{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:09:56Z","timestamp":1781006996748,"version":"3.54.1"},"reference-count":14,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ruth Strauss Foundation"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR303686"],"award-info":[{"award-number":["NIHR303686"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,3,16]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lung cancer is commonly associated with smoking. However, if considered separately, lung cancer in never-smokers (LCINS) is the seventh most common cause of cancer-related death worldwide. Expanding the limited understanding of LCINS, especially in the UK, is crucial to improving diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will establish a retrospective and prospective UK multicentre observational cohort comprising never-smoking (lifetime use of &lt;100 tobacco cigarettes) adults with lung cancer using routinely available primary and secondary care electronic health records (EHRs). Demographic data including occupation and ethnicity, exposures and lung cancer outcomes will be extracted. Deep learning-based natural language processing will be used to analyse free-text data. Quantitative or qualitative data collection for information not available in EHR may be initiated in the future. Follow-up will be until death, withdrawal or end of study (5 years from study activation date). Primary outcomes will be sociodemographic characteristics, comorbidities, environmental exposures, pathways to presentation and symptoms. A feasibility pilot of 225 patients (25 participants per year both retrospectively and prospectively) will be undertaken at one hospital before extending the study to multiple sites. Patient representatives have been involved in adapting the research protocol including the recruitment process and patient-facing materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>National ethical approval has been obtained from Health Research Authority (HRA) (24\/YH\/0147). Access to patient records without explicit consent, including deceased patient records, is legally supported by the Confidentiality Advisory Group and HRA. The study is sponsored by University College London Hospital.<\/jats:p>\n                    <jats:p>Data will be anonymised and analysed 2 years after the study start date and on study completion. Together with our patient representatives, we will disseminate data to the scientific and academic community and public through peer-reviewed publications, presentations at conferences, patient-facing charities and social media.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003966","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:55:41Z","timestamp":1781006141000},"page":"e003966","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Observational study of predictors and outcomes of lung cancer in never-smokers in the UK (OLIVE): study protocol"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct06575439","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1106-6545","authenticated-orcid":false,"given":"Sindhu Bhaarrati","family":"Naidu","sequence":"first","affiliation":[{"name":"UCL Respiratory, University College London Lungs for Living Research Centre, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Guvensen","sequence":"additional","affiliation":[{"name":"University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghan","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow, Glasgow, UK"},{"name":"Institute of Health Informatics, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rumana Z","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Statistical Science, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Menon","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Popat","sequence":"additional","affiliation":[{"name":"Lung Unit, The Royal Marsden Hospital, London, England, UK"},{"name":"Division of Clinical Studies, The Institute of Cancer Research, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Moore","sequence":"additional","affiliation":[{"name":"CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK"},{"name":"Department of Cellular Pathology, University College London Hospitals, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2649-2401","authenticated-orcid":false,"given":"Yiwen","family":"Soo","sequence":"additional","affiliation":[{"name":"Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-6119","authenticated-orcid":false,"given":"Amyn","family":"Bhamani","sequence":"additional","affiliation":[{"name":"UCL Respiratory, University College London Lungs for Living Research Centre, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricky","family":"Thakrar","sequence":"additional","affiliation":[{"name":"UCL Respiratory, University College London Lungs for Living Research Centre, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Cancer Division, University College London Hospitals, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OLIVE","family":"PPI Group","sequence":"additional","affiliation":[{"name":"UCL Respiratory, University College London Lungs for Living Research Centre, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam M","family":"Janes","sequence":"additional","affiliation":[{"name":"UCL Respiratory, University College London Lungs for Living Research Centre, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin D","family":"Forster","sequence":"additional","affiliation":[{"name":"CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK"},{"name":"Department of Medical Oncology, Cancer Division, University College London Hospitals, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Navani","sequence":"additional","affiliation":[{"name":"UCL Respiratory, University College London Lungs for Living Research Centre, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"2026060904551709000_13.1.e003966.1","unstructured":"World Health Organization . International agency for research on cancer. cancer today: data visualization tools for exploring the global cancer burden in 2020. Available: http:\/\/gco.iarc.fr\/today\/home [Accessed 25 May 2023]."},{"key":"2026060904551709000_13.1.e003966.2","unstructured":"National lung cancer audit state of the nation. 2024."},{"key":"2026060904551709000_13.1.e003966.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70041-4"},{"key":"2026060904551709000_13.1.e003966.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrc2190"},{"key":"2026060904551709000_13.1.e003966.5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/s44276-023-00006-w","article-title":"Lung cancer in never smokers (LCINS): development of a UK national research strategy","volume":"1","author":"Khan","year":"2023","journal-title":"BJC Rep"},{"key":"2026060904551709000_13.1.e003966.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.canep.2020.101771","article-title":"Twenty-year sociodemographic trends in lung cancer in non-smokers: A UK-based cohort study of 3.7 million people","volume":"67","author":"Rait","year":"2020","journal-title":"Cancer Epidemiol"},{"key":"2026060904551709000_13.1.e003966.7","unstructured":"National Cancer Equality Initiative . Reducing cancer inequality: evidence, progress and making it happen. 2010."},{"key":"2026060904551709000_13.1.e003966.8","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1017\/S1463423615000043","article-title":"Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives","volume":"16","author":"Scott","year":"2015","journal-title":"Prim Health Care Res Dev"},{"key":"2026060904551709000_13.1.e003966.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.06.031"},{"key":"2026060904551709000_13.1.e003966.10","doi-asserted-by":"crossref","DOI":"10.5334\/aogh.2419","article-title":"Global Epidemiology of Lung Cancer","volume":"85","author":"Barta","year":"2019","journal-title":"Ann Glob Health"},{"key":"2026060904551709000_13.1.e003966.11","unstructured":"UK National Screening Committee . Targeted screening for lung cancer in individuals at increased risk. 2022."},{"key":"2026060904551709000_13.1.e003966.12","article-title":"Risk Factors Associated With Incidence of Lung Cancer in Never-Smokers: A Systematic Review and Meta-Analysis","volume":"6","author":"Naidu","year":"2025","journal-title":"JTO Clin Res Rep"},{"key":"2026060904551709000_13.1.e003966.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12911-018-0623-9","article-title":"CogStack - experiences of deploying integrated information retrieval and extraction services in a large National Health Service Foundation Trust hospital","volume":"18","author":"Jackson","year":"2018","journal-title":"BMC Med Inform Decis Mak"},{"key":"2026060904551709000_13.1.e003966.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2021.102083"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-003966","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:55:47Z","timestamp":1781006147000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-003966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,6,9]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjresp-2025-003966"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-003966","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}