# An Integrative Review to Examine the Care Pathways and Support Available for Individuals Diagnosed with Lung Cancer Who Have Never Smoked

## TL;DR

This paper reviews the unique care experiences and support needs of lung cancer patients who have never smoked, highlighting issues like stigma and the need for tailored support.

## Contribution

The study provides an integrative review of care pathways and support for lung cancer patients who have never smoked, emphasizing their distinct experiences and the need for targeted interventions.

## Key findings

- Never smokers with lung cancer face unique challenges, including stigma and delayed diagnosis.
- Tailored support can improve care experiences and outcomes for never-smoking lung cancer patients.
- Increased awareness among healthcare professionals and the public is needed to reduce stigma and improve early diagnosis.

## Abstract

An increasing proportion of those diagnosed with lung cancer have never smoked. Commonly, these are oncogene-driven forms of lung cancer, including those with ALK, EGFR, and ROS1 mutations. This integrative review of the international literature provides evidence of never smokers’ experiences of the care pathway and the support available to them. It identifies key areas where their experiences are distinct from those of lung cancer patients with a history of smoking, exploring the impact of stigma and the potential for significant psychological and social consequences associated with a lung cancer diagnosis. This review highlights areas of the diagnostic process that are unique to this cohort, addresses the issue of awareness of lung cancer in never smokers, and identifies differences in the emotional burden they bear. Finally, it provides evidence of the benefit of targeted support for these patients. This review draws important conclusions about the needs and experiences of patients diagnosed with lung cancer who have never smoked and, crucially, also provides the basis for more research in this area.

As the proportion of people diagnosed with lung cancer who have never smoked rises, it is important to understand how their experiences differ from those of smokers. A better understanding of their experiences, views, and informational and supportive care needs is essential to ensuring an optimised patient-centred care pathway leading to improvements in patient satisfaction, quality of life, and treatment outcomes. This integrative review of the international literature identified 5866 articles by searching four academic databases, the grey literature, and hand-searching the reference lists of relevant systematic reviews. After screening, ten studies were selected for inclusion in the review. Thematic analysis identified five themes that spoke to the experiences of never smokers with lung cancer: stigma, awareness, diagnosis, the emotional response, and support. Stigma pervades, with potentially significant psychological and social consequences, negatively affecting patients emotionally and potentially delaying their diagnosis. Increasing awareness amongst healthcare professionals and the general public has the potential to reduce stigma and encourage earlier diagnosis. Support specifically tailored for never smokers with lung cancer can improve individuals’ experiences of care. The experiences of never smokers with lung cancer are unique, and more research is required to better tailor support and guidance for this cohort.