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Living with cancer· Appointment prep

Appointment sheet: Unresectable stage III non-small-cell lung cancer

One page to bring and write on: your details, the questions for Unresectable stage III non-small-cell lung cancer plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

Unresectable stage III non-small-cell lung cancer

Prepared with OnCo (onco.cc/prep/stage-iii-unresectable-nsclc/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

18 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example TNM stage by PET-CT, brain MRI and mediastinal sampling, EGFR mutation status, PD-L1 expression, Pulmonary function and radiation dose to lung and heart, Circulating tumour DNA after chemoradiation), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Unresectable stage III, fit, no EGFR mutation
  1. 5.For my situation (unresectable stage iii, fit, no egfr mutation), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Durvalumab, Cisplatin, Carboplatin or related drugs, and what side effects should I expect?
  3. 7.How do the results of PACIFIC apply to someone like me?
Unresectable stage III, EGFR-mutated
  1. 8.For my situation (unresectable stage iii, egfr-mutated), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Osimertinib, and what side effects should I expect?
  3. 10.How do the results of LAURA apply to someone like me?
Unfit for concurrent treatment
  1. 11.For my situation (unfit for concurrent treatment), which of the standard options do you recommend and why?
  2. 12.Am I a candidate for Durvalumab, Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?
Toxicity
  1. 13.For my situation (toxicity), which of the standard options do you recommend and why?
Any stage
  1. 14.Are there clinical trials I could join, for example of Study of Pembrolizumab With Concurrent Chemoradiation Therapy Followed by Pembrolizumab With or Without Olaparib in Stage III Non-Small Cell Lung Cancer (NSCLC) (MK-7339-012/KEYLYNK-012), Proton therapy, Pencil-beam scanning and intensity-modulated proton therapy, LAURA?
  2. 15.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 16.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 17.I read that “Pneumonitis from radiotherapy followed by immunotherapy limits treatment in patients with poor lung function”. How does that affect my plan?
  5. 18.I read that “Whether ALK, RET, ROS1 or other driver subtypes should receive targeted rather than immune consolidation is untested”. How does that affect my plan?

The words I may hear

  • Stage: How far a cancer has spread, from stage I (small and confined) to stage IV (spread to distant organs).
  • TNM staging: TNM staging is the universal system describing tumour size (T), lymph node spread (N), and distant metastasis (M).
  • Mediastinum: The space in the middle of the chest between the two lungs, containing the heart, great vessels, windpipe, food pipe and the lymph nodes that lung cancer spreads to first.
  • Interstitial lung disease (ILD) / pneumonitis: Interstitial lung disease (ILD) is lung inflammation, a serious side effect of some ADCs (especially Enhertu) and immunotherapy.
  • Radiation pneumonitis and lung fibrosis: Inflammation of the lung one to six months after chest radiotherapy, causing cough, breathlessness and fever; usually settles with steroids but can leave permanent scarring.
  • Consolidation therapy: Treatment given after a good response to kill the cancer cells that are presumably left but cannot be seen, to make the remission last.
  • Circulating tumour DNA (ctDNA): Circulating tumour DNA (ctDNA) consists of fragments of DNA shed by tumour cells into the blood, detectable with sensitive sequencing.
  • Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.

Tests and results to bring

Biomarker results to ask for: TNM stage by PET-CT, brain MRI and mediastinal sampling, EGFR mutation status (osimertinib consolidation instead of durvalumab), PD-L1 expression (durvalumab licensed for PD-L1 of 1 percent or more in Europe, regardless of PD-L1 in the United States), Pulmonary function and radiation dose to lung and heart, Circulating tumour DNA after chemoradiation (under study).

Scans and tests linked to this cancer: PET/CT, MRD / molecular residual disease testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call