Managing patients with advanced non-small cell lung cancer alongside complex comorbidities and frailty: A consensus statement and implications for the United Kingdom health system

Non-small cell lung cancer (NSCLC) is predominantly diagnosed in older adults, many of whom present with multiple comorbidities and varying degrees of frailty. These factors complicate diagnostic investigations, treatment decisions, and outcomes. Limited real-world guidance exists on managing advanced NSCLC in patients with comorbidities and frailty. To address this knowledge gap, a multidisciplinary panel of 10 United Kingdom (UK) experts, including six lung oncologists, two clinical nurse specialists, and two pharmacists, participated in two virtual workshops to identify key challenges and best practices for managing patients with advanced NSCLC and complex comorbidities or frailty. Twenty-three draft consensus statements were developed based on discussion at the workshops, with a further two experts (one respiratory physician and one geriatrician) invited to draft and/or review the statements at that time. The consensus statements were distributed via Microsoft Forms for anonymous voting and commentary. A predefined threshold of ≥70% agreement was set to define consensus. Comments not meeting this threshold were revised following expert review to increase agreement. Consensus was achieved for 22 of 23 statements. This consensus statement provides recommendations on assessments and care planning, prehabilitation strategies and comorbidity optimization, and treatment selection and individualization. The multidisciplinary, practical guidance for managing patients with advanced NSCLC with comorbidities and frailty also identifies evidence gaps requiring further study. Implementation of these recommendations may improve equitable, patient-centered care within the UK National Health Service and could be applicable to other healthcare systems.