A large project consisting of:

a) an observational trial where smoking status is recorded on 1400 consecutive people newly diagnosed with lung cancer. Smoking status is biologically validated with exhaled carbon monoxide (eCO) levels every 3 months. Survival, cancer progression and treatment complications will be recorded and compared in smokers, ex-smokers and never smokers.

Smoking causes around 85% of lung cancer. Continued smoking after diagnosis probably worsens survival and increases treatment complications but prospective well-designed studies are lacking.

This project is an observational cohort study recording outcomes in smokers, never-smokers, and ex-smokers, using exhaled carbon monoxide to validate smoking status when they attend for further lung cancer clinics.

This project is unique, as every patient with a clinical diagnosis of lung cancer will have their smoking status biologically validated by a quick and easy test, and those enrolled in the smoking cessation treatments or not will also complete a generic quality of life questionnaire at regular intervals. These appointments will coincide with other hospital appointments wherever possible, and survival status will reported up to 24 months after enrolment.

Inclusion Criteria:

• clinical diagnosis of lung cancer

Exclusion Criteria:

• refusal Consent
• inability to provide exhaled CO
• active psychiatric illness or substance misuse
• concurrent malignancies of another type other than non-melanoma skin cancer
• unable to travel for sessions with smoking cessation counsellor and / or outpatient visits from outset
• WHO performance status 4
• Life expectancy less than 6 weeks.

Patients with newly diagnosed lung cancer