Patients have played a central role in the design and development of this study. Our early work with the Wythenshawe/Christie lung cancer Patient and Public Invovlement and Engagement (PPIE) group and North Trent Consumer Research Panel clearly supported the need for quality of life and burden to be included in treatment decision making. The issue of recruitment with previous trials comparing surgery with radiotherapy has been fully explored with our patient groups. The randomisation process was a concern for some patients so it will be clearly specified in the patient information sheet and at the time of consent that the trial has been suggested to them because there was no clear indication which treatment would have the best outcome for them. Given the patients concern, it was also decided that a clinician would lead the recruitment consultation.

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