Understanding the impact of distance and disadvantage on lung cancer care and outcomes – a qualitative interview study in North East London

Background: There are wide variations in lung cancer care and inequalities in survival outcomes across the UK. These are likely to be exacerbated by the complex and rapidly-changing diagnosis and treatment landscape. Most work to date has focussed on improving the quality of lung cancer clinical services.

But there is less research into how patient-related factors, such as personal circumstance and location relative to specialist lung cancer services, contribute to this variation.

This qualitative interview study forms part of a broader project run by Cancer Research UK’s Accelerate Coordinate Evaluate (ACE) Programme.

The project is focussed on achieving universal access to optimal specialist investigation and treatment for lung cancer patients.

The overarching aim is to develop and implement a patient engagement intervention supporting patients and carers through the lung cancer care pathway, with a focus on two distinct and contrasting regions (North East London [NEL] and Lincolnshire). The insights from the proposed interview study will inform the development of this patient engagement intervention.

Aims: To explore and characterise how lung cancer patients’ and carers’ characteristics and their location in relation to specialist services intersect and impact on their capability, opportunity and motivation to engage optimally with the lung cancer pathway from diagnosis through treatment in North East London.

Methods: Up to 30 lung cancer patients and 30 carers will be recruited from Barts Health NHS Trust to take part in qualitative semi-structured interviews.

A purposive maximum variation sampling approach will be used to ensure diversity with respect to gender, ethnicity, age, socioeconomic position, disease stage and location.

The interviews will explore factors affecting patients’ and carers’ capability, opportunity and willingness to travel to multiple sites, as well as the acceptability and their interactions with the complex lung cancer care pathway. The interviews will be audio-recorded and the transcripts analysed using a framework approach to thematic analysis.

A PPI group, and the ACE steering group, will review data collection, analysis and write-up. What value will the programme of work deliver?

Findings from the NEL interview study will be combined with those from the Lincolnshire interviews to inform the development of the patient engagement intervention. The intervention will be piloted at each site (within the remit of the broader ACE project).

The intervention will aim to increase uptake of, and engagement with, diagnostic tests and treatment regimens as well as improve patients’ and carers’ overall experience of the lung cancer care pathway.