Virtual Library

Background:
Stereotactic body radiotherapy (SBRT) for NSCLC patients with T1-T2 tumors has been intensively studied the last decades and is widely used due to excellent results in terms of local control and survival in combination with the convenient and fast treatment procedure. This radiation technique has however never been compared to standard radiotherapy in a randomized manner, and consequently the Swedish lung cancer study group launched the SPACE study in 2007 (Stereotactic Precision And Conventional radiotherapy Evaluation).

Methods:
Patients with stage I medically inoperable histologically confirmed NSCLC or PET-positive tumors with progression (non-centrally located with a maximum size < 5 cm) were randomized in 9 Scandinavian centers to receive SBRT to 66 Gy in 3 fractions in one week or conventionally fractionated 3DCRT to 70 Gy in 7 weeks. Patients were followed with regard to treatment efficacy, toxicity and HRQL.

Results:
Between January 2007 and July 2011 102 patients were randomized (49 SBRT, 53 3DCRT). Mean age 74 (57-86), 60% women and the vast majority (92%) had COPD or cardiovascular comorbidity. The mean FEV1 and mean CO-diffusion capacity were 1.4 L and 55% respectively. Seventy-four percent had a histopathologic diagnose where the majority were adenocarcinomas and 65% had T1 tumors and 35% T2. The two treatment groups differed somewhat in terms of tumor size and gender where the SBRT arm included more patients with T2 tumors and of male gender. The median follow-up is 37 months with a 1- 2- and 3 year PFS of: SBRT: 89%, 70%, 62% and 3DCRT: 88%, 66% 58% with no difference between the groups and no difference regarding OS. At the end of study 72% were without progression among the SBRT patients compared to 59% in the conventional arm. Toxicity was generally low, grade ≥ 3 of any toxicity was observed in 19% in SBRT patients and 15% in the 3DCRT group with no grade 5 toxicities. Pneumonitis of any grade was observed in 19% (SBRT) and 36% (3DCRT), and any grade esophagitis in 8% and 30% respectively. HRQL was evaluated with the EORTC QLQ 30 and LC14 module and patients treated with 3DCRT experienced worse dyspnea, cough and chest pain compared to the SBRT patients.

Conclusion:
NSCLC stage I patients treated with SBRT had the same PFS and OS as the conventionally treated patients despite an imbalance of prognostic factors with regards to more T2 tumors and males in the SBRT group. There was a tendency to improved disease control rate in the SBRT patients and in addition they experienced higher QoL values regarding dyspnea, cough and chest pain. SBRT should be considered standard therapy for this patient group.

Background:
Limited data are available on the use of SBRT for tumors larger than 3cm. We analyzed results from a collaborative database to compare clinical outcomes for patients with tumors > 3cm to those with smaller tumors (<3cm).

Methods:
1192 patients with 1288 T1-T3N0M0 tumors underwent cone-beam CT image-guided lung SBRT between 10/2004-12/2014. The median prescription dose was 50 Gy in 3 fractions (range 24-64 Gy in 1-10) to the PTV. Patient, tumor and treatment factors and clinical outcomes were extracted from the database. Local recurrence (LR), regional recurrence (RR), distant metastasis (DM), overall (OS) and cause-specific survival (CSS) were calculated from SBRT completion using the Kaplan-Meier method. Univariate analyses were performed using the Cox proportional hazards model. Student’s unpaired t-test and Pearson chi-square/Fisher’s Exact test were used to compare continuous and categorical variables between groups, respectively.

Results:
Mean follow-up time was 2.1y (0.02-10.12y) and similar for both groups. 295 tumors were > 3cm (T2) and 993 < 3cm (T1) (mean size 3.98 v 1.91cm (0.5-9.6cm), p<0.001). There were no statistically significant differences between groups for gender, pulmonary function (median FEV1 1.7 L (56-60% predicted); DLCO 10 ml/min/mmHg (50-51% predicted), medical inoperability (89%), PET (94%) or any invasive mediastinal staging (6%). T1 patients were slightly younger (73.5y T1 v 76.0y T2, p<0.01) and had mildly better ECOG (80% 0-1 T1 v 71% 0-1 T2, p=0.001). T2 tumors were more often biopsied (74% T2 v 63% T1, p<0.001), less often non-squamous (74% v 83%, p=0.002), had higher SUVmax (10.3 T2 v 6.4 T1, p<0.001), more often central (0236) (19% T2 v 11% T1, p=0.001) and treated to a median prescription dose of 53.8Gy T2 v 52.2Gy T1, p<0.001. 3% received chemotherapy (T1 2.6% v T2 4.4%, p=0.11). Although LR was similar between groups, large tumors had a higher risk of RR, DM and death (Table 1). On univariate analysis, LR was predicted by multiple BED parameters (p<0.001), baseline SUVmax (p=0.003) and squamous histology (p=0.012); RR was higher for lower lobe tumors (p=0.008); DM (p=0.006) was higher while OS and CSS lower for central tumors (p=0.03, 0.01).

Clinical Outcome		Tumor < 3 cm	Tumor > 3 cm	p-value
Local recurrence	3y	7%	11%	0.13
	5y	11%	13%
Regional Recurrence	3y	9%	13%	0.006
	5y	11%	24%
Distant Metastasis	3y	11%	16%	<0.001
	5y	16%	18%
Cause-Specific Survival	3y	88%	73%	<0.001
	5y	81%	66%
Overall Survival	3y	61%	45%	<0.001
	5y	42%	28%

Conclusion:
Large tumors had a higher risk of RR, DM and death after SBRT. These data have implications for consideration and study of pre-SBRT invasive nodal staging and/or systemic therapy in this population. OS and CSS were lower for central tumors warranting further analysis.

Background:
The safety of SBRT for medically inoperable patients with centrally located early stage non-small cell lung cancer (NSCLC) was evaluated in this phase I/II multicenter RTOG study that completed accrual in Sept 2013. This is the first report of adverse events (AE) observed on the study.

Methods:
Eligible patients were medically inoperable with biopsy proven, PET staged T1-2N0M0 NSCLC, ≤ 5 cm in size, centrally located tumors (within or touching the zone of the proximal bronchial tree or adjacent to mediastinal or pericardial pleura). Patients were successively accrued onto dose-escalating 5 fraction SBRT schedules delivered over 1.5-2 weeks, starting with 10 Gy per fraction (fr), then 10.5Gy/fr, 11 Gy/fr, 11.5 Gy/fr and 12 Gy /fr. Toxicity was graded using CTCAE v4.0; any potential dose-limiting toxicity within the initial 365 days post SBRT could have led to dose reduction for subsequent patients accrued, using TITE-CRM (time-to-event continual reassessment method) statistical design.

Results:
120 patients (100 evaluable) from 43 centers were accrued between 2/2009 and 9/2013. 12 were excluded as they did not receive protocol treatment (6 of these on the 12Gy/fr cohort) and another 8 did not meet eligibility criteria. Cohort sizes were 8 (10Gy/fr), 8 (10.5Gy/fr), 18 (11Gy/fr), 43 (11.5Gy/fr), and 43 pts (12Gy/fr). Median age was 72 (range 52- 89) years, 57% were female, 45% had squamous cell carcinoma, 39% had adenocarcinoma, 65% had T1 tumors. Median follow up was 26.6 months. Most adverse events were grade (G) 1 or 2. 5/8 pts in lowest SBRT dose cohort (10 Gy/fr) experienced G2 toxicity, none had G>3. Of 7 pts in 10.5 Gy/fr, 1 had G2 and 1 had G5 toxicity. Of 14 pts in 11 Gy/fr cohort, 4 had G2 and 1 had G3. Of 38 pts in 11.5Gy/fr cohort, 11 had G2, 4 had G3 and 2 had G5. Of 33 pts in 12Gy/fr, 4 had G2, 5 had G3, 1 G4 and 1Gr 5 as the worst overall toxicity definitely, probably or possibly related to SBRT. All Gr 5 toxicities were due to hemoptysis, occuring at a mean of 13 mo post SBRT (range 5.5-14mo). G2+ GI toxicity only occurred in the 11.5Gy/fr (1/38) and 12.0Gy/fr (2/33) cohorts. G2+ pulmonary toxicity occurred in 4/8 10.0Gy/fr, 0/8 10.5Gy/fr, 5/14 11.0Gy/fr, 15/38 11.5Gy/fr, and 10/33 12.0Gy/fr pts.

Conclusion:
This phase I/II trial of SBRT provides data to inform patients of the potential toxicities with a 5 fraction SBRT schedule for centrally located NSCLC. Although SBRT was well tolerated, 4/100 pts (4%) had fatal hemoptysis potentially attributable to SBRT. Determination of the optimal SBRT dose needs to await analysis of tumor locations, DVH data and efficacy data. This project was supported by grants U10CA21661, U10CA180868, U10CA180822 and U10CA37422 from the National Cancer Institute (NCI).

Abstract not provided

Background:
In Japan, stereotactic body radiotherapy (SBRT) has been actively used as a curative treatment option for patients with early stage primary lung cancer. We organized a multi-institutional SBRT study group in Japanese Radiological Society (JRS-SBRTSG) and conducted retrospective study of SBRT for stage I non-small cell lung cancer (NSCLC).. The purpose of this study was to evaluate the treatment outcomes of SBRT for medically operable patients with stage I NSCLC of JRS-SBRTSG.

Methods:
This is a retrospective analysis to review 661 patients (median age, 75 years; male 424, female 237) with stage I (IA 506, IB 155) NSCLC treated in 20 institutions of JRS-SBRTSG. Histology was proven in 486 patients (adenocarcinoma 328, squamous cell carcinoma 117, others 41). A total dose of 32 -70 Gy mainly at the isocenter was prescribed in 4-15fractions. The median calculated biological effective dose (BED) was 107 Gy (range, 64-150 Gy) based on alpha/beta = 10Gy)

Results:
The median follow-up period for all patients was 35 months. Pulmonary complications of NCI-CTC criteria grade > 3 and grade 5 were noted in 1.9% and 0.4% of total patients, respectively. Overall survival rate (OS) at three year (OS-3y) and disease-specific survival rate at three year of total patients was 79% and 89%, respectively. Locally progression free rate at three year was better for T1 (89%) than T2 (80%) but OS-3y was not different in the two subgroups. OS-3y of female patients was much better (93%) than for male patients (72%) (P<0.01). OS-3y was better for BED ³100 Gy subgroup (80%) than BED<100 Gy subgroup (70%). OS-3y of patients accompanying pulmonary interstitial change (n=54) was much worse (42%) than the others. According to multivariate analysis, only of male and presence of pulmonary interstitial change were worse survival factor.

Conclusion:
The outcomes of SBRT for medically operable patients with stage I NSCLC in Japanese multi-institutional large database were retrospectively analyzed. The local progression-free rate and OS were similar to those of JCOG (Japan Clinical Oncology Group) 0403; a prospective phase II study of SBRT (48 Gy in 4 fractions) for stage IA NSCLC, and the OS was almost comparable to that of surgery for high-aged patients. The subgroup of male and presence of pulmonary interstitial change were worse survival factors. SBRT might be promising as an alternative to surgery for operable stage I NSCLC

Background:
For NSCLC patients treated with SBRT, we investigated if tumor location is associated with recurrence pattern and overall survival.

Methods:
From 2006-2013 1129 patients with early stage NSCLC were treated with cone beam CT guided SBRT (median 54 Gy in 3 fractions, range 23-64 Gy in 1-10 fractions) in 5 different institutes. 719 patients were analyzed after exclusion of patients with (meta)synchronous tumors (n=185), incomplete scanning data or incomplete follow-up (n=225). An average anatomy was constructed based on 109 patients of the 5 institutes using deformable image registration[1]. Subsequently, all patients were registered to this average anatomy and the corresponding dose distribution was deformed accordingly. Tumor location was defined as a 3D Gaussian distribution (standard deviation 2 cm) at the center of the high dose region. These Gaussian distributions were added to a total and per voxel a mean and standard deviation was determined. Totals were obtained for 5 different groups: local recurrence, regional recurrence, distant metastasis, all recurrent disease combined, deceased as well as their complements. By comparing 2 complimentary groups using Welch’s t-test, locations that were significantly associated (p<0.01) with recurrent disease or with overall survival were identified. Recurrent disease rates and overall survival were calculated using the Kaplan-Meier method.

Results:
With a median follow-up of 19 months, local recurrence occurred in 5% of patients, regional recurrence in 5% and distant metastasis in 9%. 74% of patients were alive and 18% was lost to follow-up. Tumors located medially in the left upper lobe were significantly associated with controlled disease (local, regional, distant and all combined). Figure 1A displays as heatmap: disease control (green), recurrent disease (purple), and the region where the two groups differ significantly (yellow). Tumors located peripherally in the left lower lobe were significantly associated with regional recurrences. Tumors located medially/centrally in the right upper lobe were significantly associated with distant metastases and all recurrent disease combined (local, regional and distant together). Tumors located medially/centrally in the right upper lobe were significantly associated with a decreased overall survival (Figure 1B). Figure 1



Conclusion:
In this group of 719 NSCLC patients treated with SBRT, an average anatomy was utilized to analyze associations of tumor location with treatment outcome. Several regions were identified that were significantly associated with disease recurrence and overall survival. Further investigations in the underlying mechanisms of these associations are warrented. 1.ADMIRE Research 2015, Elekta AB, Stockholm, Sweden

Background:
While stereotactic body radiotherapy (SBRT) for early stage non-small cell lung cancer (NSCLC) results in excellent local control, distant metastases (DM) remain the most prevalent form of failure. In this analysis, we develop and internally validate a nomogram to predict DM following SBRT for NSCLC.

Methods:
We queried our institutional registry of patients treated with lung SBRT over the past decade (2003-2014) and identified 729 patients with early stage NSCLC eligible for analysis. All patients were treated with definitive intent. Initial patient and tumor variables predicting the likelihood of developing distant metastases were identified from a multivariable Cox proportional hazard model. A nomogram was developed from the initial model using 16 candidate variables and was reduced to the find the best fitting parsimonious model. The nomogram was then internally validated using a 1000 bootstrap resampling process. Accuracy of the nomogram was measured using c-statistics.

Results:
The median follow up was 15.2 months. 157 patients (22%) developed DM at a median time of 10.3 (range 0.2-68.4) months. The median time to death after development of DM was 4.5 months. Sites of DM included lung (113/157 patients), bone (36/157 patients), liver (27/157 patients), brain (25/157 patients), adrenal (8/157 patients), and other (7/157 patients). Age at start of radiotherapy (p = 0.051), tumor size (p = 0.009), PET SUV (p = 0.026), and the presence of synchronous primaries (p = 0.048) were all predictive of DM on multivariable analysis. Using seven patient and tumor variables (Age, BMI, Charlson Comorbidity Index, Tumor Size, PET SUV, Medical Operability, and Presence of a synchronous primary NSCLC), our nomogram successfully predicted distant metastasis and has an internally validated c-statistic of 0.606 (95% CI: 0.563, 0.648). Internal validation with bootstrapping demonstrated persistent validity of the nomogram in predicting distant metastases. Figure 1



Conclusion:
This novel internally validated nomogram can predict the risk of distant metastases in early stage NSCLC treated with SBRT. External validation of this nomogram is warranted. This nomogram may help define subgroups for stratification in future clinical trials and identify patients who may benefit from adjuvant systemic therapies following lung SBRT.

Abstract not provided

Background:
On behalf of the Thoracic Surgery Group, National Lung Cancer Forum for Nurses The Thoracic Surgery Group is a sub-group of the National Lung Cancer forum for Nurses with a membership of thoracic nurse specialists, lung cancer nurse specialists, research nurses and allied health professional. The objective of the group is to develop links to other health professionals working within the specialism of thoracic surgery to enhance the care and support of patients undergoing surgical procedures for suspected or confirmed thoracic malignancies. The group has previously produced guidelines on supporting patients having lung resection surgery and telephone follow-up following thoracic surgery. Enhanced recovery is an approach to the care of patients undergoing surgery that aims to ensure that patients are in the best possible condition for surgery, have the best possible management during and after their operation, and experience the best post-operative rehabilitation. Patients on enhanced recovery programs are partners in their care pathways. This guideline has been developed, by a multi-professional group, to provide guidance to healthcare professionals involved in providing patient information on enhanced recovery programs.

Methods:
Following a literature review and review of practice in UK thoracic surgery centers the group have developed this guidance on the information required by patients undertaking an enhanced recovery program. Guidance is provided about: Thoracic surgery enhanced recovery program information Written patient information Verbal patient information Information about the enhanced recovery pathway Information about thoracic surgery Patient diary Quality assurance and patient information

Results:
Central to the enhanced recovery concept is the involvement, empowerment and partnership with the patient. Evidence shows that patients participating in enhanced recovery programs have fewer post-operative complications and reduced rates of readmission. To increase understanding of the enhanced recovery pathway it is vital that patients are provided with relevant information. The aim of this guideline is to support the provision of patient information regarding enhanced recovery programs so that patients are in partnership with healthcare professionals thereby improving patient experience and clinical outcomes. This guideline is based on evidence available and identified best practice in UK thoracic surgical centers.

Conclusion:
The guideline is relevant to all thoracic surgery centers that are running or wish to set up an enhanced recovery program, it could also be adapted for other surgical specialties. This guideline is a series of broad statements and where necessary local procedures should be developed to complement the guideline in each clinical area. This document compliments the ‘Guideline for Telephone Follow-up for Patients Undergoing Thoracic Surgery’ and the ‘Guideline to Prepare and Support Patients Undergoing Lung Resection’ also produced by the Thoracic Surgical Group. All of the guidance produce by the group are available on the National Lung Cancer Forum for Nurses (NLCFN) website

Background:
Lung cancer nurse specialists (LCNS) are an integral part of the multidisciplinary team, supporting, managing and coordinating of care for people with lung cancer. In the UK the National Institute of Health and Care Excellence (NICE) recommends that all patients have access to a LCNS in a trust, but recent National Lung Cancer Audit (NLCA) reports show that LCNS access varies across England. The aim of this study was to examine how access to a LCNS varies by patient and National Health Service (NHS) trust characteristics.

Methods:
We used data on all lung cancer patients in the NLCA first presenting to 150 English NHS trusts between January 1[st] 2007 and December 31[st] 2011. NHS trusts are health care organisations typically 1-3 hospitals collectively covering regional catchment populations. The NLCA collects key clinical information, including LCNS assessment on all individuals with a diagnosis of lung cancer presenting to NHS trusts. Data from 146/150 trusts were successfully linked with the National Cancer Action Team (NCAT) census of the LCNS workforce (number, salary grades) for 2011. Multinomial logistic regression was used to calculate the likelihood of being assessed by a LCNS by patients clinical and LCNS workforce at each trust.

Results:
Across 146 NHS trusts there were128,124 patients and 321 LCNSs. LCNS assessment records showed80,113 (62%) patients were assessed, 7,544 (6%) were not assessed, and 40,467 (32%) had missing information on assessment. Missing assessment information was random and not biased to certain types of patients or trust and data completeness increased over the years. Patients (>75 years old), those with poor performance status (i.e. PS 4) and those with comorbidities were less likely to be assessed (adjusted relative risk ratios (RRR) (95% confidence interval) 0.84 (0.75 – 0.93), 0.34 (0.24 – 0.47) & 0.71 (0.63 – 0.79) respectively). There was no difference in assessment rates by socioeconomic groups. Patients who received anti-cancer treatment (surgery, chemotherapy with radiotherapy or chemotherapy alone) were over twice likely to have been assessed by a LCNS compared with those who did not receive treatment 2.09 (1.75 – 2.50), 3.96 (3.11 – 5.04) & 3.45(2.71 – 4.38). Annual LCNS patient caseload did not appear to impact access, but there was an association between assessment and a higher salary grade of the LCNS workforce in a trust (RRR 1.59 (0.86 – 2.92) for trusts with LCNS salary band 7 & 8).

Conclusion:
We found variations in access to LCNSs by both patient and trust a feature, which indicates an unmet need for people with lung cancer in England. To meet the needs of all people with lung cancer and the clear targets set out by NICE, we need to expand the current LCNS workforce and ensure that we retain experienced nurses as LCNS are an integral part of the lung cancer team and provide help to people with lung cancer.

Background:
Patients with lung cancer often experience severe physical and psychological symptoms, such as decreased exercise capacity, muscle weakness, compromised health-related quality of life (HRQOL) and increased anxiety and depression levels, as a direct consequence of the disease or the antineoplastic therapy. The main concern of patients with lung cancer is the fear of losing independence and not being able to perform daily activities. In recent years, several studies show that exercise training is safe, feasible and beneficial for patients with inoperable lung cancer. Results have shown increased physical capacity, increases muscle strength and functionality, and reduced anxiety and depression levels.

Methods:
This presentation will focus on the rationale of exeicse in patients with inoperable lung cancer and will present results from the EXHALE study, a prospective, clinical and explorative study.

Results:
Patients showed significant improvement in physical capacity, functional capacity, muscle strength and “emotional well-being”, as well as a significant reduction in “social well-being” and the level of anxiety. No serious adverse events (SAE) or adverse events (AE) were reported.

Conclusion:
This presentation will document that the patients with inoperable lung cancer are able to complete a six-week exercise and relaxation intervention without exercise-related SAE. In addition we can conclude that patients with inoperable lung cancer can increase VO2max, functional capacity (6MWD)and muscle strength significantly. We also found that the intervention significantly reduced the patients’ level of anxiety. The patients did not improve their HRQOL significantly, but we did observe a significant improvement in emotional well-being

Abstract not provided

Background:
In the UK, Health and Wellbeing Events for people with cancer have developed as part of the National Cancer Survivorship Initiative. They are aimed at supporting people living with and beyond cancer to live as healthy and active lives as possible for as long as possible (Richards et al 2011). They are designed to provide an opportunity for people with cancer and their family members to gain information and support, to help them manage the consequences of cancer and make positive life-style changes where appropriate (NCSI 2013). Early pilot work suggests events of this kind may not only benefit attendees in terms of improved levels of knowledge, confidence and physical and emotional wellbeing, but may also lead to more appropriate use of services, and potentially reduce unplanned consultations and admissions. However, to date, much of this early work has been in the context of breast and urological cancers, and there has been little exploration and evaluation of events aimed specifically at helping people affected by lung cancer (Office for Public Management/Macmillan Cancer Support 2011). The poster will address this knowledge deficit by reporting data from an ongoing collaborative project undertaken at three London NHS Foundation Trusts. The project aims to develop and evaluate a series of Lung Cancer Health and Wellbeing Events. Specifically, data will describe the process of developing and delivering events for people with lung cancer, and identify the perceived feasibility, acceptability and usefulness of these events from the perspective of attendees (patients and their family members/close friends) and professionals involved in organising the events.

Methods:
Design: A prospective mixed method service evaluation including; 1) Event attendance rates and demographics (i.e. patient/family member, gender, age, ethnicity), 2) Participants’ perceptions of how useful the events are (using questionnaires administered immediately after the event and at 4-6 weeks), 3) Health professionals’ perceptions of the usefulness and impact of the events (using questionnaires and group discussions), 4) Analysis of the costs and resources required to host the events (e.g. professionals' time, administration and organisation, additional financial expenditure etc). Analysis: Descriptive statistics and qualitative thematic analysis will be used.

Results:
The poster will present data from the first two events held in 2015. At the time of writing, intial analysis from the first event suggests that although only a small proportion of patients with lung cancer may choose to attend these kinds of events (7% of 257 invited) , the experience of attendees (patients and family members) is reported as largely positive. For example, 71% (15/21) found the event ‘quite’ or ‘very helpful’ and 91% (20/22) would recommend it to others in a similar situation. Initial feedback from professionals is also positive whilst elucidating the resource required to develop and deliver events.

Conclusion:
Health and Wellbeing Events are a recent initiative in the UK to help support people living with and beyond a diagnosis of cancer. This poster will present results of an evaluation of lung cancers-specific events. The findings will indicate their feasibility, acceptability and accessibility to patients and family members, Implications for future service development and delivery will be discussed.

Background:
Prognosis for lung cancer is poor, with 5 year survival of 8.8% in men and 11.1% in women. (MCS 2013) It is essential to enhance performance status and timely access to treatment. NICE recommends that patients have access to specialist services from the start of the pathway. This includes the expertise of the Lung CNS (DOH 2011). It is essential that people with a thoracic malignancy have their health and wellbeing maximised before diagnosis and treatment decision to improve outcomes and quality of lie. The Lung CNS’s management of the pathway leads to improved treatment outcomes (NLCA 2013)

Methods:
Lung CNS’s have a consensus that pre-diagnosis services are currently ad hoc and inequitable. The NLCFN undertook literature reviews using key words “PREHABILITATION & LUNG CANCER”; this did not identify any significant results. The search was therefore widened to include “PULMONARY DISEASE”. This showed that the most common co morbidity associated with lung cancer was COPD. To understand Lung CNS practice, a short electronic survey was devised and distributed to all NLCFN members.

Results:
118 Lung CNS’s responded to the questionnaire (34%). Questions covered current practice with regard to: Symptom control, health promotion, co-morbidity management Availability of assessment tools. Availability of support/pre- rehabilitation services

Conclusion:
Following the literature search and questionnaire, the NLCFN devised a prompt checklist. This aide memoire captures key areas of assessments at pre-diagnosis to enable effective referrals to appropriate services which will ultimately improve the patients’ health and wellbeing in preparation for treatment.

Background:
PS is a very useful marker which is used to determine suitability for treatment on patients with lung cancer. Previous studies have shown good correlation between PS and survival. To assess the correlation between the Respiratory specialist (consultants and SpRs) and the patient’s own assessment.

Methods:
A random selection of patients attending our Rapid Access Lung Clinic were given, prior to the consultation with the doctor, the ECOG guidelines and were asked to score themselves.

Results:
50 patients were given the questionnaire but one preferred not to answer it. The results are reflected in the table below:

Identical score	21 / 50 (42%)
Patient score higher than doctor	14 / 50 (28%)
Patient score lower than doctor	4 / 50 (8%)
Not documented by doctor	11 / 50 (22%)

from Rapid Access Lung clinic on the same day without a diagnosis of malignancy Out of the patients that scored themselves higher than the doctors, only 2/ 14 gave themselves All the patients that did not have a PS documented by the doctor were discharged a score two points higher.

Conclusion:
Although nearly half of the scores between patients and doctors were the same there is a significant number of patients that scores themselves higher than the medical professionals. This is likely to be a combination of the fact that the doctors could be overlooking some co-morbidities and that they are keen to give the patient the best opportunity for treatment.

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