust: thoracic services, a regional service for all of Northern Ireland, provided at Belfast City Hospital and the Royal Victoria Hospital","url":"https://belfasttrust.hscni.net/service/thoracic-services/","date":"2026-09-25"},{"label":"ISRCTN10142971: CONCORDE, a platform trial of DNA damage response inhibitors with radical radiotherapy in non-small-cell lung cancer (University of Leeds; recruiting to 30 June 2027, 13 centres in all four nations)","url":"https://www.isrctn.com/ISRCTN10142971","date":"2026-09-25"},{"label":"Northern Ireland Cancer Registry 2026: routes to diagnosis 2018 to 2022 (lung: 41.2 percent of diagnoses through an emergency presentation, 40.5 percent in Northern Ireland against 33.7 percent in England for 2018 to 2020)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/pdf/Routes%20to%20diagnosis%202018-2022.pdf","date":"2026"}],"institutionName":"Northern Ireland Cancer Centre, Belfast City Hospital"}],"centresNote":{"text":"Lung cancer is diagnosed almost everywhere and operated on in very few places. The National Lung Cancer Audit counted 123 English NHS trusts caring for people with lung cancer in 2024, but its data tables name only 28 NHS thoracic units in England and Wales that perform lung cancer resections: 26 in England and 2 in Wales, between them doing 8,559 operations with a 98.4 percent 90-day survival rate. Every English and Welsh unit except one is listed above with the number of resections it did in 2024, read from that workbook; Blackpool Teaching Hospitals, which did 261, has no card because its website did not respond to any request during the check. NHS England's thoracic surgery service specification 170016/S sets the volume rules: every unit should perform at least 150 lung cancer resections a year, a target set for 2018/19, and none should run a lung cancer surgical service with fewer than 70 patients a year; a unit needs at least three full-time thoracic surgeons and a catchment of around 1.5 million people. On the 2024 numbers, 16 of the 28 units were above 250 resections and four were below 170; Swansea Bay, at 64, is below the specification's floor, though the specification applies to England. Scotland and Northern Ireland are not in the audit at all, so no comparable resection counts exist for them. Scotland has three adult cardiothoracic surgery centres, identifiable from Public Health Scotland's activity data for 2024/25: the Golden Jubilee National Hospital in Clydebank (18,846 episodes), the Royal Infirmary of Edinburgh (16,539) and Aberdeen Royal Infirmary (4,900); Glasgow Royal Infirmary, sometimes listed elsewhere, recorded none. Northern Ireland runs a single regional thoracic service across Belfast City Hospital and the Royal Victoria Hospital. In Wales the audit records resections against Cardiff and Vale and Swansea Bay, though only Swansea Bay publishes a cardiothoracic surgery service page. The audit's third recommendation for 2026 is that providers ensure sufficient thoracic surgery capacity for the growth in demand from screening.","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NHS England: thoracic surgery (adults) service specification 170016/S (the volume rules: every unit to perform at least 150 lung cancer resections a year by 2018/19, and none below 70; 29 units in England, minimum three full-time thoracic surgeons and a catchment of around 1.5 million)","url":"https://www.england.nhs.uk/wp-content/uploads/2017/07/thoracic-surgery-service-specification.pdf","date":"2017-07"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Northern Ireland Cancer Registry 2026: routes to diagnosis 2018 to 2022 (lung: 41.2 percent of diagnoses through an emergency presentation, 40.5 percent in Northern Ireland against 33.7 percent in England for 2018 to 2020)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/pdf/Routes%20to%20diagnosis%202018-2022.pdf","date":"2026"}]},"funding":[{"line":"Stage 1 to 2, fit for surgery","treatment":"Lobectomy, open or thoracoscopic, with hilar and mediastinal lymph node sampling; sublobar resection or stereotactic ablative radiotherapy if lobectomy is declined or contraindicated","refs":["lobectomy","sbrt"],"england":{"body":"NHS England","decision":"Not a drug decision: NICE NG122 recommendations 1.5.1 to 1.5.8 set the standard, and thoracic surgery is commissioned nationally under service specification 170016/S. VIOLET, the UK trial, established that keyhole surgery leaves people functioning better at five weeks with the same survival","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management"},"wales":"NICE NG122 applies. Wales has two thoracic units, at Cardiff and Vale and Swansea Bay, which did 162 and 64 resections in 2024; the Welsh resection rate was 17.1 percent.","northernIreland":"NICE NG122 applies. Thoracic surgery is a single regional service run by the Belfast Health and Social Care Trust across Belfast City Hospital and the Royal Victoria Hospital; Northern Ireland is not in the national audit, so no resection rate is published.","note":"7,878 operations in England in 2024, 21.8 percent of everyone with non-small-cell disease, against an audit standard of 17 percent and a GIRFT recommendation of more than 20 percent. Scotland's three cardiothoracic centres are the Golden Jubilee National Hospital, the Royal Infirmary of Edinburgh and Aberdeen Royal Infirmary.","refNames":["Lobectomy","SBRT / SABR (stereotactic radiotherapy)"]},{"line":"After complete resection (adjuvant), EGFR mutation-positive","treatment":"Osimertinib for three years","refs":["osimertinib","egfr-mutant-nsclc"],"england":{"body":"NICE","decision":"Recommended for adjuvant treatment of completely resected stage 1B to 3A non-small-cell lung cancer with EGFR exon 19 deletions or the exon 21 L858R substitution; stop at three years, or earlier on recurrence or unacceptable toxicity. Routinely funded from 27 May 2025 (Blueteq OSI3)","ref":"TA1043","date":"2025-02-26","url":"https://www.nice.org.uk/guidance/ta1043"},"scotland":{"body":"SMC","decision":"Accepted for restricted use for adjuvant treatment after complete resection of stage 1B to 3A disease, under the orphan equivalent process with PACE (SMC2383, 8 November 2021), more than three years before NICE","ref":"SMC2383","date":"2021-11-08","url":"https://scottishmedicines.org.uk/medicines-advice/osimertinib-tagrisso-full-smc2383/"},"wales":"NICE TA1043 applies; the All Wales Therapeutics and Toxicology Centre's record for osimertinib is marked excluded from AWMSG appraisal because NICE has appraised it.","northernIreland":"NICE TA1043 applies through the Department of Health.","refNames":["Osimertinib","EGFR-mutated non-small-cell lung cancer"]},{"line":"After complete resection (adjuvant), ALK-positive","treatment":"Alectinib","refs":["alectinib","alk-positive-nsclc"],"england":{"body":"NICE","decision":"Recommended for adjuvant treatment of completely resected stage 1B (tumours of at least 4 cm) to 3A ALK-positive non-small-cell lung cancer, the ALINA indication. Routinely funded from 11 February 2025 (Blueteq ALE2)","ref":"TA1014","date":"2024-11-13","url":"https://www.nice.org.uk/guidance/ta1014"},"scotland":{"body":"SMC","decision":"Accepted for use within NHSScotland for the same indication (SMC2749, 7 April 2025)","ref":"SMC2749","date":"2025-04-07","url":"https://scottishmedicines.org.uk/medicines-advice/alectinib-hydrochloride-alecensa-full-smc2749/"},"wales":"NICE TA1014 applies. Wales's only AWMSG-authored alectinib decision is a 2017 statement of advice refusing endorsement of the post-crizotinib indication after a non-submission, now superseded by NICE.","northernIreland":"NICE TA1014 applies.","refNames":["Alectinib","ALK-positive non-small-cell lung cancer"]},{"line":"After complete resection (adjuvant), no driver mutation","treatment":"Atezolizumab if PD-L1 is 50 percent or more, or pembrolizumab, after platinum-based chemotherapy","refs":["atezolizumab","pembrolizumab"],"england":{"body":"NICE","decision":"Atezolizumab recommended for adjuvant treatment of resected non-small-cell lung cancer with PD-L1 on 50 percent or more of tumour cells, at high risk of recurrence and without EGFR mutations or ALK rearrangements (the IMpower010 indication); routinely funded from 21 July 2025 (Blueteq ATE10). Pembrolizumab monotherapy recommended for adjuvant treatment after complete resection and platinum chemotherapy in TA1037 (5 February 2025), routinely funded from 6 May 2025","ref":"TA1071","date":"2025-06-19","url":"https://www.nice.org.uk/guidance/ta1071"},"scotland":{"body":"SMC","decision":"Atezolizumab accepted for adjuvant use after complete resection of stage 2 to 3A disease with PD-L1 of 50 percent or more (SMC2492, 8 August 2022), nearly three years before NICE. Pembrolizumab accepted for restricted use in the adjuvant setting (SMC2689, 7 October 2024)","ref":"SMC2492","date":"2022-08-08","url":"https://scottishmedicines.org.uk/medicines-advice/atezolizumab-tecentriq-full-smc2492/"},"wales":"Both NICE appraisals apply.","northernIreland":"Both NICE appraisals apply.","note":"TA1037 is the pembrolizumab appraisal referred to here.","refNames":["Atezolizumab","Pembrolizumab"]},{"line":"Resectable disease, before and after surgery (perioperative)","treatment":"Nivolumab, durvalumab or pembrolizumab with platinum-based chemotherapy before surgery, then the antibody alone after it","refs":["nivolumab","durvalumab","pembrolizumab"],"england":{"body":"NICE","decision":"Perioperative nivolumab with chemotherapy recommended for resectable tumours of at least 4 cm or node-positive disease without EGFR or ALK alterations (the CheckMate-77T indication); recommendation 1.2 tells teams to use the least expensive of nivolumab, pembrolizumab and durvalumab. Neoadjuvant nivolumab alone is TA876 (22 March 2023), perioperative pembrolizumab TA1017 (20 November 2024) and perioperative durvalumab TA1030 (15 January 2025). All four are routinely funded","ref":"TA1127","date":"2026-02-04","url":"https://www.nice.org.uk/guidance/ta1127","cdf":false},"scotland":{"body":"SMC","decision":"Scotland funds none of the perioperative regimens. Neoadjuvant nivolumab alone was accepted (SMC2619, 11 December 2023), but perioperative pembrolizumab was not recommended (SMC2688, 11 November 2024), perioperative durvalumab was not recommended (SMC2677, 9 December 2024) and perioperative nivolumab was not recommended in the absence of a submission (SMC2874, 13 October 2025)","ref":"SMC2874","date":"2025-10-13","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-nonsub-smc2874/"},"wales":"All four NICE appraisals apply, so Wales funds what England funds.","northernIreland":"All four NICE appraisals apply.","note":"The single widest England-Scotland divergence on this page: three perioperative regimens funded in England, Wales and Northern Ireland and none in Scotland.","refNames":["Nivolumab","Durvalumab","Pembrolizumab"]},{"line":"Stage 3 unresectable, after chemoradiotherapy","treatment":"Durvalumab if PD-L1 is 1 percent or more; osimertinib instead if the tumour is EGFR mutation-positive","refs":["durvalumab","osimertinib","stage-iii-unresectable-nsclc"],"england":{"body":"NICE","decision":"Durvalumab recommended as maintenance treatment of unresectable non-small-cell lung cancer with PD-L1 expression on 1 percent or more of tumour cells whose disease has not progressed after concurrent platinum-based chemoradiation, the PACIFIC indication; only after concurrent, not sequential, chemoradiotherapy. Osimertinib recommended for EGFR mutation-positive unresectable stage 3 disease after platinum chemoradiotherapy in TA1156 (21 May 2026, the LAURA indication), routinely funded from 19 August 2026","ref":"TA798","date":"2022-06-22","url":"https://www.nice.org.uk/guidance/ta798"},"scotland":{"body":"SMC","decision":"Durvalumab accepted under the ultra-orphan and end of life process with PACE (SMC2156, 10 June 2019), three years before NICE. Osimertinib for the same stage 3 setting accepted (SMC2815, 13 April 2026)","ref":"SMC2156","date":"2019-06-10","url":"https://scottishmedicines.org.uk/medicines-advice/durvalumab-imfinzi-full-smc2156/"},"wales":"Both NICE appraisals apply.","northernIreland":"Both NICE appraisals apply.","refNames":["Durvalumab","Osimertinib","Unresectable stage III non-small-cell lung cancer"]},{"line":"Advanced disease, EGFR mutation-positive (exon 19 deletion or L858R)","treatment":"Osimertinib alone, osimertinib with pemetrexed and platinum chemotherapy, or amivantamab with lazertinib","refs":["osimertinib","amivantamab","lazertinib","pemetrexed","egfr-mutant-nsclc"],"england":{"body":"NICE","decision":"Osimertinib recommended for untreated EGFR mutation-positive disease (TA654, 14 October 2020, the FLAURA indication) and after a first-generation inhibitor in T790M-positive disease (TA653). Osimertinib with pemetrexed and platinum chemotherapy recommended in TA1060 (8 May 2025, the FLAURA2 indication), routinely funded from 5 August 2025. Amivantamab with lazertinib recommended in TA1122 (21 January 2026, the MARIPOSA indication), routinely funded from 21 April 2026. Earlier inhibitors remain options: gefitinib TA192, erlotinib TA258, afatinib TA310, dacomitinib TA595","ref":"TA1122","date":"2026-01-21","url":"https://www.nice.org.uk/guidance/ta1122"},"scotland":{"body":"SMC","decision":"Osimertinib first line accepted on resubmission under the orphan equivalent process with PACE (SMC2382, 17 January 2022); the FLAURA2 combination accepted (SMC2736, 7 July 2025); amivantamab with lazertinib accepted under the orphan equivalent process with PACE (SMC2834, 11 May 2026)","ref":"SMC2834","date":"2026-05-11","url":"https://scottishmedicines.org.uk/medicines-advice/amivantamab-rybrevant-full-smc2834/"},"wales":"All the NICE appraisals apply; every Welsh record for these medicines is marked excluded from AWMSG appraisal because NICE has appraised them.","northernIreland":"The NICE appraisals apply.","refNames":["Osimertinib","Amivantamab","Lazertinib","Pemetrexed","EGFR-mutated non-small-cell lung cancer"]},{"line":"Advanced disease, EGFR exon 20 insertion","treatment":"Amivantamab with carboplatin and pemetrexed, through managed access","refs":["amivantamab","carboplatin","pemetrexed"],"england":{"body":"NICE","decision":"Recommended for use during the managed access period, with a managed access agreement, for untreated EGFR exon 20 insertion-positive advanced non-squamous disease; in the Cancer Drugs Fund section of the national list from 8 May 2026 (Blueteq AMI2). Amivantamab monotherapy after platinum chemotherapy was not recommended (TA850, 14 December 2022), and mobocertinib's guidance (TA855, 4 January 2023) has been withdrawn because the marketing authorisation was withdrawn","ref":"TA1158","date":"2026-05-28","url":"https://www.nice.org.uk/guidance/ta1158","cdf":true},"scotland":{"body":"SMC","decision":"Accepted for routine use on resubmission under the end of life and orphan equivalent process with PACE (SMC2878, 8 December 2025), six months before NICE granted managed access. Amivantamab monotherapy after platinum chemotherapy was not recommended on non-submission (SMC2638, 11 December 2023)","ref":"SMC2878","date":"2025-12-08","url":"https://scottishmedicines.org.uk/medicines-advice/amivantamab-rybrevant-fasttrackresub-smc2878/"},"wales":"NICE TA1158 applies, so access is through the Cancer Drugs Fund equivalent arrangements.","northernIreland":"NICE TA1158 applies.","note":"One of the four lung indications in the Cancer Drugs Fund proper on version 1.408 of the national list.","refNames":["Amivantamab","Carboplatin","Pemetrexed"]},{"line":"Advanced disease, ALK-positive","treatment":"Alectinib, brigatinib or lorlatinib first line; lorlatinib or brigatinib after a first inhibitor","refs":["alectinib","brigatinib","lorlatinib","ceritinib","crizotinib","alk-positive-nsclc"],"england":{"body":"NICE","decision":"Alectinib (TA536, 8 August 2018), brigatinib (TA670, 27 January 2021), lorlatinib (TA1103, 21 October 2025), ceritinib (TA500, 24 January 2018) and crizotinib (TA406, 28 September 2016) are all recommended for untreated ALK-positive advanced disease; lorlatinib (TA628) and brigatinib (TA571) are recommended after a first inhibitor. Five of the six are routinely funded, lorlatinib first line from 19 January 2026","ref":"TA1103","date":"2025-10-21","url":"https://www.nice.org.uk/guidance/ta1103"},"scotland":{"body":"SMC","decision":"Alectinib accepted under the orphan medicine process (SMC2012, 13 August 2018); brigatinib accepted on an abbreviated submission (SMC2314, 18 January 2021); lorlatinib accepted first line on an abbreviated submission (SMC2415, 7 March 2022), three and a half years before NICE, and reassessed and accepted for the post-inhibitor setting under the end of life process (SMC2867, 7 September 2026). Ceritinib first line was not recommended in the absence of a submission (1333/18, 9 April 2018), so Scotland has no positive first-line ceritinib advice","ref":"SMC2415","date":"2022-03-07","url":"https://scottishmedicines.org.uk/medicines-advice/lorlatinib-lorviqua-abb-smc2415/"},"wales":"The NICE appraisals apply.","northernIreland":"The NICE appraisals apply.","refNames":["Alectinib","Brigatinib","Lorlatinib","Ceritinib","Crizotinib","ALK-positive non-small-cell lung cancer"]},{"line":"Advanced disease, ROS1-positive","treatment":"Crizotinib or entrectinib","refs":["crizotinib","entrectinib","ros1-positive-nsclc"],"england":{"body":"NICE","decision":"Crizotinib recommended for ROS1-positive advanced disease in people who have not had a ROS1 inhibitor, with recommendation 1.2 telling teams to use the least expensive of crizotinib and entrectinib; entrectinib recommended for the same setting in TA643 (12 August 2020). Both routinely funded","ref":"TA1021","date":"2024-12-04","url":"https://www.nice.org.uk/guidance/ta1021"},"scotland":{"body":"SMC","decision":"Entrectinib accepted under the orphan equivalent process with PACE (SMC2294, 18 January 2021); crizotinib accepted for ROS1-positive disease under the ultra-orphan process with PACE (1329/18, 11 June 2018)","ref":"SMC2294","date":"2021-01-18","url":"https://scottishmedicines.org.uk/medicines-advice/entrectinib-rozlytrek-full-smc2294/"},"wales":"Both NICE appraisals apply.","northernIreland":"Both NICE appraisals apply.","note":"Repotrectinib, licensed in the European Union for ROS1-positive disease, has no NICE appraisal: NICE discontinued the appraisal on 10 February 2026 after hearing nothing from the company since May 2024.","refNames":["Crizotinib","Entrectinib","ROS1-positive non-small-cell lung cancer"]},{"line":"Advanced disease, RET fusion-positive","treatment":"Selpercatinib","refs":["selpercatinib","pralsetinib","ret-fusion-nsclc"],"england":{"body":"NICE","decision":"Selpercatinib recommended for previously treated RET fusion-positive advanced disease (TA1042, 19 February 2025), routinely funded from 20 May 2025; and recommended with managed access for untreated disease (TA911, 26 July 2023), one of the four lung entries in the Cancer Drugs Fund section of the national list, available from 22 June 2023. Pralsetinib was not recommended (TA812, 3 August 2022) and its marketing authorisation was later discontinued","ref":"TA1042","date":"2025-02-19","url":"https://www.nice.org.uk/guidance/ta1042"},"scotland":{"body":"SMC","decision":"Selpercatinib accepted for restricted use in treatment-naive patients on an interim basis subject to reassessment, under the end of life and orphan equivalent process with PACE (SMC2573, 13 November 2023). Its earlier advice for the previously treated setting, not recommended (SMC2371, 8 November 2021), is stated on the newer page to remain valid, so Scotland does not fund what NICE recommends in TA1042","ref":"SMC2573","date":"2023-11-13","url":"https://scottishmedicines.org.uk/medicines-advice/selpercatinib-retsevmo-full-smc2573/"},"wales":"Both NICE appraisals apply.","northernIreland":"Both NICE appraisals apply.","refNames":["Selpercatinib","Pralsetinib","RET fusion-positive non-small-cell lung cancer"]},{"line":"Advanced disease, KRAS G12C-mutated, previously treated","treatment":"Sotorasib, through the Cancer Drugs Fund","refs":["sotorasib","adagrasib","kras-g12c-nsclc"],"england":{"body":"NICE","decision":"Recommended for use within the Cancer Drugs Fund, with a managed access agreement, for KRAS G12C-mutated advanced disease previously treated with at least one systemic therapy; in the Cancer Drugs Fund section of the national list from 3 March 2022 (Blueteq SOT1). The managed access review is in development. Adagrasib's appraisal was terminated on 2 July 2025 because Bristol Myers Squibb will consider restarting when the final overall survival analysis is available","ref":"TA781","date":"2022-03-30","url":"https://www.nice.org.uk/guidance/ta781","cdf":true},"scotland":{"body":"SMC","decision":"Sotorasib accepted on an interim basis subject to reassessment, under the end of life and orphan equivalent process with PACE (SMC2443, 7 March 2022): a different mechanism from the Cancer Drugs Fund with the same effect","ref":"SMC2443","date":"2022-03-07","url":"https://scottishmedicines.org.uk/medicines-advice/sotorasib-lumykras-full-smc2443/"},"wales":"NICE TA781 applies. The Welsh record for sotorasib is marked excluded from AWMSG appraisal pending the managed access review.","northernIreland":"NICE TA781 applies.","note":"Adagrasib is the clearest case of a Welsh record being excluded from appraisal on the basis of a NICE appraisal that was terminated, so there is no live positive route in any nation.","refNames":["Sotorasib","Adagrasib","KRAS G12C-mutant non-small-cell lung cancer"]},{"line":"Advanced disease, MET exon 14 skipping","treatment":"Tepotinib","refs":["tepotinib","capmatinib","met-altered-nsclc"],"england":{"body":"NICE","decision":"Recommended within its marketing authorisation for advanced non-small-cell lung cancer with MET exon 14 skipping alterations; routinely funded from 17 June 2022 for both untreated and previously treated disease (Blueteq TEP1 and TEP2). Capmatinib's appraisal was terminated on 3 May 2023 because Novartis did not provide an evidence submission, so tepotinib is the only MET inhibitor funded","ref":"TA789","date":"2022-05-18","url":"https://www.nice.org.uk/guidance/ta789"},"scotland":{"body":"SMC","decision":"Accepted on resubmission under the end of life process with PACE (SMC2535, 16 January 2023)","ref":"SMC2535","date":"2023-01-16","url":"https://scottishmedicines.org.uk/medicines-advice/tepotinib-tepmetko-resub-smc2535/"},"wales":"NICE TA789 applies; capmatinib's Welsh record is excluded from appraisal on the basis of the terminated NICE appraisal TA884.","northernIreland":"NICE TA789 applies.","refNames":["Tepotinib","Capmatinib","MET exon 14 and MET-amplified non-small-cell lung cancer"]},{"line":"Advanced disease, BRAF V600-mutated","treatment":"Encorafenib with binimetinib, or dabrafenib with trametinib, first line","refs":["encorafenib","binimetinib","dabrafenib-trametinib","braf-v600e-nsclc"],"england":{"body":"NICE","decision":"Encorafenib with binimetinib recommended for BRAF V600E mutation-positive advanced non-small-cell lung cancer, first line only; routinely funded from 4 August 2026 (Blueteq ENC3). Dabrafenib with trametinib recommended for BRAF V600 mutation-positive disease, also first line only (TA898, 14 June 2023), routinely funded from 12 September 2023","ref":"TA1150","date":"2026-05-06","url":"https://www.nice.org.uk/guidance/ta1150"},"scotland":{"body":"SMC","decision":"Encorafenib with binimetinib not recommended in the absence of a submission (SMC2865, 8 September 2025). Scotland's only advice on dabrafenib with trametinib in lung cancer is also a non-submission refusal (1264/17, 10 July 2017). Neither BRAF regimen has a positive Scottish decision","date":"2025-09-08","url":"https://scottishmedicines.org.uk/medicines-advice/encorafenib-braftovi-nonsub-smc2865/"},"wales":"Both NICE appraisals apply, so Wales funds what Scotland does not.","northernIreland":"Both NICE appraisals apply.","refNames":["Encorafenib","Binimetinib","Dabrafenib + trametinib","BRAF V600E-mutant non-small-cell lung cancer"]},{"line":"Advanced disease, NTRK fusion-positive","treatment":"Larotrectinib, through the Cancer Drugs Fund","refs":["larotrectinib","entrectinib","ntrk-fusion-nsclc"],"england":{"body":"NICE","decision":"Recommended for use within the Cancer Drugs Fund, with a managed access agreement, for NTRK fusion-positive solid tumours including lung, where there is no satisfactory alternative; in the Cancer Drugs Fund section of the national list from 21 April 2020 (Blueteq LAR1, whose form asks the clinician to state the histology, for example squamous or non-squamous lung cancer). Entrectinib is no longer an option for NTRK fusions: TA1118 terminated its appraisal on 7 January 2026 because Roche did not provide a complete evidence submission, replacing TA644, though people already taking it continue","ref":"TA630","date":"2020-05-27","url":"https://www.nice.org.uk/guidance/ta630","cdf":true},"wales":"NICE TA630 applies.","northernIreland":"NICE TA630 applies.","note":"NTRK fusions are rare in lung cancer; they are found on the same comprehensive panel as the commoner drivers.","refNames":["Larotrectinib","Entrectinib","NTRK fusion-positive non-small-cell lung cancer"]},{"line":"Advanced disease, no driver, PD-L1 50 percent or more","treatment":"Pembrolizumab, atezolizumab or cemiplimab, with or without chemotherapy","refs":["pembrolizumab","atezolizumab","cemiplimab","pdl1-high-nsclc"],"england":{"body":"NICE","decision":"Pembrolizumab monotherapy recommended for untreated metastatic disease with a tumour proportion score of 50 percent or more and no EGFR or ALK alteration, stopped at two years (TA531, 18 July 2018). Atezolizumab monotherapy recommended where PD-L1 is on 50 percent or more of tumour cells or 10 percent or more of immune cells (TA705, 2 June 2021). Cemiplimab with platinum-based chemotherapy recommended in TA1165 (16 June 2026) for PD-L1 of 1 percent or more, but only where pembrolizumab with chemotherapy would otherwise be offered","ref":"TA531","date":"2018-07-18","url":"https://www.nice.org.uk/guidance/ta531"},"scotland":{"body":"SMC","decision":"Pembrolizumab accepted for restricted use first line at a tumour proportion score of 50 percent or more under the end of life and orphan equivalent process with PACE (1239/17, 10 July 2017). Atezolizumab monotherapy accepted (SMC2379, 8 November 2021). Cemiplimab with chemotherapy was not recommended in the absence of a submission (SMC2724, 7 October 2024), and a monotherapy submission is due on 9 November 2026","ref":"SMC2379","date":"2021-11-08","url":"https://scottishmedicines.org.uk/medicines-advice/atezolizumab-tecentriq-full-smc2379/"},"wales":"The NICE appraisals apply, including TA1165, which Scotland does not fund.","northernIreland":"The NICE appraisals apply.","refNames":["Pembrolizumab","Atezolizumab","Cemiplimab","PD-L1-high non-small-cell lung cancer without a driver mutation"]},{"line":"Advanced disease, no driver, PD-L1 below 50 percent","treatment":"Pembrolizumab with pemetrexed and platinum chemotherapy in non-squamous disease, or with carboplatin and paclitaxel in squamous disease; atezolizumab with bevacizumab and chemotherapy as an alternative in non-squamous disease","refs":["pembrolizumab","pemetrexed","carboplatin","paclitaxel","atezolizumab","bevacizumab"],"england":{"body":"NICE","decision":"Pembrolizumab with pemetrexed and platinum chemotherapy recommended for untreated metastatic non-squamous disease, stopped at two years, the KEYNOTE-189 indication; routinely funded from 8 June 2021. Pembrolizumab with carboplatin and paclitaxel recommended for untreated metastatic squamous disease in TA770 (9 February 2022). Atezolizumab with bevacizumab, carboplatin and paclitaxel recommended in TA584 (5 June 2019) for untreated non-squamous disease with a tumour proportion score of 0 to 49 percent, or after failure of targeted therapy in driver-positive disease","ref":"TA683","date":"2021-03-10","url":"https://www.nice.org.uk/guidance/ta683"},"scotland":{"body":"SMC","decision":"Pembrolizumab with pemetrexed and platinum accepted for restricted use on resubmission under the end of life process with PACE (SMC2207, 7 October 2019); pembrolizumab with carboplatin and paclitaxel accepted for restricted use (SMC2187, 9 September 2019). The atezolizumab combination was not recommended (SMC2208, 11 November 2019), so Scotland does not fund the IMpower150 regimen that England does","ref":"SMC2207","date":"2019-10-07","url":"https://scottishmedicines.org.uk/medicines-advice/pembrolizumab-keytruda-resub-smc2207/"},"wales":"All three NICE appraisals apply.","northernIreland":"All three NICE appraisals apply.","note":"Nivolumab with ipilimumab and two cycles of chemotherapy was refused in both nations: NICE TA724 (8 September 2021) and SMC2397 (17 January 2022).","refNames":["Pembrolizumab","Pemetrexed","Carboplatin","Paclitaxel / nab-paclitaxel","Atezolizumab","Bevacizumab"]},{"line":"Advanced disease, after chemotherapy","treatment":"Nivolumab, atezolizumab or pembrolizumab if no prior immunotherapy; docetaxel with nintedanib in adenocarcinoma","refs":["nivolumab","atezolizumab","pembrolizumab","docetaxel","nintedanib"],"england":{"body":"NICE","decision":"Nivolumab recommended for advanced non-squamous disease after chemotherapy where PD-L1 is positive, stopped at two years (TA713, 7 July 2021) and for squamous disease after chemotherapy (TA655, 21 October 2020); atezolizumab recommended after chemotherapy (TA520, 16 May 2018); pembrolizumab recommended for PD-L1-positive disease after chemotherapy (TA428, 11 January 2017). Nintedanib with docetaxel recommended in adenocarcinoma only (TA347, 22 July 2015). Ramucirumab with docetaxel was not recommended (TA403, 24 August 2016) and pemetrexed after chemotherapy was not recommended (TA124, 22 August 2007)","ref":"TA713","date":"2021-07-07","url":"https://www.nice.org.uk/guidance/ta713"},"scotland":{"body":"SMC","decision":"Nivolumab accepted for restricted use in non-squamous disease with a two-year stopping rule (1180/16, 10 October 2016) and accepted for squamous disease (1144/16, 11 July 2016); atezolizumab accepted for restricted use (1336/18, 9 July 2018); pembrolizumab accepted for restricted use (1204/17, 16 January 2017); nintedanib accepted under the end of life and orphan equivalent process with PACE (1027/15, 13 April 2015). Ramucirumab with docetaxel was not recommended on non-submission (1165/16, 13 June 2016), as in England","date":"2016-10-10","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-fullsubmission-118016/"},"wales":"The NICE appraisals apply.","northernIreland":"The NICE appraisals apply.","note":"Erlotinib and gefitinib after chemotherapy are the one place NICE says both yes and no in the same appraisal: TA374 recommends erlotinib in two defined situations, refuses it where the tumour is EGFR-TK mutation-negative and refuses gefitinib outright.","refNames":["Nivolumab","Atezolizumab","Pembrolizumab","Docetaxel","Nintedanib"]},{"line":"Extensive-stage small-cell lung cancer, first line","treatment":"Platinum and etoposide with durvalumab, atezolizumab or serplulimab","refs":["platinum-etoposide","durvalumab","atezolizumab","serplulimab","extensive-stage-sclc"],"england":{"body":"NICE","decision":"Durvalumab with etoposide and either carboplatin or cisplatin recommended for untreated extensive-stage disease in people with an ECOG performance status of 0 or 1, the CASPIAN indication; recommendation 1.3 tells teams to use the least expensive of durvalumab and atezolizumab. Atezolizumab with carboplatin and etoposide recommended in TA638 (1 July 2020, the IMpower133 indication). Serplulimab with carboplatin and etoposide recommended in TA1167 (18 June 2026), routinely funded from 16 September 2026","ref":"TA1041","date":"2025-02-19","url":"https://www.nice.org.uk/guidance/ta1041"},"scotland":{"body":"SMC","decision":"Durvalumab accepted on an abbreviated submission (SMC2734, 10 February 2025) and atezolizumab accepted under the end of life and orphan process with PACE (SMC2279, 9 November 2020). Serplulimab was not recommended after a full submission with PACE (SMC2840, 19 January 2026), so Scotland does not fund what NICE recommends in TA1167","ref":"SMC2734","date":"2025-02-10","url":"https://scottishmedicines.org.uk/medicines-advice/durvalumab-imfinzi-abb-smc2734/"},"wales":"All three NICE appraisals apply.","northernIreland":"All three NICE appraisals apply.","refNames":["Platinum + etoposide (EP / CE)","Durvalumab","Atezolizumab","Serplulimab","Extensive-stage small-cell lung cancer"]},{"line":"Limited-stage small-cell lung cancer","treatment":"Cisplatin and etoposide with twice-daily thoracic radiotherapy, then prophylactic cranial irradiation, then durvalumab","refs":["cisplatin","etoposide","durvalumab","limited-stage-sclc"],"england":{"body":"NICE","decision":"Durvalumab recommended for limited-stage small-cell lung cancer that has not progressed after platinum-based chemoradiotherapy, the ADRIATIC indication; routinely funded from 30 December 2025 (Blueteq DUR7). The chemoradiotherapy itself comes from NG122 recommendations 1.10.1 to 1.10.5, whose twice-daily schedule rests on CONVERT","ref":"TA1099","date":"2025-10-01","url":"https://www.nice.org.uk/guidance/ta1099"},"scotland":{"body":"SMC","decision":"Accepted for use within NHSScotland (SMC2818, 11 May 2026), seven months after NICE: one of the few places on this page where England moved first","ref":"SMC2818","date":"2026-05-11","url":"https://scottishmedicines.org.uk/medicines-advice/durvalumab-imfinzi-full-smc2818/"},"wales":"NICE TA1099 applies.","northernIreland":"NICE TA1099 applies.","refNames":["Cisplatin","Etoposide","Durvalumab","Limited-stage small-cell lung cancer"]},{"line":"Relapsed small-cell lung cancer","treatment":"Oral topotecan, or re-treatment with a platinum-based or anthracycline-containing regimen","refs":["topotecan","tarlatamab","lurbinectedin"],"england":{"body":"NICE","decision":"Oral topotecan recommended only where re-treatment with the first-line regimen is inappropriate and cyclophosphamide, doxorubicin and vincristine is contraindicated; intravenous topotecan is not recommended. Tarlatamab was not recommended after two or more lines including platinum chemotherapy (TA1091, 20 August 2025) and does not appear anywhere in the 320-page national Cancer Drugs Fund list. Lurbinectedin has no published NICE lung appraisal; an appraisal is in development with no date","ref":"TA184","date":"2009-11-25","url":"https://www.nice.org.uk/guidance/ta184"},"scotland":{"body":"SMC","decision":"Topotecan capsules accepted for restricted use where first-line re-treatment is inappropriate (545/09, 14 April 2009). Tarlatamab not recommended (SMC2816, 10 November 2025), as in England","ref":"SMC2816","date":"2025-11-10","url":"https://scottishmedicines.org.uk/medicines-advice/tarlatamab-imdylltra-full-smc2816/"},"wales":"NICE TA184 applies; tarlatamab's Welsh record is excluded from AWMSG appraisal on the basis of the NICE refusal.","northernIreland":"NICE TA184 applies.","note":"The bleakest row on the page: in relapsed small-cell disease the NHS funds a 2009 oral chemotherapy and nothing newer, in any of the four nations.","refNames":["Topotecan","Tarlatamab","Lurbinectedin"]},{"line":"Bone metastases","treatment":"Denosumab to prevent skeletal-related events","refs":["denosumab"],"england":{"body":"NICE","decision":"Recommended for preventing skeletal-related events in adults with bone metastases from solid tumours other than prostate cancer, which includes lung cancer","ref":"TA265","date":"2012-10-24","url":"https://www.nice.org.uk/guidance/ta265"},"wales":"NICE TA265 applies.","northernIreland":"NICE TA265 applies.","refNames":["Denosumab"]}],"fundingNote":{"text":"NICE's lung cancer topic page listed 181 products on the check date, with 66 published technology appraisals and 16 terminated ones. Version 1.408 of the national Cancer Drugs Fund list, updated 24 September 2026 and read in full, carries 43 routinely funded lung indications in its section B and four in the Cancer Drugs Fund proper: amivantamab with carboplatin and pemetrexed (from 8 May 2026), larotrectinib (from 21 April 2020), selpercatinib first line (from 22 June 2023) and sotorasib (from 3 March 2022). Eight lung appraisals are outright refusals: tarlatamab (TA1091), amivantamab monotherapy (TA850), pralsetinib (TA812), nivolumab with ipilimumab and chemotherapy (TA724), necitumumab (TA411), ramucirumab with docetaxel (TA403), erlotinib maintenance (TA227) and pemetrexed after chemotherapy (TA124), with partial refusals inside TA374 and TA184. Sixteen appraisals were terminated, fifteen of them because a company did not provide an evidence submission: entrectinib (TA1118), adagrasib (TA1076), tislelizumab twice (TA1072, TA1058), atezolizumab three times (TA1047, TA618, and in combination), trastuzumab deruxtecan (TA976), capmatinib (TA884), cemiplimab (TA848), durvalumab (TA662), ramucirumab with erlotinib (TA635), afatinib (TA444), alectinib (TA438), bevacizumab twice (TA436, TA148) and nab-paclitaxel (TA362). One appraisal has been withdrawn outright: mobocertinib (TA855), because Takeda stopped marketing the drug. Scotland's register carries 108 lung entries and diverges from England in ten places, six of them medicines England funds and Scotland refuses: serplulimab, perioperative pembrolizumab, perioperative durvalumab, perioperative nivolumab, encorafenib with binimetinib and cemiplimab with chemotherapy, plus no positive advice for dabrafenib with trametinib, first-line ceritinib or previously treated selpercatinib. Scotland was earlier than NICE on adjuvant atezolizumab (by nearly three years), first-line lorlatinib (by three and a half) and first-line amivantamab with chemotherapy, and it alone has a positive decision on oral vinorelbine (179/05, 13 June 2005), which NICE has never appraised. Wales is a NICE-follower for lung cancer: 69 of its 74 lung records are marked excluded from AWMSG appraisal because NICE has appraised the medicine, the only AWMSG-authored outcomes are two statements of advice refusing endorsement after non-submission (afatinib in 2016 and alectinib in 2017), and none of the 28 One Wales interim decisions covers lung cancer. Thirty-two appraisals are in development and 33 awaiting development, including tarlatamab after platinum chemotherapy (expected 13 January 2027), durvalumab with radiotherapy in unresected stage 1 or 2 disease (14 April 2027) and zongertinib for HER2-mutated disease (7 July 2027).","sources":[{"label":"NICE: all products on lung cancer (181 products on the check date; 66 published technology appraisals and 16 terminated ones). The same address with a page-size parameter answered HTTP 403","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/lung-cancer/products","date":"2026-09-25"},{"label":"NHS England: national Cancer Drugs Fund list version 1.408, updated 24 September 2026, read in full (320 pages): four lung indications in the Cancer Drugs Fund section and 43 routinely funded lung indications in section B, each with its Blueteq form, appraisal reference and funding date","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"},{"label":"NHS England: national Cancer Drugs Fund list (the page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026)","url":"https://www.england.nhs.uk/cancer/cdf/cancer-drugs-fund-list/"},{"label":"NICE TA1091: tarlatamab for extensive-stage small-cell lung cancer after two or more treatments, not recommended (20 August 2025)","url":"https://www.nice.org.uk/guidance/ta1091","date":"2025-08-20"},{"label":"NICE TA1118: entrectinib for NTRK fusion-positive solid tumours in people 12 and over, terminated 7 January 2026 because Roche did not provide a complete evidence submission; it replaces TA644, and people already taking it through the Cancer Drugs Fund continue","url":"https://www.nice.org.uk/guidance/terminated/ta1118","date":"2026-01-07"},{"label":"NICE TA855: mobocertinib for EGFR exon 20 insertion-positive advanced non-small-cell lung cancer after platinum chemotherapy (4 January 2023); NICE has withdrawn this guidance because Takeda stopped marketing mobocertinib and its marketing authorisation was withdrawn","url":"https://www.nice.org.uk/guidance/ta855","date":"2023-01-04"},{"label":"Scottish Medicines Consortium: medicines advice, keyword lung (108 results over six pages on the check date)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=lung","date":"2026-09-25"},{"label":"All Wales Therapeutics and Toxicology Centre: medicine recommendations (the keyword search and the results table are loaded by script and returned no rows to OnCo; the 74 lung-cancer records were enumerated from the site's own sitemap)","url":"https://awttc.nhs.wales/accessing-medicines/medicine-recommendations/","date":"2026-09-25"},{"label":"All Wales Therapeutics and Toxicology Centre: One Wales medicines, interim decisions (all 28 decisions read; none is for lung cancer)","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/one-wales-medicines-interim-decisions/","date":"2026-09-25"},{"label":"NICE: the lung cancer topic page, whose counters give 66 published and 16 terminated technology appraisals, 32 appraisals in development and 33 awaiting development on the check date. The products list answered HTTP 403 whenever a page-size parameter was added to the address","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/lung-cancer","date":"2026-09-25"}]},"tests":[{"target":"PD-L1 expression (tumour proportion score)","code":"pathology (immunohistochemistry, not in the genomic directory)","test":"Immunohistochemistry on the tumour block, done in the local pathology laboratory at the same time as the slides are prepared for sequencing","opens":"Pembrolizumab monotherapy first line at 50 percent or more (TA531), atezolizumab monotherapy at 50 percent of tumour cells or 10 percent of immune cells (TA705), cemiplimab with chemotherapy at 1 percent or more (TA1165), durvalumab after chemoradiotherapy in stage 3 disease at 1 percent or more (TA798), adjuvant atezolizumab at 50 percent or more (TA1071), and combination immunochemotherapy below 50 percent (TA683, TA770)","how":"Reflex: the National Optimal Lung Cancer Pathway has PD-L1 testing and slide preparation for sequencing happening together in local pathology by day 3 after the sample is taken. In Wales, where the audit could count, around a quarter of patients with a recorded result had expression above 50 percent and roughly half had expression below 1 percent","sources":[{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"NICE TA531: pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer (18 July 2018, tumour proportion score of 50 percent or more, stopped at two years; the KEYNOTE-024 indication)","url":"https://www.nice.org.uk/guidance/ta531","date":"2018-07-18"},{"label":"NICE TA1071: atezolizumab for adjuvant treatment of resected non-small-cell lung cancer (19 June 2025, PD-L1 of 50 percent or more, the IMpower010 indication)","url":"https://www.nice.org.uk/guidance/ta1071","date":"2025-06-19"},{"label":"NLCA blog: what do we know about genomic testing in lung cancer in Wales? (Lauren Dixon for the NLCA project team, 23 June 2026): 745 of 1,546 Welsh patients with a record in the new system had at least one genomic test result","url":"https://www.natcan.org.uk/news/nlca-blog-what-do-we-know-about-genomic-testing-in-lung-cancer-in-wales/","date":"2026-06-23"}]},{"target":"EGFR (exon 19 deletions, exon 21 L858R, exon 20 insertions, T790M)","code":"M4.1, M4.13 (panel); M4.4 (hotspot tissue), M4.5 (hotspot ctDNA)","test":"Comprehensive next-generation sequencing of DNA and RNA on the tumour block, through a Genomic Laboratory Hub","opens":"Osimertinib alone or with chemotherapy and amivantamab with lazertinib in advanced disease (TA654, TA1060, TA1122), adjuvant osimertinib after resection (TA1043), osimertinib after chemoradiotherapy in stage 3 disease (TA1156), and amivantamab with chemotherapy for exon 20 insertions (TA1158). A negative result matters too: it moves you to the immunotherapy rows","how":"Reflex, and mandatory. Version 16 of the National Genomic Test Directory, of 16 July 2026, says testing is indicated for all non-squamous non-small-cell lung cancer and for selected squamous cases with features suggesting a targetable mutation (under 50 and never-smokers), and that the gene targets covered by M4.1 and M4.2 are mandatory to be reported by the Genomic Laboratory Hubs. NG122 recommendation 1.2.12, amended in February 2026, points at the directory for comprehensive next-generation sequencing panels, replacing the earlier single-mutation wording. M4.4, the single-gene EGFR test, is restricted to rare cases where a panel cannot deliver and is subject to close audit. The Welsh audit blog found marked variation between health boards in recorded EGFR results, which it attributes to coding and mapping rather than biology","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (the M4 lung indications and their codes, target genes, technologies and eligibility criteria). The directory's own publication page answers HTTP 202 with an empty body","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging","date":"2026-02"},{"label":"NICE NG122: update information (February 2026 amended recommendation 1.2.12 from single-mutation testing to comprehensive next-generation sequencing panels through genomic laboratory hubs, and added links to the technology appraisals; March 2024 removed the mobocertinib pathways after that guidance was withdrawn)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Update-information","date":"2026-02"},{"label":"NICE HTG316 (formerly DG9): EGFR-TK mutation testing in adults with locally advanced or metastatic non-small-cell lung cancer (14 August 2013)","url":"https://www.nice.org.uk/guidance/htg316","date":"2013-08-14"},{"label":"NLCA blog: what do we know about genomic testing in lung cancer in Wales? (Lauren Dixon for the NLCA project team, 23 June 2026): 745 of 1,546 Welsh patients with a record in the new system had at least one genomic test result","url":"https://www.natcan.org.uk/news/nlca-blog-what-do-we-know-about-genomic-testing-in-lung-cancer-in-wales/","date":"2026-06-23"}]},{"target":"ALK and ROS1 rearrangement","code":"M4.2, M4.13 (panel); M4.6, M4.10 (fluorescence in situ hybridisation), M4.11 (ALK hotspot)","test":"RNA-based next-generation sequencing for fusions on the tumour block; fluorescence in situ hybridisation or immunohistochemistry where there is not enough tissue for sequencing","opens":"Alectinib, brigatinib, lorlatinib, ceritinib or crizotinib for ALK (TA536, TA670, TA1103, TA500, TA406) and adjuvant alectinib after resection (TA1014); crizotinib or entrectinib for ROS1 (TA1021, TA643)","how":"Reflex, on the same panel: M4.2 covers ROS1, RET, EML4-ALK and NTRK1, NTRK2 and NTRK3 as structural variants. Both DNA and RNA sequencing should be done in any histological subtype of non-small-cell disease. If tissue runs out, the optimal pathway's salvage route is a limited DNA panel plus fluorescence in situ hybridisation, which the directory carries as its own codes: M4.6 and M4.10 for ROS1 and EML4-ALK. Positives are rare: the Welsh audit found overall prevalence of around 1 to 2 percent for each","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (the M4 lung indications and their codes, target genes, technologies and eligibility criteria). The directory's own publication page answers HTTP 202 with an empty body","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging","date":"2026-02"},{"label":"NLCA blog: what do we know about genomic testing in lung cancer in Wales? (Lauren Dixon for the NLCA project team, 23 June 2026): 745 of 1,546 Welsh patients with a record in the new system had at least one genomic test result","url":"https://www.natcan.org.uk/news/nlca-blog-what-do-we-know-about-genomic-testing-in-lung-cancer-in-wales/","date":"2026-06-23"},{"label":"NICE TA1014: alectinib for adjuvant treatment of ALK-positive non-small-cell lung cancer (13 November 2024, stage 1B of 4 cm or larger to 3A; the ALINA indication)","url":"https://www.nice.org.uk/guidance/ta1014","date":"2024-11-13"}]},{"target":"KRAS G12C, BRAF V600, MET exon 14 skipping, RET fusion, NTRK fusion and HER2 mutation","code":"M4.1 (small variant), M4.2 (structural variant), M4.3 and M4.8 (MET copy number), M4.7 (RET), M4.13 (combined)","test":"The same comprehensive next-generation sequencing panel, reported together","opens":"Sotorasib for KRAS G12C through the Cancer Drugs Fund (TA781); encorafenib with binimetinib or dabrafenib with trametinib for BRAF V600, first line only (TA1150, TA898); tepotinib for MET exon 14 skipping (TA789); selpercatinib for RET fusions (TA911 and TA1042); larotrectinib for NTRK fusions through the Cancer Drugs Fund (TA630). A HER2 mutation currently opens nothing: the trastuzumab deruxtecan appraisal was terminated in 2024 and zongertinib's is not expected until July 2027","how":"All on one reflex request, which is the argument for a comprehensive panel rather than sequential single-gene tests: NICE made exactly that change to NG122 in February 2026. Note what the directory does and does not make essential. KRAS p.(G12C) and MET exon 14 skipping are essential targets on M4.1, so a squamous cancer gets tested for those two even when the full panel is not indicated. HER2 and ERBB2 are not essential targets for any lung indication in version 16: they appear only in the clinical-trials column, to be reported when a panel is already being run for standard-of-care analysis. In small-cell disease the directory offers M231.1, an RB1 copy-number panel for use when the diagnosis cannot be made on morphology or radiology, and M231.2 for NTRK fusions in someone eligible for an NTRK inhibitor","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (the M4 lung indications and their codes, target genes, technologies and eligibility criteria). The directory's own publication page answers HTTP 202 with an empty body","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NICE NG122: update information (February 2026 amended recommendation 1.2.12 from single-mutation testing to comprehensive next-generation sequencing panels through genomic laboratory hubs, and added links to the technology appraisals; March 2024 removed the mobocertinib pathways after that guidance was withdrawn)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Update-information","date":"2026-02"},{"label":"North Thames Genomic Laboratory Hub: requesting genomic testing in non-small-cell lung cancer (which panel to ask for in squamous against non-squamous disease, and the sample requirements)","url":"https://norththamesgenomics.nhs.uk/tool/non-small-cell-lung-cancer/","date":"2026-09-25"},{"label":"NICE TA781: sotorasib for previously treated KRAS G12C mutation-positive advanced non-small-cell lung cancer (30 March 2022, Cancer Drugs Fund)","url":"https://www.nice.org.uk/guidance/ta781","date":"2022-03-30"},{"label":"NICE TA789: tepotinib for advanced non-small-cell lung cancer with MET gene alterations (18 May 2022, MET exon 14 skipping)","url":"https://www.nice.org.uk/guidance/ta789","date":"2022-05-18"},{"label":"NICE TA976: trastuzumab deruxtecan for HER2-mutated advanced non-small-cell lung cancer after platinum-based chemotherapy, terminated 29 May 2024 because Daiichi Sankyo did not provide an evidence submission","url":"https://www.nice.org.uk/guidance/ta976","date":"2024-05-29"}]},{"target":"Circulating tumour DNA, when there is not enough tissue or the result is needed sooner","code":"M4.14 (combined ctDNA panel), M4.5 (EGFR hotspot ctDNA)","test":"A blood test sequenced for the same driver mutations, either as a blood predictive biomarker taken at the fast-track clinic before any biopsy, or as salvage after an inadequate sample","opens":"The same targeted drugs, sooner. In the NHS pilot of more than 2,500 patients over three years, circulating tumour DNA results came back on average 16 days faster than tissue genotyping, and a health economic analysis estimated savings of around 11 million pounds a year","how":"Ask about it if the biopsy was small or the result is slow. The directory's eligibility for M4.14 is explicit on both uses: radiologically suspected stage 3 or 4 lung cancer unlikely to be suitable for curative treatment with a performance status of 0 to 3, and, separately, a confirmed new diagnosis of non-small-cell lung cancer, previously untreated for advanced disease, where diagnostic molecular testing has failed and the alternative would be to re-biopsy. Its committee note says the blood sample should preferably be taken before the biopsy. M4.5, the single-gene EGFR ctDNA test, is for use when a biopsy is not available at all. Circulating tumour DNA testing was added to the directory in May 2025 and is available to all eligible patients in England, though central procurement of the blood collection kits has ended and trusts now fund them locally. The Genomic Laboratory Hub guidance written by Alastair Greystoke and reviewed by Sanjay Popat and Matthew Krebs tells the clinician how to read the result: green means start the targeted treatment immediately, orange means start standard systemic treatment without waiting for the tissue panel, and red means the sample held too little tumour DNA and you must wait for the tissue result","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (the M4 lung indications and their codes, target genes, technologies and eligibility criteria). The directory's own publication page answers HTTP 202 with an empty body","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"NHS England: implementation of circulating tumour DNA testing in the NHS (7 April 2026), signed by Sue Hill, Rhydian Phillips and Peter Johnson: ctDNA is commissioned for suspected non-small-cell lung cancer, central kit procurement has ended and trusts now fund the blood collection kits themselves","url":"https://www.england.nhs.uk/long-read/implementation-of-circulating-tumour-dna-ctdna-testing-in-the-nhs/","date":"2026-04-07"},{"label":"North Thames Genomic Laboratory Hub: circulating tumour DNA guidance for clinicians treating patients with advanced lung cancer (page dated 5 March 2026; document authored by Alastair Greystoke, reviewed by Sanjay Popat and Matthew Krebs, version 1.0 approved 7 July 2025), which sets out the green, orange and red result scheme","url":"https://norththamesgenomics.nhs.uk/ctdna-guidance-for-clinicians-for-patients-with-advanced-lung-cancer/","date":"2026-03-05"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"Newcastle University: Professor Alastair Greystoke","url":"https://www.ncl.ac.uk/medical-sciences/people/profile/alastairgreystoke.html","date":"2026-09-25"}]},{"target":"Enough tissue in the first place","code":"not a test: a pathway rule","test":"Adequate sampling at the first procedure, with additional passes taken specifically for molecular testing","opens":"Everything above. This is the step that most often fails","how":"NG122 recommendation 1.2.11 says ensure samples are adequate, without unacceptable risk, to permit pathological diagnosis including tumour subtyping and the assessment of molecular markers, and 1.2.13 says think carefully before doing a test that gives only diagnostic pathology when staging information is also needed. The optimal pathway says to consider taking additional samples for molecular testing at the time of biopsy, and if the tissue is still insufficient the pathologist must email or telephone the lung multidisciplinary team the same day so the team can decide between repeat sampling, which is allowed until day 21, and the salvage route","sources":[{"label":"NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging","date":"2026-02"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"}]},{"target":"Spirometry, transfer factor and cardiopulmonary fitness","code":"pathology and physiology, not genomics","test":"Spirometry and transfer factor before any treatment with curative intent; shuttle walk testing or cardiopulmonary exercise testing where the risk of postoperative breathlessness is moderate or high","opens":"Surgery. Fitness, not stage, is what most often decides whether someone with an early cancer is offered an operation: among English patients with stage 1 or 2 disease, 75.3 percent with performance status 0 had surgery against 19.2 percent with performance status 2","how":"NG122 recommendations 1.4.9 to 1.4.14 set the tests and the thresholds: a shuttle walk of more than 400 m and a maximal oxygen uptake of more than 15 ml/kg/minute count as good function, and people with a predicted postoperative forced expiratory volume or transfer factor below 30 percent should still be offered treatment with curative intent if they accept the risks. The optimal pathway defines routine fitness testing as spirometry, transfer factor, transthoracic echocardiography and, where indicated, a six-minute walk","sources":[{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"}]}],"testsNote":{"text":"The single most useful thing to know about molecular testing in lung cancer in the NHS is the clock, and the second is that nobody publishes whether it is being met. The National Optimal Lung Cancer Pathway gives it 14 calendar days from the moment the sample is taken to a full molecular report in the clinician's hands, with the treating specialist seeing the patient within three working days of the result, which puts the outside limit at 17 days from biopsy; GIRFT asked for ten calendar days, and Roy Castle campaigns for 14 days as something a patient should be able to expect. There is no turnaround column in the test directory and no published national genomic turnaround statistic: NHS England's genomic testing activity release says only activity data has been published and that waiting-time data is planned for a future publication. The last hard numbers are old and bad. The 2019 GIRFT and audit organisational survey found 46 percent of services met the three-day target to a pathological diagnosis and 38 percent met the ten-day target to a molecular result, and the audit's 2020 spotlight on molecular testing, looking at people diagnosed in 2017, found a median of 18 days from tissue acquisition to an EGFR result.\n\nThe activity itself is now counted: 4,769 lung cancer genomic tests were done nationally in June 2026, from 1,095 in the North Thames Genomic Laboratory Hub to 310 in the South West. But the National Lung Cancer Audit publishes no biomarker testing rates for England at all. A full-text search of its 2026 report for EGFR, ALK, ROS1, PD-L1, molecular, genomic and biomarker returns a single hit, in a recommendation asking trusts to ensure molecular pathology capacity. The only NLCA biomarker data anywhere is a blog about Wales, which found that of 1,546 Welsh patients with a record in the new cancer information system, 745, or 48 percent, had at least one recorded genomic test result. So the NHS mandates a reflex panel, sets a 14-day clock for it, and cannot say what proportion of English patients get either.","sources":[{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/01/Lung-Cancer-National-Report-07-10j-FINAL.pdf","date":"2021-10"},{"label":"Roy Castle Lung Cancer Foundation: campaigns (Let Go of the Labels, This is Lung Cancer, and the policy ask that no one should wait longer than 14 days for genomic testing)","url":"https://roycastle.org/about-us/campaigns/","date":"2026-09-25"},{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (the M4 lung indications and their codes, target genes, technologies and eligibility criteria). The directory's own publication page answers HTTP 202 with an empty body","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NHS England: genomic testing activity, quarter 1 of 2026/27, published 11 September 2026 (4,769 lung cancer genomic tests nationally in June 2026, from 1,095 in North Thames to 310 in the South West). The same page says waiting-time data for genomics is not yet published","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Genomics-performance-data-Q1-26-27.xlsx","date":"2026-09-11"},{"label":"NHS Genomics Education Programme, GeNotes: presentation of a patient with advanced non-small-cell lung cancer (last reviewed 7 February 2024, and now past its review date), which says every patient with possible, probable or definite adenocarcinoma suitable for systemic therapy should have molecular testing regardless of smoking status","url":"https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/presentation-patient-with-advanced-lung-cancer-non-small-cell/","date":"2024-02-07"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"NLCA blog: what do we know about genomic testing in lung cancer in Wales? (Lauren Dixon for the NLCA project team, 23 June 2026): 745 of 1,546 Welsh patients with a record in the new system had at least one genomic test result","url":"https://www.natcan.org.uk/news/nlca-blog-what-do-we-know-about-genomic-testing-in-lung-cancer-in-wales/","date":"2026-06-23"}]},"trials":[{"registry":"ISRCTN70247820","name":"REFINE-Lung: reduced-frequency pembrolizumab in first-line advanced lung cancer","status":"Recruiting, 20 June 2022 to 28 February 2027","setting":"Advanced non-small-cell lung cancer starting first-line pembrolizumab; a phase 3 multi-arm frequency-response optimisation design asking whether the drug can be given less often without losing effect, target 1,750","sites":["40 UK centres, the widest network of any lung trial here: Charing Cross, the Royal Marsden, Guy's and St Thomas', Barts and North Middlesex in London","Weston Park, The Christie, Clatterbridge, St James's (Leeds), Nottingham City, Leicester Royal Infirmary and Addenbrooke's","Beatson West of Scotland and New Victoria (Glasgow), Western General and St John's (Lothian), Forth Valley Royal, Victoria Hospital (Kirkcaldy)","Velindre (Cardiff), and district general hospitals from Truro and Barnstaple to Kettering and Worthing"],"url":"https://www.isrctn.com/ISRCTN70247820","note":"Sponsor Imperial College London, funded by the NIHR Health Technology Assessment Programme. A de-escalation trial: the question is cost, toxicity and hospital visits, not a new drug."},{"registry":"ISRCTN17123858","name":"PRINCE: first-line systemic treatment with or without thoracic radiotherapy in stage 4 lung cancer","status":"Recruiting, 30 July 2024 to 31 January 2028","setting":"Stage 4 non-small-cell lung cancer fit for chemotherapy or immunotherapy: does adding early high-dose chest radiotherapy improve symptoms, progression, survival and quality of life? Randomised, target 472","sites":["29 centres across all four nations and Ireland, including The Christie, Weston Park, Addenbrooke's, Nottingham City and Churchill (Oxford)","Beatson West of Scotland and New Victoria (Glasgow), Belfast Health and Social Care Trust, Altnagelvin (Londonderry)","Velindre (Cardiff), Royal Surrey, Guy's and St Thomas', UCLH, Southampton General, Bristol Haematology and Oncology Centre, Mount Vernon"],"url":"https://www.isrctn.com/ISRCTN17123858","note":"Sponsor The Christie, funded by the NIHR and coordinated by Southampton Clinical Trials Unit. Its sister trial QUARTZ LUNG (ISRCTN52137148) asks the same question for people not having systemic treatment."},{"registry":"ISRCTN10142971","name":"CONCORDE: DNA damage response inhibitors with radical radiotherapy","status":"Recruiting, 16 December 2020 to 30 June 2027","setting":"Non-small-cell lung cancer that has not spread beyond the chest: a Bayesian adaptive platform finding the safe dose of a DNA damage response inhibitor alongside radical radiotherapy, and in some arms immunotherapy; target 210","sites":["13 centres across all four nations: Newcastle, The Christie, Leeds, Sheffield, the Royal Marsden, UCLH, Barts, Birmingham Heartlands, Addenbrooke's and Clatterbridge","Velindre (Cardiff), NHS Lothian (Edinburgh), Belfast Health and Social Care Trust"],"url":"https://www.isrctn.com/ISRCTN10142971","note":"Sponsor University of Leeds, funded by Cancer Research UK, the NIHR and AstraZeneca; joint chief investigators Corinne Faivre-Finn and Alastair Greystoke."},{"registry":"ISRCTN70717445","name":"LungVax: a neoantigen vaccine to prevent lung cancer coming back","status":"Recruiting, 1 June 2026 to 31 March 2027","setting":"People who have had a stage 1A or 1B non-small-cell lung cancer surgically removed: can a ChAdOx2 vaccine teach the immune system to recognise neoantigen flags on pre-cancerous cells and stop a new or recurrent cancer forming? Phase 1, target 40","sites":["University College London Hospitals"],"url":"https://www.isrctn.com/ISRCTN70717445","note":"Sponsor University of Oxford, funded by Cancer Research UK and the CRIS Cancer Foundation. The National Cancer Plan names it as the world's first preventative vaccine trial for lung cancer."},{"registry":"ISRCTN11668189","name":"SEARCH: lung screening for Hodgkin lymphoma survivors","status":"Recruiting, 1 September 2026 to 1 May 2027","setting":"People aged 45 to 74 treated for classical Hodgkin lymphoma at least three years ago, who carry raised lung cancer risk from their earlier radiotherapy and chemotherapy but are not eligible for the national programme; target 4,400","sites":["Manchester University NHS Foundation Trust","University Hospitals of North Midlands (Stoke-on-Trent), Doncaster and Bassetlaw, University Hospitals Plymouth","University Hospital Southampton, NHS Cambridgeshire and Peterborough, Harrogate and District, The Royal Marsden"],"url":"https://www.isrctn.com/ISRCTN11668189","note":"Sponsor University of Manchester, funded by SBRI Healthcare through the NHS Cancer Programme Innovation Call, with Roy Castle Lung Cancer Foundation support. Invitation is by text message from NHS records, then a telephone assessment and a lung health check."},{"registry":"ISRCTN33418225","name":"IMPALA: pathway navigation to increase informed participation in lung screening","status":"Recruiting, 19 January 2026 to 18 January 2027","setting":"A trained pathway navigator using motivational interviewing and decision coaching, to get more people, especially in poorer and underserved groups, to make an informed choice about attending lung screening; randomised, target 2,400","sites":["North Bristol NHS Trust"],"url":"https://www.isrctn.com/ISRCTN33418225","note":"Sponsor North Bristol NHS Trust, funded by the NIHR. It exists because every UK screening study, from SUMMIT to the Yorkshire Lung Screening Trial, has found uptake lowest among the people at highest risk."},{"registry":"ISRCTN87248310","name":"MEDLEY: low-dose CT instead of chest X-ray in primary care","status":"Recruiting, 1 August 2025 to 30 September 2026","setting":"Adults over 40 referred by a GP for a chest X-ray with possible lung cancer symptoms: should the scan replace the X-ray, which misses about a fifth of lung cancers? Non-randomised feasibility, target 900","sites":["Leeds Teaching Hospitals","Royal United Hospitals Bath, Manchester University NHS Foundation Trust","Hull University Teaching Hospitals, Queen Mary University of London"],"url":"https://www.isrctn.com/ISRCTN87248310","note":"Sponsor University of Leeds, funded by the NIHR and run from the Leeds Clinical Trials Research Unit."},{"registry":"ISRCTN10364896","name":"YorQuit: which stop-smoking offer works inside lung screening","status":"Recruiting, 2 June 2025 to 31 March 2027","setting":"Smokers attending for lung cancer screening in Yorkshire, randomised three ways between an NHS app with local services, telephone support from a team attached to the screening service, and the addition of a modest financial incentive; target 1,935","sites":["Bradford Royal Infirmary","Hull Royal Infirmary","St James's University Hospital (Leeds)","Manchester University NHS Foundation Trust"],"url":"https://www.isrctn.com/ISRCTN10364896","note":"Sponsor University of Nottingham, funded by Yorkshire Cancer Research, with Matthew Callister as scientific contact. The UK National Screening Committee recommended screening with integrated smoking cessation, and this is the trial working out what that should be."},{"registry":"ISRCTN40412033","name":"Fit 4 Surgery 2: app-based prehabilitation before and after lung cancer surgery","status":"Recruiting, 12 October 2023 to 31 December 2026","setting":"People having lung resection: a personalised app delivering exercise, nutrition and health information before and after the operation, against usual care; randomised, target 902. The record notes that up to 45 percent of patients currently have a postoperative complication","sites":["20 UK thoracic units, including University Hospitals Birmingham, Royal Papworth, Manchester University, Leeds, Sheffield, South Tees, Plymouth and Hull","Golden Jubilee National Hospital (Clydebank) and the Royal Infirmary of Edinburgh","Royal Brompton and Harefield, Guy's and St Thomas', Imperial, Oxford, Bristol, Coventry, Wolverhampton, Blackpool and Mid and South Essex"],"url":"https://www.isrctn.com/ISRCTN40412033","note":"Sponsor University of Birmingham, funded by the NIHR, run from Birmingham Clinical Trials Unit. It is the direct answer to the audit's fifth recommendation for 2026."},{"registry":"ISRCTN22734699","name":"QuicDNA: liquid biopsy folded into the routine diagnostic pathway across Wales","status":"Closed to recruitment, 1 July 2023 to 30 June 2025; 763 enrolled of a target 1,260","setting":"People with suspected advanced lung cancer across the whole of Wales: does adding a circulating tumour DNA test to the standard diagnostic pathway get people onto the right targeted treatment sooner?","sites":["All six Welsh health boards: Aneurin Bevan, Cardiff and Vale, Hywel Dda, Swansea Bay, Betsi Cadwaladr and Cwm Taf Morgannwg"],"url":"https://www.isrctn.com/ISRCTN22734699","note":"Sponsor Aneurin Bevan University Health Board, funded by Health and Care Research Wales with Amgen, Moondance, Lilly, Illumina, AstraZeneca and Bayer. A whole-nation implementation study, and the reason Wales is the one nation with published lung genomic testing data."},{"registry":"ISRCTN11752949","name":"NEOVACC: personalised DNA vaccines in PD-L1-high lung cancer","status":"Recruiting, 30 September 2025 to 31 December 2026","setting":"PD-L1-high non-small-cell lung cancer that has not cleared on anti-PD-1 treatment: is a personalised Doggybone DNA vaccine safe and active? Phase 1 single-arm, target 15","sites":["Clatterbridge Cancer Centre (Wirral)"],"url":"https://www.isrctn.com/ISRCTN11752949","note":"Sponsor University of Liverpool, funded by UK Research and Innovation and the Medical Research Council."},{"registry":"ISRCTN10688513","name":"APPLIED-LUNG: a blood protein test to refine risk before the screening scan","status":"Recruiting, 17 February 2026 to 31 January 2029","setting":"People invited for NHS lung screening in Cheshire and Merseyside: can a plasma proteomic test with artificial intelligence identify those at such low risk that they may not need a CT at all? Observational prospective cohort, target 11,000","sites":["Liverpool Heart and Chest Hospital, within the Cheshire and Merseyside lung cancer screening programme"],"url":"https://www.isrctn.com/ISRCTN10688513","note":"Sponsor University of Liverpool, funded by the NIHR and Oxford Cancer Analytics."},{"registry":"ISRCTN13013437","name":"TACTICAL1: adding an abdominal scan to the screening CT","status":"Recruiting, 31 October 2025 to 30 November 2026","setting":"A quick non-contrast abdominal CT bolted onto the lung screening scan, to catch kidney cancer and aortic aneurysms: does it put people off attending or add impractical time? Cluster randomised pilot, target 6,272","sites":["Hull University Teaching Hospitals","NHS West Yorkshire Integrated Care Board (Wakefield)"],"url":"https://www.isrctn.com/ISRCTN13013437","note":"Sponsor University of Cambridge, funded by Yorkshire Cancer Research. The National Cancer Plan calls this moving the scanner down."},{"registry":"ISRCTN53398136","name":"HALT: stereotactic radiotherapy for oligoprogressive oncogene-addicted lung tumours","status":"Closed to recruitment 17 July 2023; follow-up to 31 December 2026; 113 enrolled","setting":"Lung cancer driven by a targetable mutation where only one or two sites are growing: does adding dose-intensified stereotactic radiotherapy to the targeted drug buy time before the drug has to be changed? Randomised","sites":["19 centres: the Royal Marsden (Sutton and London), The Christie, Weston Park, Royal Surrey, Nottingham City, St Bartholomew's, Guy's, Southampton General, Clatterbridge, UCLH, Churchill (Oxford), Leicester Royal Infirmary, Bristol, Castle Hill and Addenbrooke's","Beatson West of Scotland (Glasgow) and Western General (Edinburgh)","Belfast City Hospital"],"url":"https://www.isrctn.com/ISRCTN53398136","note":"Sponsor the Institute of Cancer Research, funded by Cancer Research UK; also open in France, Italy, Spain and Switzerland."},{"registry":"NCT07372508","name":"GALACTIC-1: low-dose CT and artificial intelligence case-finding in Glasgow","status":"Recruiting, May 2026 to December 2026","setting":"Ages 55 to 74 attending a lung health check in Glasgow: adding structured CT reporting, blood tests, an electrocardiogram and spirometry to look for chronic obstructive pulmonary disease, fibrosis, coronary disease, heart failure and osteoporosis at the same time, and benchmarking artificial intelligence against radiologist reporting","sites":["NHS Greater Glasgow and Clyde"],"url":"https://bepartofresearch.nihr.ac.uk/trial-details/trial-detail?trialId=59789","note":"Registered on ClinicalTrials.gov rather than ISRCTN; the link is the NIHR Be Part of Research record, because this page cites UK public sources only. Scotland has no national screening programme, so this is how the question is being asked there."},{"registry":"Portfolio study, no registry identifier published","name":"Observational study of lung cancer in never-smokers","status":"Recruiting","setting":"People diagnosed with lung cancer who have never smoked; the study's own summary says more than a quarter of adults diagnosed with lung cancer have never smoked","sites":["University College London Hospitals NHS Foundation Trust"],"url":"https://bepartofresearch.nihr.ac.uk/trial-details/trial-detail?trialId=61184","note":"Sponsor University College London Hospitals. The Be Part of Research record carries only a portfolio number, with no ISRCTN or ClinicalTrials.gov identifier."}],"trialsNote":{"text":"ISRCTN is the UK registry, and its record pages answer HTTP 200 but serve a JavaScript cookie challenge rather than the record, so every trial above was read through the registry's public API. Searches on lung cancer, non-small-cell lung cancer and small-cell lung cancer returned 205, 84 and 105 records; after de-duplication, 158 list a UK recruitment country. The registry split matters for anyone looking for a trial: ISRCTN carries the publicly funded academic portfolio, funded by the NIHR, Cancer Research UK, Yorkshire Cancer Research, the Chief Scientist Office and Health and Care Research Wales, while almost the entire industry portfolio running in UK centres sits on ClinicalTrials.gov and is invisible on ISRCTN. Two of the most important British lung studies have no ISRCTN record at all: TRACERx and SUMMIT. The NIHR's Be Part of Research is the only public place both can be seen together, and it returned 169 recruiting lung cancer studies on the check date. One trial is included here as a failure rather than omitted: RAMON, testing local consolidative treatment in stage 4 disease, is marked Stopped on its own record with 11 people recruited against a target of 244.","sources":[{"label":"ISRCTN registry, public API (the record pages answer HTTP 200 but serve a cookie challenge, so every trial here was read through the API): 205 records on lung cancer, 84 on non-small-cell and 105 on small-cell, of which 158 list a UK recruitment country","url":"https://www.isrctn.com/api/query/format/default?q=condition%3A%22lung%20cancer%22","date":"2026-09-25"},{"label":"NIHR Be Part of Research: lung cancer studies recruiting in the UK (169 recruiting studies on the check date; the industry portfolio sits on ClinicalTrials.gov rather than ISRCTN, and Be Part of Research is the only public place a patient can see both)","url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=lung%20cancer","date":"2026-09-25"},{"label":"NIHR Be Part of Research: TRACERx, which is registered on ClinicalTrials.gov and has no ISRCTN record","url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=TRACERx%20lung","date":"2026-09-25"},{"label":"NIHR Be Part of Research: the SUMMIT study, which is registered on ClinicalTrials.gov and has no ISRCTN record","url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=SUMMIT%20lung%20health%20check","date":"2026-09-25"},{"label":"ISRCTN11613852: RAMON, local consolidative treatment in stage 4 non-small-cell lung cancer (Royal Brompton, NIHR); the record is marked Stopped, with 11 of a target 244 recruited","url":"https://www.isrctn.com/ISRCTN11613852","date":"2026-09-25"}]},"legacy":[{"title":"The lung health checks (1990 to 2026): the evidence for the national programme is almost entirely British","trialIds":["ukls","ylst","summit-lung","lungsearch"],"story":"The letter inviting someone to a lung health check is the end of a thirty-year British argument. It began in Liverpool in 1990, when the thoracic surgeon Ray Donnelly, frustrated that patients reached him too late to operate, could not find anyone to fund work on early detection and set up what became the Roy Castle Lung Cancer Foundation to do it himself. Its first grant, in May 1993, paid for work on early genetic changes; in 1999 it paid for the first UK mobile laboratory to recruit high-risk people into screening.\n\nFour trials then did the work. Lung-SEARCH, funded by Cancer Research UK, tested the cheap option: annual sputum cytology in 1,568 smokers with chronic obstructive pulmonary disease, with CT only for those whose sputum was abnormal. It failed honestly: sputum sensitivity was 40.5 percent and 55 percent of cancers never appeared in the sputum at all. UKLS, led by John Field from Liverpool, approached 247,354 people and randomised 4,055 selected by the Liverpool Lung Project risk model; 85.7 percent of the cancers it found were stage 1 or 2, and at 7.3 years there were 30 lung cancer deaths in the screened arm against 46. Philip Crosbie's Manchester Lung Health Check pilot then proved the delivery model by parking CT scanners in supermarket car parks in the poorest parts of the city: 75 percent of attendees came from the lowest deprivation quintile, 80 percent of the cancers were early stage, and it cost 10,069 pounds per quality-adjusted life-year. The Liverpool Healthy Lung Programme reached a similar population with similar results. The Yorkshire Lung Screening Trial, run by Matthew Callister and Crosbie with Yorkshire Cancer Research money, then settled the operational questions: which risk rule (PLCOm2012 at 1.51 percent found 91.1 percent of cancers against 62.8 percent for the American categorical rule), what it costs (under 4,100 pounds per quality-adjusted life-year on every rule), and whether stopping smoking can be built into the same appointment (89 percent accepted, 12.4 percent validated quitters at four weeks). SUMMIT, from University College London, took the same model into 329 diverse London practices and found 79.3 percent of its 261 cancers at stage 1 or 2.\n\nThe UK National Screening Committee recommended targeted screening in June 2022. By the time the National Cancer Plan was published in February 2026, more than 1.5 million people had attended a lung health check, over 9,000 cancers had been found, 76 percent of them at stage 1 or 2 against 30 percent outside the programme, and the early-diagnosis gap between the richest and poorest areas had narrowed by a quarter. Every study also found the same uncomfortable thing: uptake is lowest among current smokers and in the most deprived areas, which is why IMPALA and INSIGHT are now trying to fix it.","sources":[{"label":"Field JK and others, UK Lung Cancer Screening trial: design and baseline, Health Technology Assessment 2016 (247,354 approached, 4,055 randomised, 42 cancers, 85.7 percent stage 1 or 2)","url":"https://europepmc.org/article/MED/27224642","date":"2016"},{"label":"Field JK and others, UKLS mortality results, Lancet Regional Health Europe 2021 (30 lung cancer deaths against 46, relative rate 0.65; pooled with eight other trials, 0.84)","url":"https://europepmc.org/article/MED/34806061","date":"2021"},{"label":"Crosbie PA and others, implementing lung cancer screening: baseline results from a community Lung Health Check pilot in deprived areas of Manchester, Thorax 2019 (75 percent of attendees in the poorest fifth; 80 percent of the cancers found were early stage)","url":"https://europepmc.org/article/MED/29440588","date":"2019"},{"label":"Ghimire B and others, evaluation of the Liverpool Healthy Lung Programme, Lung Cancer 2019 (more than 80 percent of attenders from the most deprived fifth; 64 percent of cancers stage 1)","url":"https://europepmc.org/article/MED/31319997","date":"2019"},{"label":"Gabe R and others, comparing eligibility criteria in the Yorkshire Lung Screening Trial, Journal of Thoracic Oncology 2025 (the PLCOm2012 risk model at 1.51 percent found 91.1 percent of cancers against 62.8 percent for the 2013 US Preventive Services Task Force rule)","url":"https://europepmc.org/article/MED/39709114","date":"2025"},{"label":"Bhamani A and others, the SUMMIT study baseline round, Lancet Oncology 2025 (12,773 participants from 329 London practices; 79.3 percent of the 261 cancers at stage 1 or 2)","url":"https://europepmc.org/article/MED/40154514","date":"2025"},{"label":"Spiro SG and others, Lung-SEARCH final results, European Respiratory Journal 2019 (1,568 randomised at ten UK centres; no clear stage shift, sputum sensitivity 40.5 percent)","url":"https://europepmc.org/article/MED/31537697","date":"2019"},{"label":"UK National Screening Committee: lung cancer recommendation (June 2022 review): targeted screening with low-dose computed tomography is recommended for people aged 55 to 74 at high risk, with integrated smoking cessation, and the Targeted Lung Health Checks programme is a feasible starting point in England","url":"https://view-health-screening-recommendations.service.gov.uk/lung-cancer/","date":"2022-06"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Roy Castle Lung Cancer Foundation: research (the first grant in May 1993; Roy Castle's Tour of Hope raised a million pounds towards the world's first lung cancer research centre, opened May 1998; clinical research fellowships since 2012)","url":"https://roycastle.org/about-us/research/","date":"2026-09-25"}]},{"title":"What British trials settled about treatment (1990 to 2022): CHART, the Big Lung Trial, CONVERT, QUARTZ and VIOLET","trialIds":["chart-lung","big-lung-trial","convert","quartz","violet"],"story":"British lung cancer trials have a distinctive character: they tend to ask whether a treatment is worth having at all, and they are willing to publish the answer no.\n\nCHART is the exception that proves it. Michele Saunders and Stanley Dische at Mount Vernon reasoned that tumour cells repopulate during a six-week radiotherapy course, and built a schedule that gave the whole dose in twelve consecutive days, three fractions a day, weekends included. In 563 patients it cut the relative risk of death by 24 percent and lifted two-year survival from 20 to 29 percent, and in squamous cancers from 19 to 33 percent. The schedule was too demanding for most departments to run, but the principle, that a radiotherapy course should not be allowed to drag, survived it.\n\nThe Big Lung Trial then tested the 1995 meta-analysis in four settings and found chemotherapy worth nine weeks in advanced disease (hazard ratio 0.77) and worth nothing after surgery or after radical radiotherapy. Its companion paper reported that of 688 newly diagnosed patients at two London centres only 63 entered the trial, and of those potentially eligible, 73.5 percent refused, which is the most honest paragraph in British lung cancer research. QUARTZ, run from the MRC Clinical Trials Unit, randomised 538 people with brain metastases to whole-brain radiotherapy or to supportive care alone and found the radiotherapy added no quality-adjusted survival, a de-implementation result that stopped a routine treatment. CONVERT, led from Manchester by Corinne Faivre-Finn with Cancer Research UK funding, ran 547 patients across 73 centres in eight countries to show that once-daily radiotherapy was better than twice-daily in limited-stage small-cell disease, and did not, which is why NG122 still recommends the twice-daily schedule. VIOLET, from the Royal Brompton, randomised 503 people between keyhole and open lobectomy and found better physical function at five weeks and fewer serious adverse events after discharge, with the same survival: the trial behind the fact that three quarters of English lung resections are now minimally invasive.","sources":[{"label":"Saunders M and others, continuous hyperfractionated accelerated radiotherapy against conventional radiotherapy in non-small-cell lung cancer, Lancet 1997 (563 patients, 24 percent reduction in the relative risk of death, two-year survival 20 to 29 percent)","url":"https://europepmc.org/article/MED/9250182","date":"1997"},{"label":"Saunders M and others, CHART mature results, Radiotherapy and Oncology 1999 (22 percent reduction in the relative risk of death overall and 30 percent in squamous cancers)","url":"https://europepmc.org/article/MED/10577699","date":"1999"},{"label":"Spiro SG and others, the Big Lung Trial in the supportive care setting, Thorax 2004 (725 randomised; chemotherapy gave a hazard ratio of 0.77 and a median gain of nine weeks)","url":"https://europepmc.org/article/MED/15454647","date":"2004"},{"label":"Spiro SG and others, the difficulty of recruiting to lung cancer trials, Thorax 2000 (of 688 newly diagnosed patients at two London centres only 63, or 9.2 percent, entered the trial)","url":"https://europepmc.org/article/MED/10817793","date":"2000"},{"label":"Mulvenna P and others, QUARTZ, Lancet 2016 (538 patients at 69 UK and three Australian centres; whole-brain radiotherapy added no quality-adjusted survival)","url":"https://europepmc.org/article/MED/27604504","date":"2016"},{"label":"Faivre-Finn C and others, CONVERT, Lancet Oncology 2017 (547 patients; median survival 30 months twice-daily against 25 months once-daily, hazard ratio 1.18, so twice-daily 45 Gy remained the standard)","url":"https://europepmc.org/article/MED/28642008","date":"2017"},{"label":"Lim E and others, VIOLET: video-assisted thoracoscopic or open lobectomy in early-stage lung cancer, NEJM Evidence 2022 (503 randomised; better physical function at five weeks and fewer serious adverse events after discharge with keyhole surgery, same survival at a year)","url":"https://europepmc.org/article/MED/38319202","date":"2022"},{"label":"NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management","date":"2026-02"}]},{"title":"Following one cancer through (2014 to 2026): TRACERx, PEACE and the National Lung Matrix Trial","trialIds":["tracerx","national-lung-matrix-trial"],"story":"Two British programmes changed what a lung cancer is understood to be, and both were funded by Cancer Research UK.\n\nTRACERx, led by Charles Swanton from the UCL Cancer Institute and the Francis Crick Institute with Mariam Jamal-Hanjani as lead clinician, took multiple regions from each resected tumour and sequenced them. The first 100 tumours, across 327 regions, showed that the classic drivers were almost always clonal but that later, scattered drivers were present in more than three quarters of tumours, and that copy-number heterogeneity carried a hazard ratio of 4.9 for recurrence or death. The 421-patient analysis found 22 of 40 common cancer genes under subclonal selection in adenocarcinoma, subclonal whole-genome doubling in 19 percent, and that 8 percent of adenocarcinomas in people with a smoking history carried no tobacco mutational signature and behaved like never-smoker tumours. The PEACE autopsy programme carried the same patients to death: 501 samples from 24 people, covering 70 percent of the metastases visible on imaging, showed that in 62.5 percent of cases several primary subclones disseminated independently and that more than half the metastases sampled had been seeded by other metastases. The same group then showed how lung cancer arises in people who never smoked, finding oncogenic EGFR variants in 18 percent of histologically normal lung tissue and a mechanism by which fine particulate air pollution wakes them up.\n\nThe National Lung Matrix Trial asked the practical version of the question. Run by Gary Middleton from the Cancer Research UK Clinical Trials Unit in Birmingham across the experimental cancer medicine centre network, it was the largest umbrella trial ever run in lung cancer: 5,467 patients screened, 2,007 molecularly eligible, 302 given genotype-matched therapy across 19 drug-biomarker cohorts. Its 2020 Nature paper said plainly that despite the preclinical rationale only a limited number of combinations showed clinically relevant benefit, and that those were concentrated in cancers associated with minimal tobacco exposure. A later arm reported that vistusertib cannot be recommended in STK11-deficient disease. Between them the two programmes explain why a comprehensive reflex panel is now NHS policy, and why most of the drivers it finds still have nothing to offer.","sources":[{"label":"Jamal-Hanjani M and others, tracking the evolution of non-small-cell lung cancer, New England Journal of Medicine 2017 (multiregion sequencing of 100 tumours; copy-number heterogeneity carried a hazard ratio of 4.9 for recurrence or death)","url":"https://europepmc.org/article/MED/28445112","date":"2017"},{"label":"Frankell AM and others, the evolution of lung cancer and the impact of subclonal selection in TRACERx, Nature 2023 (1,644 regions from 421 patients; 8 percent of adenocarcinomas in people with a smoking history showed no tobacco mutational signature)","url":"https://europepmc.org/article/MED/37046096","date":"2023"},{"label":"Hessey S and others, evolutionary characterisation of lung cancer metastasis, Nature 2026 (501 samples from 24 people in the PEACE autopsy programme; more than half the metastases sampled were seeded by other metastases)","url":"https://europepmc.org/article/MED/42056508","date":"2026"},{"label":"Hill W and others, lung adenocarcinoma promotion by air pollutants, Nature 2023 (particulate matter and EGFR-driven lung cancer across 32,957 cases; oncogenic EGFR variants found in 18 percent of histologically normal lung samples)","url":"https://europepmc.org/article/MED/37020004","date":"2023"},{"label":"Middleton G and others, the National Lung Matrix Trial of personalised therapy in lung cancer, Nature 2020 (5,467 screened, 2,007 molecularly eligible, 302 treated across 19 drug-biomarker cohorts)","url":"https://europepmc.org/article/MED/32669708","date":"2020"},{"label":"Middleton G and others, a phase 2 trial of mTORC1/2 inhibition in STK11-deficient non-small-cell lung cancer, npj Precision Oncology 2025 (vistusertib cannot be recommended in this setting)","url":"https://europepmc.org/article/MED/40069402","date":"2025"}]}],"figures":[{"label":"New cases a year","value":"50,218","nation":"UK","period":"2019, 2021-2022 average","source":{"label":"Cancer Research UK: lung cancer incidence","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/incidence","date":"2026-09-25"},"note":"The third most common cancer, 11 percent of all new cases, nearly 140 a day: around 25,500 in males and 24,700 in females. Rates are highest at ages 80 to 84, and 46 percent of cases are in people aged 75 and over."},{"label":"Deaths a year","value":"32,800","nation":"UK","period":"2022-2024 average","source":{"label":"Cancer Research UK: lung cancer mortality (the deprivation gradient in mortality and the deaths linked with deprivation)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality","date":"2026-09-25"},"note":"The most common cause of cancer death in the UK, 90 a day; 54 percent in people aged 75 and over. Rates are down 40 percent since the early 1970s and 22 percent in the last decade. An estimated 668,000 lung cancer deaths were avoided in the UK by 2021."},{"label":"Ten-year survival","value":"11.1%","nation":"UK","period":"2018 (predicted)","source":{"label":"Cancer Research UK: lung cancer survival (including five-year survival by deprivation group in England)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/survival","date":"2026-09-25"},"note":"Up from 3.3 percent in the 1970s, and still far below most common cancers; five-year relative survival is generally below the European average. A population average, not a personal prognosis."},{"label":"Mortality gradient by deprivation","value":"102% higher in females and 93% higher in males in the most deprived fifth than the least","nation":"UK","period":"current CRUK analysis","source":{"label":"Cancer Research UK: lung cancer mortality (the deprivation gradient in mortality and the deaths linked with deprivation)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality","date":"2026-09-25"},"note":"The steepest deprivation gradient of any common cancer. Around 13,400 lung cancer deaths a year in the UK are linked with deprivation, around 6,500 in females and 6,900 in males."},{"label":"Five-year survival by deprivation","value":"20.1% in the most deprived group against 27.6% in the least","nation":"England","period":"2018-2022","source":{"label":"Cancer Research UK: lung cancer survival (including five-year survival by deprivation group in England)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/survival","date":"2026-09-25"},"note":"A gap of 7.5 percentage points on a base of one in five, so the poorest are about a quarter less likely to survive five years."},{"label":"Incidence gradient by deprivation","value":"165.8 per 100,000 in the most deprived fifth against 52.4 in the least, a rate ratio of 3.16","nation":"Scotland","period":"2020-2024","source":{"label":"Public Health Scotland: cancer incidence by deprivation, table 3 (trachea, bronchus and lung, SIMD quintiles, 2020 to 2024: 165.8 per 100,000 in the most deprived fifth against 52.4 in the least)","url":"https://publichealthscotland.scot/media/39935/table-3-cancer_incidence_by_deprivation.xlsx","date":"2026-08-18"},"note":"The steepest gradient of any cancer site in Public Health Scotland's workbook, and it has widened: the ratio was 2.97 for 2015 to 2019. In absolute terms 7,772 lung cancers arose in the most deprived fifth over five years against 3,104 in the least. Scotland's own cancer strategy puts it in one line: lung cancer is three times more common in the most deprived areas than the least."},{"label":"Mortality gradient by deprivation","value":"123.1 per 100,000 in the most deprived fifth against 34.9 in the least, a rate ratio of 3.52","nation":"Scotland","period":"2020-2024","source":{"label":"Public Health Scotland: cancer mortality by deprivation, table 5 (trachea, bronchus and lung, 2020 to 2024: 123.1 per 100,000 in the most deprived fifth against 34.9 in the least)","url":"https://publichealthscotland.scot/media/39569/table-5-cancer_mortality_by_deprivation_2024.xlsx","date":"2026-07-14"},"note":"Also widening, from 3.09 in 2015 to 2019. Public Health Scotland attributes part of Scotland's overall cancer mortality gap to the greater likelihood of developing cancers with low survival, naming lung cancer."},{"label":"Incidence gradient by deprivation","value":"62.1% above the Northern Ireland average in the most deprived areas and 33.6% below it in the least","nation":"Northern Ireland","period":"2019-2023","source":{"label":"Northern Ireland Cancer Registry 2026: lung cancer 1993 to 2023 (1,369 cases a year 2019 to 2023; 94.7 percent staged; incidence 62.1 percent above the Northern Ireland average in the most deprived areas and 33.6 percent below it in the least)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Lung%20cancer%20report.pdf","date":"2026"},"note":"A most-to-least ratio of about 2.44. Over the five years, 1,775 cases arose in the most deprived fifth against 982 in the least."},{"label":"Incidence gradient by deprivation","value":"2.3 times higher in the most deprived fifth than the least","nation":"Wales","period":"2022","source":{"label":"Public Health Wales, Welsh Cancer Intelligence and Surveillance Unit: cancer incidence in Wales (published 23 October 2025): the lung cancer incidence rate was 2.3 times higher in the most deprived fifth of areas than the least in 2022","url":"https://phw.nhs.wales/reports/cancer-incidence-in-wales/","date":"2025-10-23"},"note":"Late-stage incidence in the most deprived areas was 2.6 times the late-stage rate in the least deprived, so the gap is wider for advanced disease than for early disease."},{"label":"Contribution to the life expectancy gap","value":"Almost a whole year of the nine-year gap between richer and poorer parts of England","nation":"England","period":"National Cancer Plan, 2026","source":{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},"note":"One disease accounting for roughly a ninth of the entire socioeconomic life expectancy gap."},{"label":"Smoking attributable fraction","value":"72% of cases and 86% of deaths","nation":"UK","period":"current CRUK analysis","source":{"label":"Cancer Research UK: lung cancer risk factors (the preventable fraction and the smoking attributable fraction)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/risk-factors","date":"2026-09-25"},"note":"71 percent from active smoking and 1 percent from environmental tobacco smoke; 79 percent of UK lung cancer cases are preventable in total. Occupational exposures account for 13 percent, outdoor air pollution 8 percent and ionising radiation 5 percent."},{"label":"People diagnosed","value":"39,409 in England and 2,135 in Wales","nation":"England and Wales","period":"2024","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"Across 123 English NHS trusts. For the first time more women than men were diagnosed: 50.8 percent female. Median age 74.0 years. Small-cell disease was 6.6 percent of English cases, down from 8.6 percent in 2019."},{"label":"Diagnosed at stage 1 or 2","value":"40.2% in England, 34.8% in Wales","nation":"England and Wales","period":"2024","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"England was 32 percent in 2022 and 35.5 percent in 2023: the fastest stage shift in any common cancer, and the audit attributes it to screening. Stage 4 fell from 47 percent in 2022 to 41 percent in 2024."},{"label":"Stage 1 or 2 among screen-detected cancers","value":"76.2%","nation":"England","period":"April 2019 to March 2025","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"The NHS Lung Cancer Screening Programme reported 7,329 cancers among people aged 55 to 74 invited over this period, of which 3,175 were in 2024 to 2025 alone. The proportion at stage 1 or 2 ranged from 63 to 81 percent between cancer alliances."},{"label":"Diagnosed after an emergency admission","value":"30.2% in England, 26.4% in Wales","nation":"England and Wales","period":"2024","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"Down from 33 percent in England in 2022, but the audit says the screening programme's effect has not yet translated into fewer emergency presentations."},{"label":"Diagnosed after an emergency presentation","value":"41.2%","nation":"Northern Ireland","period":"2018-2022","source":{"label":"Northern Ireland Cancer Registry 2026: routes to diagnosis 2018 to 2022 (lung: 41.2 percent of diagnoses through an emergency presentation, 40.5 percent in Northern Ireland against 33.7 percent in England for 2018 to 2020)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/pdf/Routes%20to%20diagnosis%202018-2022.pdf","date":"2026"},"note":"The registry's own comparison for 2018 to 2020 put Northern Ireland at 40.5 percent against England's 33.7 percent. One-year net survival was 22.9 percent for this route against 61.6 percent for the other-outpatient route."},{"label":"Surgical resection rate","value":"21.8% in England (7,878 operations), 17.1% in Wales (1,910 operations)","nation":"England and Wales","period":"2024","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"Up from 19.6 percent in England in 2023 and 18 percent in 2022; the absolute number of people receiving curative treatment rose from 5,561 in 2019 to 8,936 in 2024, an increase of more than 60 percent. Resection rates range from 15 to 37 percent between cancer alliances."},{"label":"Median time from referral to surgery in stage 1 to 2 disease","value":"81 days in England, 91 days in Wales, against a 49-day optimal pathway","nation":"England and Wales","period":"2024","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"Only 12 percent of English patients were operated on within 49 days. For radical radiotherapy the median was 98 days and 3.2 percent met the target; for systemic therapy in stage 3B to 4 disease, 63 days and 27 percent."},{"label":"One-year survival","value":"50.7% in England, 49.2% in Wales","nation":"England and Wales","period":"diagnosed January to June 2024 (England) and 2024 (Wales)","source":{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},"note":"England's median survival was 372 days, up from 349 in 2023 and 281 in 2022; in stage 4 disease the median was 95 days. Ninety-day survival after lung resection was 98.4 percent across England and Wales."},{"label":"Net survival by stage","value":"Stage 1 58.7%, stage 2 35.3%, stage 3 13.6%, stage 4 3.4% at five years","nation":"England","period":"diagnosed 2014-2018","source":{"label":"Public Health England: adult cancer survival data tables (lung, England, diagnosed 2014 to 2018: five-year age-standardised net survival 58.7 percent at stage 1 against 3.4 percent at stage 4)","url":"https://assets.publishing.service.gov.uk/media/5fa3e639d3bf7f03a6550dfc/adultcancerfinal_ods_update051120.ods","date":"2020-11-05"},"note":"Age-standardised net survival; all stages together, 41.9 percent at one year and 17.6 percent at five. The seventeen-fold gap between stage 1 and stage 4 is the whole argument for screening."},{"label":"Net survival by stage","value":"Stage 1 50.6%, stage 2 31.3%, stage 3 12.6%, stage 4 3.5% at five years","nation":"Wales","period":"diagnosed 2018-2022","source":{"label":"Welsh Cancer Intelligence and Surveillance Unit: cancer survival data tables 2002 to 2022 (lung by stage, diagnosed 2018 to 2022: one-year net survival 85.9 percent at stage 1 against 17.7 percent at stage 4)","url":"https://phw.nhs.wales/app/uploads/sites/2/2026/03/CancerSurvivalWales_DataTables_2002-2022.xlsx","date":"2026-03-26"},"note":"One-year net survival by stage was 85.9 percent at stage 1 against 17.7 percent at stage 4. All stages together, 42.5 percent at one year and 18.5 percent at five."},{"label":"Net survival by stage","value":"Stage I 55.6%, stage II 37.2%, stage III 10.8%, stage IV 2.0% at five years","nation":"Northern Ireland","period":"diagnosed 2014-2018","source":{"label":"Northern Ireland Cancer Registry 2026: lung cancer 1993 to 2023 (1,369 cases a year 2019 to 2023; 94.7 percent staged; incidence 62.1 percent above the Northern Ireland average in the most deprived areas and 33.6 percent below it in the least)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Lung%20cancer%20report.pdf","date":"2026"},"note":"All stages together, 39.4 percent at one year and 16.8 percent at five. By histology, five-year survival ranged from 23.2 percent for adenocarcinoma to 6.8 percent for small-cell and 4.1 percent for large-cell carcinoma."},{"label":"New cases a year","value":"5,200","nation":"Scotland","period":"2024","source":{"label":"Public Health Scotland open data: cancer incidence at Scotland level (trachea, bronchus and lung, ICD-10 C33-C34: 5,200 cases in 2024)","url":"https://www.opendata.nhs.scot/dataset/c2c59eb1-3aff-48d2-9e9c-60ca8605431d/resource/72c852b8-ee28-4fd8-84a9-5f415f4bc325/download/opendata_inc0024_scotland.csv","date":"2026-08-18"},"note":"European age-standardised rate 89.1 per 100,000, down from 98.1 in 2022. Lung cancer rates fell 23 percent in males and 7 percent in females over the decade to 2024."},{"label":"Deaths a year","value":"3,651","nation":"Scotland","period":"2024","source":{"label":"Public Health Scotland: cancer mortality, annual update to 2024 (published 14 July 2026): 3,651 lung cancer deaths in Scotland in 2024, 22.3 percent of all cancer deaths","url":"https://publichealthscotland.scot/publications/cancer-mortality/","date":"2026-07-14"},"note":"The most common cause of cancer death in Scotland, 22.3 percent of all cancer deaths, at a European age-standardised rate of 62.8 per 100,000."},{"label":"Stage at diagnosis","value":"Stage I 24.6%, stage II 6.9%, stage III 19.4%, stage IV 41.1%, not known 8.0%","nation":"Scotland","period":"2024","source":{"label":"Public Health Scotland: trends in cancer staging, table 9 (lung, Scotland 2024: 24.6 percent stage I, 41.1 percent stage IV)","url":"https://publichealthscotland.scot/media/39990/table-9-trends_in_cancer_staging.xlsx","date":"2026-08-18"},"note":"Of the 4,784 cases with a known stage, 34.3 percent were stage I or II. One-year net survival rose from 40.8 percent for 2013 to 2017 to 45.7 percent for 2018 to 2022, and five-year from 16.4 to 19.9 percent."},{"label":"New cases a year","value":"1,369","nation":"Northern Ireland","period":"2019-2023 average","source":{"label":"Northern Ireland Cancer Registry 2026: lung cancer 1993 to 2023 (1,369 cases a year 2019 to 2023; 94.7 percent staged; incidence 62.1 percent above the Northern Ireland average in the most deprived areas and 33.6 percent below it in the least)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Lung%20cancer%20report.pdf","date":"2026"},"note":"6,845 cases over the five years, 48.5 percent in women; 13.0 percent of all cancers in both sexes. Median age at diagnosis 73. 94.7 percent had a stage assigned, the best stage completeness of the four nations, with 20.2 percent stage I and 44.6 percent stage IV."},{"label":"Deaths a year","value":"1,024","nation":"Northern Ireland","period":"2019-2023 average","source":{"label":"Northern Ireland Cancer Registry 2026: lung cancer 1993 to 2023 (1,369 cases a year 2019 to 2023; 94.7 percent staged; incidence 62.1 percent above the Northern Ireland average in the most deprived areas and 33.6 percent below it in the least)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Lung%20cancer%20report.pdf","date":"2026"},"note":"22.6 percent of all male and 21.8 percent of all female cancer deaths. At the end of 2023, 2,964 people diagnosed since 1999 were alive."},{"label":"Lung cancer as a share of cancer deaths","value":"Two in every ten","nation":"Wales","period":"2025","source":{"label":"Welsh Cancer Intelligence and Surveillance Unit: cancer mortality in Wales (published 15 July 2026): lung cancer causes two in every ten cancer deaths in Wales","url":"https://phw.nhs.wales/reports/cancer-mortality-in-wales/","date":"2026-07-15"},"note":"Of 9,053 cancer deaths in Wales in 2025, lung cancer was the largest single cause. All-cancer death rates were 54 percent higher in the most deprived fifth than the least."},{"label":"Research funding against burden","value":"26% of UK cancer deaths, 6% of cancer research funding","nation":"UK","period":"2010 National Cancer Research Institute data, published 2015","source":{"label":"Carter AJ, Delarosa B and Hur H, an analysis of discrepancies between UK cancer research funding and societal burden, Health Research Policy and Systems 2015: lung cancer accounted for 26 percent of UK cancer deaths while receiving 6 percent of cancer research funding (2010 National Cancer Research Institute data)","url":"https://europepmc.org/article/MED/26526609","date":"2015"},"note":"Lung cancer caused more than twice as many deaths as the next most lethal category while receiving less funding than four other cancer types. The authors attribute the gap to a blame-the-victim attitude. No more recent UK-wide figure could be found on a public UK page."}],"support":[{"institutionId":"roy-castle-lung-cancer-foundation","name":"Roy Castle Lung Cancer Foundation","kind":"charity","provides":["Ask the Nurse: a free confidential helpline on 0800 358 7200, answered by experienced lung cancer nurses, Monday to Thursday 9am to 5pm and Friday 9am to 4pm","Keep in Touch: fortnightly one-to-one calls for up to twelve sessions, for patients or carers","Free information days across the UK with oncologists, thoracic surgeons, nurses, physiotherapists and dietitians, and nurse-led local support groups","Information on symptoms, screening, diagnosis, treatment, living with lung cancer, advanced disease and recurrence","Travel insurance and will-writing guidance, and a stop-smoking section","Campaigning on stigma (Let Go of the Labels) and on a 14-day limit for genomic testing"],"url":"https://roycastle.org/","source":{"label":"Roy Castle Lung Cancer Foundation (helpline 0800 358 7200; registered charity 1046854 in England and Wales, SC037596 in Scotland)","url":"https://roycastle.org/","date":"2026-09-25"}},{"institutionId":"cruk","name":"Cancer Research UK","kind":"charity","provides":["Freephone nurse helpline on 0808 800 40 40, Monday to Friday 9 to 5","Plain-English information on lung cancer, reviewed by lung cancer clinical nurse specialists, and a clinical trial database","The UK statistics quoted on this page","Funder of CONVERT, ADSCaN, HALT, LungVax, Lung-SEARCH, PROMINENT, the National Lung Matrix Trial and CONCORDE"],"url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer","source":{"label":"Cancer Research UK: about lung cancer (patient information, reviewed 10 March 2026; freephone nurse helpline 0808 800 40 40, Monday to Friday 9 to 5)","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer","date":"2026-03-10"}},{"institutionId":"macmillan-cancer-support","name":"Macmillan Cancer Support","kind":"charity","provides":["Support line on 0808 808 00 00, 8am to 8pm every day, with online chat and an email service","Separate information for non-small-cell, small-cell and secondary lung cancer, reviewed by a consultant clinical oncologist and carrying the PIF TICK quality mark","Understanding lung cancer booklet and audiobook, and an easy-read version","An online community lung cancer forum, and cancercaremap.org to find local services","Grants and benefits advice"],"url":"https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer","source":{"label":"Macmillan Cancer Support: lung cancer (support line 0808 808 00 00, 8am to 8pm every day)","url":"https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer","date":"2026-09-25"}},{"institutionId":"maggies-centres","name":"Maggie's","kind":"charity","provides":["29 centres across the UK beside major cancer hospitals, plus online support; support line 0300 123 1801","Courses such as Getting Started With Cancer Treatment, support groups and workshops in centres and online","One-to-one support with a psychologist, a benefits adviser or a cancer support specialist, free and without an appointment"],"url":"https://www.maggies.org/support-and-information/about-cancer/types/lung-cancer/","source":{"label":"Maggie's: lung cancer (last reviewed 12 November 2024); 29 UK centres and a support line on 0300 123 1801","url":"https://www.maggies.org/support-and-information/about-cancer/types/lung-cancer/","date":"2024-11-12"}},{"name":"NHS lung cancer information and the lung cancer screening programme","kind":"nhs","provides":["Symptoms, tests and treatment on nhs.uk, reviewed 20 August 2026","The lung cancer screening page: who is invited, what happens at a lung health check, and the cancer alliance areas where checks are live","Stop-smoking advice offered to current smokers at the screening appointment"],"url":"https://www.nhs.uk/conditions/lung-cancer/","source":{"label":"NHS: lung cancer screening (the lung health check: who is invited, the telephone or online risk assessment, the scan in a mobile unit, the result letter within four weeks, and the cancer alliance areas where checks are live; page last reviewed 27 March 2023)","url":"https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/","date":"2023-03-27"}},{"name":"Free NHS prescriptions in England (medical exemption certificate)","kind":"benefit","provides":["Prescriptions cost 9.90 pounds an item in England unless you are exempt","Anyone being treated for cancer, the effects of cancer or the effects of cancer treatment is entitled to a five-year medical exemption certificate; ask the hospital or GP for the FP92A form"],"url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","source":{"label":"NHS: prescription charges (9.90 pounds per item in England)","url":"https://www.nhs.uk/nhs-services/prescriptions/nhs-prescription-charges/","date":"2026-09-25"}},{"name":"Prescriptions in Scotland, Wales and Northern Ireland","kind":"benefit","provides":["Scotland: free for everyone, with no certificate needed","Wales: free for anyone registered with a Welsh GP","Northern Ireland: all prescriptions dispensed there are free"],"url":"https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","source":{"label":"Welsh Government: free prescriptions","url":"https://www.gov.wales/free-prescriptions","date":"2026-09-25"}},{"name":"Special rules for end of life (SR1)","kind":"benefit","provides":["If a doctor, consultant or specialist nurse says you may have 12 months or less to live, claims for Personal Independence Payment, Universal Credit, Employment and Support Allowance and Attendance Allowance are fast-tracked at the higher rate with no assessment","This matters more in lung cancer than in most: median survival in stage 4 disease was 95 days in England in 2024"],"url":"https://www.gov.uk/benefits-end-of-life","source":{"label":"DWP: the special rules, how the benefit system supports people nearing the end of life (the SR1 form, for clinicians)","url":"https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","date":"2026-09-25"}},{"name":"Personal Independence Payment and Attendance Allowance","kind":"benefit","provides":["Non-means-tested payments for people whose illness or treatment affects daily living or mobility: Personal Independence Payment under State Pension age, Attendance Allowance over it","Breathlessness, fatigue and the effects of thoracic surgery are the kinds of daily-living difficulty these are meant for"],"url":"https://www.gov.uk/pip","source":{"label":"GOV.UK: Attendance Allowance","url":"https://www.gov.uk/attendance-allowance","date":"2026-09-25"}},{"name":"Healthcare Travel Costs Scheme","kind":"benefit","provides":["Help with fares to hospital for people on qualifying benefits or a low income","It matters in lung cancer because radical radiotherapy can mean daily attendance for four to six and a half weeks, and because the disease is concentrated in the poorest fifth of the population"],"url":"https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","source":{"label":"NHS: Healthcare Travel Costs Scheme","url":"https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","date":"2026-09-25"}},{"name":"Macmillan Grants","kind":"benefit","provides":["One-off payments for costs such as heating, travel or clothing; a nurse or social worker applies with you","Heating matters here: breathlessness is worse in a cold house"],"url":"https://www.macmillan.org.uk/cancer-information-and-support/get-help/financial-and-work/macmillan-grants","source":{"label":"Macmillan Grants","url":"https://www.macmillan.org.uk/cancer-information-and-support/get-help/financial-and-work/macmillan-grants","date":"2026-09-25"}}],"nations":[{"topic":"Lung cancer screening","england":"A national programme. The UK National Screening Committee recommended targeted screening in June 2022; NHS England invites people aged 55 to 74 whose GP record shows a smoking history to a lung health check, risk-assesses them by telephone, online or in person, and scans those at high risk in a mobile unit. Coverage was about 40 percent of the country at the time of the 2026 audit; the National Cancer Plan commits to national coverage by 2030, more than 6 million invitations between 2026 and 2035, and up to 50,000 cancers detected by 2035.","scotland":"Committed, phase 1 in 2027/28. The Cancer Strategy for Scotland 2023 to 2033 committed to taking forward the screening committee's recommendation, and the Programme for Government 2026 to 2031, published 1 September 2026, says the government will be rolling out phase 1 of national lung screening in 2027/28. One pilot has run, in Lothian and Fife. Nothing is live yet: Public Health Scotland and NHS inform both list six adult screening programmes and lung is not among them.","wales":"Committed 28 June 2025, first invitations anticipated 2027. A written statement by the Cabinet Secretary for Health announced a national lung screening programme, Wales's fourth population cancer screening programme, delivered by mobile low-dose CT units, phased by age starting with the top of the range, at 2.3 million pounds in 2025-26 rising to around 13 million a year once fully implemented. It follows a pilot in North Rhondda that invited people aged 60 to 74 who had ever smoked, scanned more than 600 people from September 2023 and found twelve cancers, two thirds at stage 1 or 2. Nothing is live yet: Public Health Wales lists eight programmes and lung is not among them.","northernIreland":"No commitment, no pilot, no timetable. The Cancer Strategy for Northern Ireland 2022 to 2032 says the UK National Screening Committee is considering a targeted programme and that no pilot currently exists in Northern Ireland; the March 2026 progress report says work to implement the committee's recommendations is under way but progress will depend on available funding and resources. nidirect lists seven screening programmes and lung is not among them.","sources":[{"label":"UK National Screening Committee: lung cancer recommendation (June 2022 review): targeted screening with low-dose computed tomography is recommended for people aged 55 to 74 at high risk, with integrated smoking cessation, and the Targeted Lung Health Checks programme is a feasible starting point in England","url":"https://view-health-screening-recommendations.service.gov.uk/lung-cancer/","date":"2022-06"},{"label":"NHS: lung cancer screening (the lung health check: who is invited, the telephone or online risk assessment, the scan in a mobile unit, the result letter within four weeks, and the cancer alliance areas where checks are live; page last reviewed 27 March 2023)","url":"https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/","date":"2023-03-27"},{"label":"GOV.UK: new lung cancer screening roll out to detect cancer sooner (Department of Health and Social Care, 26 June 2023): ages 55 to 74 with a GP record of smoking, 270 million pounds a year once fully implemented, up to 9,000 cancers a year and almost a million scans, 76 percent of cancers found at an earlier stage in the first phase, around 70 percent of screening delivered in mobile units in areas where people are four times more likely to smoke","url":"https://www.gov.uk/government/news/new-lung-cancer-screening-roll-out-to-detect-cancer-sooner","date":"2023-06-26"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"Scottish Government: Cancer strategy for Scotland 2023 to 2033 (published 15 June 2023): under Optimise Screening it commits to taking forward the UK National Screening Committee's recommendations on targeted lung screening, and it records that lung cancer is Scotland's single biggest cause of cancer mortality and is three times more common in the most deprived areas than the least","url":"https://www.gov.scot/publications/cancer-strategy-scotland-2023-2033/","date":"2023-06-15"},{"label":"Scottish Government: Programme for Government 2026 to 2031 (published 1 September 2026), which commits to rolling out phase 1 of national lung screening in 2027/28","url":"https://www.gov.scot/publications/programme-government-2026-2031/pages/5/","date":"2026-09-01"},{"label":"Scottish Government: Scottish Screening Committee minutes, January 2023 (one lung screening pilot in Scotland, in Lothian and Fife, about halfway through, and a lung cancer screening implementation group to be taken forward)","url":"https://www.gov.scot/publications/scottish-screening-committee-minutes-january-2023/","date":"2023-06-01"},{"label":"Public Health Scotland: disease screening programmes (six programmes listed, none of them lung)","url":"https://publichealthscotland.scot/population-health/conditions-and-diseases/disease-screening/","date":"2026-09-25"},{"label":"Welsh Government: written statement, a national lung screening programme for Wales (Jeremy Miles MS, 28 June 2025): Wales's fourth population screening programme, delivered by mobile low-dose CT, phased by age from the top of the range, 2.3 million pounds in 2025-26 rising to around 13 million a year, with the first invitations anticipated in 2027","url":"https://www.gov.wales/written-statement-national-lung-screening-programme-wales","date":"2025-06-28"},{"label":"NHS Wales Performance and Improvement: the lung health check pilot in North Rhondda, which invited people aged 60 to 74 who had ever smoked, scanned more than 600 people between September 2023 and 2025 and found twelve lung cancers, two thirds at stage 1 or 2; the national programme is due to launch in 2027","url":"https://performanceandimprovement.nhs.wales/functions/networks-and-planning/cancer/workstreams/lung-health-check/","date":"2026-09-25"},{"label":"Northern Ireland Department of Health: Cancer Strategy for Northern Ireland 2022 to 2032 (published 22 March 2022), whose lung screening section says the UK National Screening Committee is considering a targeted programme and that no pilot currently exists in Northern Ireland","url":"https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-cancer-strategy-march-2022.pdf","date":"2022-03-22"},{"label":"Northern Ireland Department of Health: Cancer Strategy for Northern Ireland progress report, March 2022 to March 2026, which says work to implement the screening committee's recommendations is under way but progress will depend on available funding and resources","url":"https://www.health-ni.gov.uk/sites/default/files/2026-07/Cancer%20Strategy%20for%20Northern%20Ireland%20Progress%20Report%20March%202022%20-%20March%202026.pdf","date":"2026-07"},{"label":"nidirect: health screening (seven Northern Ireland programmes, none of them lung)","url":"https://www.nidirect.gov.uk/articles/health-screening","date":"2025-11-25"}]},{"topic":"The national audit","england":"The National Lung Cancer Audit covers every NHS trust; the 2026 State of the Nation report, published February 2026, covers 39,409 people diagnosed in England in 2024, with trust-level results on a public dashboard.","scotland":"Not in the audit. Public Health Scotland publishes incidence, mortality, survival, staging and cancer waiting times separately, and is the only nation that publishes a lung-specific waiting-time split.","wales":"In the audit: 2,135 people in 2024. Welsh data quality is affected by an ongoing cancer informatics implementation; quarterly Welsh data are expected from 2027.","northernIreland":"Not in the audit. The Northern Ireland Cancer Registry publishes incidence, stage, survival, mortality and routes to diagnosis for lung cancer.","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"},{"label":"Public Health Scotland: cancer incidence in Scotland to December 2024 (published 18 August 2026): lung cancer rates down 23 percent in males and 7 percent in females over the decade","url":"https://publichealthscotland.scot/publications/cancer-incidence-in-scotland/","date":"2026-08-18"},{"label":"Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (published 30 June 2026)","url":"https://publichealthscotland.scot/publications/cancer-waiting-times/","date":"2026-06-30"},{"label":"Northern Ireland Cancer Registry (Queen's University Belfast): lung cancer data by tumour type","url":"https://www.qub.ac.uk/research-centres/nicr/cancer-information/cancer-data-by-tumour-type/lung-cancer/","date":"2026-09-25"}]},{"topic":"Thoracic surgery units","england":"26 NHS thoracic units performed lung cancer resections in 2024, doing 8,333 of the 8,559 operations counted in England and Wales. NHS England's service specification 170016/S asks every unit to do at least 150 a year and none to run a service below 70.","scotland":"Not counted by the audit. Thoracic surgery is concentrated in a small number of centres; no comparable published volume figures could be found.","wales":"Two units: Cardiff and Vale University Health Board (162 resections in 2024) and Swansea Bay University Health Board (64), the smallest unit in England and Wales.","northernIreland":"Not counted by the audit; thoracic surgery is centralised at the Belfast Health and Social Care Trust.","sources":[{"label":"National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-SotN-2026-Data-Tables.xlsx","date":"2026-02"},{"label":"NHS England: thoracic surgery (adults) service specification 170016/S (the volume rules: every unit to perform at least 150 lung cancer resections a year by 2018/19, and none below 70; 29 units in England, minimum three full-time thoracic surgeons and a catchment of around 1.5 million)","url":"https://www.england.nhs.uk/wp-content/uploads/2017/07/thoracic-surgery-service-specification.pdf","date":"2017-07"}]},{"topic":"Waiting-time standards","england":"28-day Faster Diagnosis Standard, 31 days from decision to treat and 62 days from referral to first treatment; the National Cancer Plan sets 80, 96 and 85 percent respectively by March 2029. For lung cancer the clinical standard is tighter: the National Optimal Lung Cancer Pathway asks for treatment within 49 days, and only 12 percent of surgical patients met it in 2024.","scotland":"31 days from decision to treat and 62 days from an urgent suspicion of cancer referral, both at 95 percent. In the quarter to March 2026 lung cancer achieved 98.4 percent at 31 days and 83.6 percent at 62 days, against all-cancer figures of 94.5 and 72.2 percent; board performance ranged from 67.7 percent in Greater Glasgow and Clyde to 94.1 percent in Lanarkshire.","wales":"A single suspected cancer pathway measured from the point of suspicion, with a 75 percent target at 62 days; 60.1 percent in July 2026 for all cancers. No lung-specific figure is published.","northernIreland":"31 days at 98 percent and 62 days at 95 percent. No lung-specific figure was obtainable.","sources":[{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways)","url":"https://rmpartners.nhs.uk/wp-content/uploads/2024/09/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf","date":"2024-01-01"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (published 17 September 2026): 60.1 percent of suspected cancer pathways started treatment within 62 days against a 75 percent target; no lung-specific figure is published","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},{"label":"National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival)","url":"https://www.natcan.org.uk/wp-content/uploads/2026/02/NLCA-State-of-the-Nation-Report-2026.pdf","date":"2026-02"}]},{"topic":"Who decides drug funding","england":"NICE technology appraisals, with the Cancer Drugs Fund for managed access; NHS England commissions and publishes the funded list with Blueteq forms. Version 1.408, of 24 September 2026, carries 43 routinely funded lung indications and four in the Cancer Drugs Fund.","scotland":"The Scottish Medicines Consortium, with the Patient and Clinician Engagement process for end of life and orphan equivalent medicines, and interim acceptance subject to reassessment where England would use managed access. It refuses six lung medicines England funds.","wales":"NICE appraisals apply; the All Wales Medicines Strategy Group appraises only what NICE has not, and for lung cancer that is almost nothing: 69 of 74 Welsh lung records are marked excluded from appraisal because NICE has appraised the medicine. No One Wales decision covers lung cancer.","northernIreland":"NICE appraisals are applied through the Department of Health.","sources":[{"label":"NHS England: national Cancer Drugs Fund list version 1.408, updated 24 September 2026, read in full (320 pages): four lung indications in the Cancer Drugs Fund section and 43 routinely funded lung indications in section B, each with its Blueteq form, appraisal reference and funding date","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"},{"label":"Scottish Medicines Consortium: medicines advice, keyword lung (108 results over six pages on the check date)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=lung","date":"2026-09-25"},{"label":"All Wales Therapeutics and Toxicology Centre: medicine recommendations (the keyword search and the results table are loaded by script and returned no rows to OnCo; the 74 lung-cancer records were enumerated from the site's own sitemap)","url":"https://awttc.nhs.wales/accessing-medicines/medicine-recommendations/","date":"2026-09-25"},{"label":"All Wales Therapeutics and Toxicology Centre: One Wales medicines, interim decisions (all 28 decisions read; none is for lung cancer)","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/one-wales-medicines-interim-decisions/","date":"2026-09-25"}]},{"topic":"Where the four nations actually differ on drugs","england":"Funds the three perioperative immunotherapy regimens (TA1127, TA1017, TA1030), serplulimab in extensive-stage small-cell disease (TA1167), encorafenib with binimetinib (TA1150), cemiplimab with chemotherapy (TA1165), dabrafenib with trametinib (TA898), first-line ceritinib (TA500) and previously treated selpercatinib (TA1042).","scotland":"Funds none of those nine. Against that it accepted adjuvant atezolizumab nearly three years before NICE, first-line lorlatinib three and a half years before, and first-line amivantamab with chemotherapy six months before, and it alone has a positive decision on oral vinorelbine (179/05, 2005), which NICE has never appraised.","wales":"Follows NICE, so funds everything England funds and nothing Scotland alone funds.","northernIreland":"Follows NICE.","sources":[{"label":"Scottish Medicines Consortium: medicines advice, keyword lung (108 results over six pages on the check date)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=lung","date":"2026-09-25"},{"label":"SMC2840: serplulimab with carboplatin and etoposide, untreated extensive-stage small-cell lung cancer, not recommended after a full submission with PACE (19 January 2026), where NICE recommended it in TA1167","url":"https://scottishmedicines.org.uk/medicines-advice/serplulimab-hetronifly-full-smc2840/","date":"2026-01-19"},{"label":"SMC2688: pembrolizumab, perioperative treatment of resectable non-small-cell lung cancer, not recommended (11 November 2024), where NICE recommended it in TA1017","url":"https://scottishmedicines.org.uk/medicines-advice/pembrolizumab-keytruda-full-smc2688/","date":"2024-11-11"},{"label":"SMC2677: durvalumab, perioperative treatment of resectable non-small-cell lung cancer, not recommended (9 December 2024), where NICE recommended it in TA1030","url":"https://scottishmedicines.org.uk/medicines-advice/durvalumab-imfinzi-full-smc2677/","date":"2024-12-09"},{"label":"SMC2874: nivolumab, perioperative treatment of resectable non-small-cell lung cancer, not recommended in the absence of a submission from the marketing authorisation holder (13 October 2025), where NICE recommended it in TA1127","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-nonsub-smc2874/","date":"2025-10-13"},{"label":"SMC2865: encorafenib with binimetinib, BRAF V600E advanced non-small-cell lung cancer, not recommended on non-submission (8 September 2025), where NICE recommended it in TA1150","url":"https://scottishmedicines.org.uk/medicines-advice/encorafenib-braftovi-nonsub-smc2865/","date":"2025-09-08"},{"label":"SMC2724: cemiplimab with platinum chemotherapy, untreated PD-L1-positive advanced non-small-cell lung cancer, not recommended on non-submission (7 October 2024), where NICE recommended it in TA1165","url":"https://scottishmedicines.org.uk/medicines-advice/cemiplimab-libtayo-non-sub-smc2724/","date":"2024-10-07"},{"label":"SMC 179/05: oral vinorelbine capsules, first-line stage 3 or 4 non-small-cell lung cancer, accepted for restricted use within NHS Scotland (13 June 2005); no NICE technology appraisal exists for this, so it is a Scotland-only positive decision","url":"https://scottishmedicines.org.uk/medicines-advice/vinorelbine-capsule-navelbine-oral-fullsubmission-17905/","date":"2005-06-13"},{"label":"SMC2492: atezolizumab, adjuvant treatment after complete resection of stage 2 to 3A non-small-cell lung cancer with PD-L1 of 50 percent or more, accepted (8 August 2022), nearly three years before NICE recommended it in TA1071","url":"https://scottishmedicines.org.uk/medicines-advice/atezolizumab-tecentriq-full-smc2492/","date":"2022-08-08"},{"label":"SMC2415: lorlatinib, ALK-positive advanced non-small-cell lung cancer not previously treated with an ALK inhibitor, accepted on an abbreviated submission (7 March 2022), three and a half years before NICE recommended it in TA1103","url":"https://scottishmedicines.org.uk/medicines-advice/lorlatinib-lorviqua-abb-smc2415/","date":"2022-03-07"}]},{"topic":"Cancer statistics","england":"The National Disease Registration Service publishes cancer registration statistics; its pages and download host answered HTTP 403 to OnCo, so England figures here come from Cancer Research UK, the National Lung Cancer Audit and an archived Public Health England survival release on GOV.UK.","scotland":"Public Health Scotland publishes incidence to 2024, mortality to 2024, survival to 2022 and staging, with deprivation breakdowns in downloadable workbooks: the most complete public lung cancer data of the four nations.","wales":"The Welsh Cancer Intelligence and Surveillance Unit publishes incidence and stage to 2022, mortality to 2025 and survival by stage to 2022.","northernIreland":"The Northern Ireland Cancer Registry at Queen's University Belfast publishes a lung cancer report covering 1993 to 2023 and a routes to diagnosis report for 2018 to 2022, with 94.7 percent stage completeness, the best of the four nations.","sources":[{"label":"GOV.UK: cancer survival in England, cancers diagnosed 2016 to 2020 (NHS Digital, 16 February 2023); the release itself lives on digital.nhs.uk, which answered HTTP 403 to OnCo","url":"https://www.gov.uk/government/statistics/cancer-survival-in-england-2020","date":"2023-02-16"},{"label":"Cancer Research UK: lung cancer statistics (key stats, early diagnosis and routes by nation, treatment shares)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer","date":"2026-09-25"},{"label":"Public Health Scotland: cancer incidence in Scotland to December 2024 (published 18 August 2026): lung cancer rates down 23 percent in males and 7 percent in females over the decade","url":"https://publichealthscotland.scot/publications/cancer-incidence-in-scotland/","date":"2026-08-18"},{"label":"Public Health Wales, Welsh Cancer Intelligence and Surveillance Unit: cancer incidence in Wales (published 23 October 2025): the lung cancer incidence rate was 2.3 times higher in the most deprived fifth of areas than the least in 2022","url":"https://phw.nhs.wales/reports/cancer-incidence-in-wales/","date":"2025-10-23"},{"label":"Northern Ireland Cancer Registry 2026: lung cancer 1993 to 2023 (1,369 cases a year 2019 to 2023; 94.7 percent staged; incidence 62.1 percent above the Northern Ireland average in the most deprived areas and 33.6 percent below it in the least)","url":"https://www.qub.ac.uk/research-centres/nicr/file-store/OfficialStats1993-2023/Lung%20cancer%20report.pdf","date":"2026"}]},{"topic":"Genomic testing route","england":"Comprehensive next-generation sequencing through seven Genomic Laboratory Hubs, requested reflexly; circulating tumour DNA testing for non-small-cell lung cancer was added to the National Genomic Test Directory in May 2025. The directory pages answered HTTP 202, so no test codes are quoted here.","scotland":"The Scottish Genomic Test Directory, through four regional laboratories.","wales":"The All Wales Medical Genomics Service. Wales is the only nation with published lung genomic testing rates, from the audit's own analysis of the new Welsh cancer information system: 745 of 1,546 patients, or 48 percent, had at least one recorded result. QuicDNA put liquid biopsy into the routine pathway across all six health boards.","northernIreland":"The Northern Ireland Regional Genetics Centre in Belfast.","sources":[{"label":"GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer","url":"https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version","date":"2026-02-04"},{"label":"NLCA blog: what do we know about genomic testing in lung cancer in Wales? (Lauren Dixon for the NLCA project team, 23 June 2026): 745 of 1,546 Welsh patients with a record in the new system had at least one genomic test result","url":"https://www.natcan.org.uk/news/nlca-blog-what-do-we-know-about-genomic-testing-in-lung-cancer-in-wales/","date":"2026-06-23"},{"label":"ISRCTN22734699: QuicDNA, liquid biopsy folded into the routine lung cancer diagnostic pathway across all six Welsh health boards (Aneurin Bevan University Health Board with Health and Care Research Wales; 763 enrolled)","url":"https://www.isrctn.com/ISRCTN22734699","date":"2026-09-25"},{"label":"NICE NG122: update information (February 2026 amended recommendation 1.2.12 from single-mutation testing to comprehensive next-generation sequencing panels through genomic laboratory hubs, and added links to the technology appraisals; March 2024 removed the mobocertinib pathways after that guidance was withdrawn)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Update-information","date":"2026-02"}]},{"topic":"Prescription charges","england":"9.90 pounds an item unless exempt; anyone being treated for cancer or its effects gets a five-year medical exemption certificate, and everyone over 60 is exempt, which covers most people with lung cancer given a median age at diagnosis of 74.","scotland":"Free for everyone; no certificate needed.","wales":"Free for anyone registered with a Welsh GP.","northernIreland":"Free: all prescriptions dispensed in Northern Ireland are free of charge.","sources":[{"label":"NHS: prescription charges (9.90 pounds per item in England)","url":"https://www.nhs.uk/nhs-services/prescriptions/nhs-prescription-charges/","date":"2026-09-25"},{"label":"NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment)","url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","date":"2026-09-25"},{"label":"NHS inform: prescription charges and exemptions (prescriptions in Scotland are free)","url":"https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","date":"2026-09-25"},{"label":"Welsh Government: free prescriptions","url":"https://www.gov.wales/free-prescriptions","date":"2026-09-25"},{"label":"nidirect: help with health costs (all prescriptions dispensed in Northern Ireland are free of charge)","url":"https://www.nidirect.gov.uk/articles/help-health-costs","date":"2026-09-25"}]},{"topic":"Benefits under the special rules for end of life","england":"Personal Independence Payment under State Pension age or Attendance Allowance over it, fast-tracked at the higher rate with no assessment when a clinician says 12 months or less, using the SR1 form.","scotland":"Adult Disability Payment and Pension Age Disability Payment replace them, with equivalent fast-track rules.","wales":"As England.","northernIreland":"As England, administered by the Department for Communities.","sources":[{"label":"GOV.UK: get benefits if you are nearing the end of life (special rules)","url":"https://www.gov.uk/benefits-end-of-life","date":"2026-09-25"},{"label":"DWP: the special rules, how the benefit system supports people nearing the end of life (the SR1 form, for clinicians)","url":"https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","date":"2026-09-25"},{"label":"GOV.UK: Personal Independence Payment","url":"https://www.gov.uk/pip","date":"2026-09-25"},{"label":"nidirect: benefits if you are nearing the end of life","url":"https://www.nidirect.gov.uk/articles/benefits-if-you-are-nearing-end-life","date":"2026-09-25"}]}],"gaps":["Every HTML page on england.nhs.uk answers HTTP 202 with an empty Amazon Web Services firewall challenge body to automated readers: the National Genomic Test Directory page, the Cancer Drugs Fund list page, the cancer waiting times pages, the lung screening protocol page and the thoracic surgery service specification page. The files those pages link to, under wp-content/uploads, do resolve, and so does the site's content interface, which is how the current filenames were found: every guessed filename in the older Cancer Drugs Fund version-1.NNN pattern answered 404, and the live file is version 1.408. So the content on this page is sound but no england.nhs.uk web page could be read directly, and a reader following one of those links in a script will see nothing.","Wales publishes no lung-specific waiting-time figure. Its suspected cancer pathway data are reported for all cancers together in the monthly NHS activity and performance summary; the site-level and tumour-site data sit on StatsWales, whose catalogue pages answered HTTP 200 with navigation chrome and no data and whose comma-separated download address answered 404, and the underlying publisher, Digital Health and Care Wales, is not a public UK health domain this page cites. Northern Ireland publishes no 28-day faster diagnosis standard, and its 62-day figures are tumour-site aggregated; its lung split exists only for the 31-day standard.","NDRS cancer registration statistics for England are unreachable. Every digital.nhs.uk address, including files.digital.nhs.uk, answered HTTP 403 with a Cloudflare challenge to a default client, to a Chrome user agent over HTTP/2 and to a Googlebot user agent. The GOV.UK landing pages for Cancer Survival in England 2016 to 2020 and Routes to Diagnosis 2018 exist but carry no attachments, only links back to the blocked host. The England survival-by-stage figures on this page therefore come from the archived 2014 to 2018 Public Health England release, whose data tables are on assets.publishing.service.gov.uk and do resolve.","Cancer Research UK has rebuilt its statistics section and moved most breakdowns, including lung incidence by deprivation quintile, into JavaScript data hubs on a separate analytics host; the old deprivation sub-pages now answer 404. The deprivation figures quoted here are the ones CRUK still prints in the served HTML (the mortality rate ratios, the deaths linked with deprivation, and the five-year survival split), plus the four national registries' own workbooks. CRUK's Cancer in the UK 2025 deprivation report, which carries the England incidence rates of 128 against 48 per 100,000, is served from CRUK's content delivery network rather than from cancerresearchuk.org, so it is named rather than cited as a source row.","The National Lung Cancer Audit publishes no biomarker testing rates for England. A full-text search of the 2026 State of the Nation report for EGFR, ALK, ROS1, PD-L1, molecular, genomic and biomarker returns a single hit, in a recommendation asking trusts to ensure molecular pathology capacity. The only NLCA biomarker data anywhere is a blog about Wales. There is therefore no published figure for what proportion of English lung cancer patients receive the reflex testing NG122 requires, which is the largest single evidence gap on this page.","GIRFT began answering HTTP 403 to page requests part-way through the check: its site search, its lung cancer workstream page and its workstreams index all refused, though the reports index and the report PDFs themselves resolved. The lung cancer national specialty report quoted here is dated October 2021 and is the most recent GIRFT lung output; there is no GIRFT lung cancer best practice timed pathway, and the timed standard both GIRFT and the audit use is NHS England's National Optimal Lung Cancer Pathway, version 4.0 of 1 January 2024.","Two of the most important British lung cancer studies have no ISRCTN record and so cannot be linked to a UK registry: TRACERx, which is NCT01888601, and SUMMIT, which is NCT03934866. Searches of the ISRCTN API for both returned zero records, as did a search for SARON. Their rows link to the NIHR Be Part of Research search instead, and their results come from the published papers. ISRCTN record pages themselves answer HTTP 200 but serve a JavaScript cookie challenge, so every trial on this page was read through the registry's public API.","Eight UK lung cancer researchers whose role is documented on a trial record or a published paper have no public professional page that could be read, so they have no record here: Mariam Jamal-Hanjani, Sam Janes and Neal Navani (ucl.ac.uk answered 403, uclh.nhs.uk answered 403 and the UCL profiles site renders in the browser only), Michael Davidson, Robert Rintoul (four addresses tried, two 404s and two pages without the name), Yvonne Summers, Judith Cave and Anna Bibby. Charles Swanton's UCL Cancer Institute profile also answered 403; his record cites the Francis Crick Institute page instead. Matthew Callister has no reachable University of Leeds page, so the Leeds Teaching Hospitals consultant directory is cited.","Roy Castle Lung Cancer Foundation's own contacts page is the only readable source here for the UK Lung Cancer Coalition, Asthma and Lung UK, ALK Positive UK, EGFR Positive UK and Lung Cancer Nursing UK; none of their own sites is a public UK health, government or university domain of the kind this page cites, so none is quoted directly and none has a support row.","The research funding figure on this page, that lung cancer caused 26 percent of UK cancer deaths while receiving 6 percent of cancer research funding, comes from 2010 National Cancer Research Institute data published in 2015. No more recent UK-wide funding-against-burden comparison could be found on a public UK domain. Roy Castle's current campaign statements make the same argument but carry no percentage.","health-ni.gov.uk serves its pages through a Varnish caching layer that answers HTTP 403 to some requests and HTTP 200 to others, apparently at random. The Northern Ireland cancer strategy, its progress report and the revised cancer waiting times release quoted here were all read, but a reader following those links in a script may get nothing. The Scottish Government's site behaved the same way under repeated requests, answering 200 and then 202 for the same address.","Blackpool Teaching Hospitals NHS Foundation Trust performed 261 lung cancer resections in 2024 and belongs in the centres list, but its website did not respond to any request during the check, so it is named in the centres note rather than given a card. NHS Grampian's site also failed to respond, so Aberdeen Royal Infirmary, the third Scottish cardiothoracic centre, is named in the note rather than given a card, and the Golden Jubilee National Hospital, which does the most cardiothoracic work in Scotland, is on a domain this page does not cite, so it too appears only in the note.","No NHS England document names the thoracic surgery centres. Service specification 170016/S sets the volume rules and says there were 29 units in England when it was written, but it lists none of them, and it has not been refreshed since July 2017. The centre cards here are therefore built from the National Lung Cancer Audit's 2024 resection counts, which name every English and Welsh unit, cross-checked against each trust's own service page where one exists. Three trusts with audit resection counts have no readable thoracic surgery page of their own: University Hospitals Coventry and Warwickshire describes its centre as cardiac, University Hospital Southampton's site is rendered in the browser only, and University Hospitals Bristol and Weston has no thoracic page. Cardiff and Vale University Health Board's own service directory lists no cardiothoracic or thoracic surgery service at all, although the audit records 162 resections against it, so its card names the health board rather than a hospital.","There is no published national statistic for how long genomic testing takes. The National Genomic Test Directory has no turnaround column, and NHS England's genomic testing activity release says only activity data has been published and that waiting-time data is planned for a future publication. The 46 percent and 38 percent figures quoted on this page are from the 2019 GIRFT and audit organisational survey and the 18-day median is from the audit's 2020 spotlight on people diagnosed in 2017; nothing newer exists.","The version of the National Optimal Lung Cancer Pathway cited here, version 4.0 of 1 January 2024, is hosted by a cancer alliance rather than by NHS England, which publishes no copy of its own that could be read. NHS England's own timed lung cancer diagnostic pathway, which does resolve through its content interface, carries the day-by-day audit tool and the multidisciplinary team membership but not the 49-day treatment 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