The specific objectives of WP1 are to:
• Provide effective management and coordination, decision making and governance mechanisms for the project, including scientific and ethics coordination
• Ensure fulfilment of the work plan, including risk management and quality assurance; guarantee punctuality and quality of the project’s deliverables and milestones
• Facilitate effective communication and punctual reporting to the European Commission
• Ensure efficient financial and administrative management of the project
• Maintain regular and seamless communication between the project partners
• Manage project-related meetings
• Set up and maintain a national implementation taskforce
• Coordinate data management

• To establish a web-based knowledge hub (IT platform) providing all results and documents developed within this project as well as all external data compiled in WP 3 and WP 7. SOLACEs knowledge hub will be used to make the pathway modules, evidence-based guidelines, technical and methodology papers accessible for everybody who wishes to design, plan, pilot and roll out LCSP, representing the guideline, quality assurance and implementation package (GIP). This is to empower member states and regions to set up their future screening programs. Based on its modular matrix structure (toolbox), Member states and regions can tailor their lung cancer screening programme to best match and address their needs. The knowledge hub will also ensure easy, free, public access of these living documents in order to reach out to all potential participants as well as the general population.
• To prepare, consent and approve the GIP on lung cancer screening.
• To periodically update and assure quality of the GIP on lung cancer screening by pre-defined systematic evidence searches relating to the lung cancer screening pathway.
• To perform annual assessments of national data on epidemiology and populations at risk for lung cancer in all member states and EEA states.
• To perform annual benefit-harm-balance analyses, amongst others overdiagnosis and radiation exposure, in the accessible LDCT lung cancer screening data sets from previous and ongoing clinical trials, national LCSPs and implementation pilots WP 4-6.
• To perform cost-effectiveness as well as budget impact analysis using the abovementioned assessments in the already named lung cancer screening datasets and further available sources in member states and EEA states. It is the aim to develop a decision-analytic model (e.g. Markov model) to develop a cost-model for LCSP in different archetypes of EU healthcare systems.
• To regularly observe and appraise newly available approaches and developments with regard to LDCT lung cancer screening by pre-defined systematic searches.

Within WP 3, SOLACE will create an active implementation network structure with the EU, member states and other EEA countries to assess their individual implementation status and needs regarding LCSP on an annual basis. These findings will be incorporated into country-specific gap-analyses covering the entire screening pathway, taking into account national benefit-harm-balance and cost-effectiveness considerations. A multi-professional SOLACE expert team will then prepare customised implementation plans and mutually discuss it with member states. By sharing expertise and best practices, SOLACE aims to empower member states to plan, initiate and optimise structured, evidence-based LDCT lung cancer screening within national programmes.

The specific objectives of WP 3 are:
● To set up the implementation network structure linking SOLACE with the EU as well as member states and other EEA countries as the national implementation taskforce.
● To set-up the methodology and tools for the needs assessment
● To perform customised gap-analyses for each of the member states and other EEA countries based on the detailed assessment data.
● To generate comprehensive report drafts of the implementation status and existing gaps and to derive from there customised implementation plans for each of the member states and other EEA countries.
● For interested member states and other EEA countries:

1. to directly present and discuss the SOLACE gap-analyses findings with their national implementation teams;
2. to share specific expertise by the SOLACE expert team to their national implementation teams and to discuss best practices, obstacles and lessons learnt leading to a mutual generation of a customised implementation strategy towards a national LDCT lung cancer screening programme or its optimization if already on-going.

The general objectives of the implementation WP 4 are:

1) to demonstrate the feasibility of enhancing participation rates of females in LDCT lung cancer screening programmes by different means,

2) to elaborate characteristics of female participants and to compare with male participants (when data are available),

3) to evaluate the adherence to smoking cessation support in female participants and evaluate its success rate, and

4) to evaluate the detection of co-morbidities and evaluate the practicability of the guidelines for reporting incidental findings.

This implementation WP will involve nine different European countries (Croatia, Estonia, France, Germany, Hungary, Poland, Czech Republic, Ireland and Greece).

The specific objectives of this implementation WP are:
1) Active invitation measures to enhance female participation rates
● To establish a link between breast and lung cancer screening programmes, e.g. via combined invitation letters
● To test other means of promoting lung cancer screening (media, billboards, social networks)
● To involve general practitioners
● To send out targeted letters by national health authorities

2) Collection of female gender-specific data
● To assess the lung cancer prevalence among female lung cancer screening participants
● To assess overdiagnosis in female lung cancer screening participants
● To assess the radiation dose in female lung cancer screening participants
● To assess psychological burden of female lung cancer screening participants

● To assess cost-effectiveness in female lung cancer screening participants

3) To explore the effect of smoking cessation programmes in female lung cancer screening participants

4) To detect comorbidities and incidental findings in female participants and assess gender differences.

The general objective of this implementation WP 5 is to enhance awareness and participation rates in different hard-to-reach populations. This WP will be rolled-out within three national lung screening programmes and five implementation pilots of eight different European countries (Croatia, Czech Republic, Estonia, France, Germany, Hungary, Ireland and Poland).

Using several different methodological approaches, we aim to demonstrate their feasibility to better include hard-to-reach populations in lung cancer screening programmes. Hard-to-reach populations will include:

1) socially deprived populations (all countries),

2) ethnic minorities (Roma populations in Croatia and Hungary, Turkish population in Germany),

3) populations living in geographically remote regions (France, Hungary, Ireland, Germany, Poland), and

4) worker/employee population taken care of by occupational medicine (Germany).

The specific objectives of this implementation WP 5 relate to:
a) Socially deprived populations and

b) ethnic minorities
To prepare target population-oriented information documents and media for both populations and their respective contacts (i.e. professionals/next-of-kins)
● To train target population-oriented ambassadors reaching out to both populations
● To approach both populations with the respective information materials as well as through ambassadors
● To measure the effect of these two campaigns after introduction of targeted information materials and ambassadors compared to baseline (number of screened individuals in both populations)

c) Populations living in geographically remote regions
To use a CT screening truck to reach out to populations in remote areas (France, Ireland, Hungary, Germany, Poland)

d) Worker/employee population exclusively taken care of by occupational medicine
To prepare an enrolment programme of eligible individuals for lung cancer screening (in at least 1 large German enterprise) into on-going implementation pilots by utilising the German system of occupational health physicians and German Social Accident Insurance
● To train occupational health physicians/medical staff to assess lung cancer risk and to inform/advise workers/employees with regard to lung cancer screening within the context of regular occupational health surveillance
● To implement assessment of lung cancer risk and information on lung cancer screening in the setting of occupational health surveillance/examinations; to link occupational health checks to LCSP
● To investigate acceptance and participation in lung cancer screening in worker/employee populations; focussing on specific groups difficult to reach by other means than in the occupational setting, e.g. BASF (regular health surveillance, 20k health examinations per yr; assess LC risk based on this data). The company BASF (site Ludwigshafen) have agreed to participate in the pilot study. The company has its own medical department and carries out about 20k annual health checks/examinations in the context of occupational health surveillance.

The LCSP currently being implemented in different countries of the EU are targeted in general to the risk group defined by age and smoking status, i.e., pack/years. This group of interest represents the individuals with the highest probability of lung cancer and also highest effectiveness if the therapeutic intervention is performed timely. However, within this group we identified subgroups with substantially higher risk of lung cancer, thus, early diagnosis and treatment will be even more beneficial. These are patients with COPD, fibrotic ILD and cancer survivors at high risk of lung cancer as a secondary malignancy.

The goal of WP 6 will be to increase awareness in both physicians taking care of these individuals and also the patients to increase interest in these individuals to enter the lung cancer screening programmes. Additional and targeted efforts to increase participation of these patients will be undertaken and effects assessed. This WP will be implemented in Czech Republic, Hungary, Estonia, France, Ireland, Italy and Spain.
● Prepare information materials targeted to physicians treating patients with COPD and fibrotic ILD and cancer survivors
● Motivate the physicians to offer lung cancer screening to these higher risk patients
● Measure the effect of the campaign:
○ by measuring increase of the number of screened individuals in the higher risk groups
○ by investigating change inf the attitude of physicians and target population through surveys.

WP7 aims to ensure that the project results will have a lasting impact on lung cancer screening in and beyond Europe.

The specific objectives are to:
● Establish and maintain an Evaluation Working Group
● Monitor, assess and amend the projects action level indicators
● Adaption of ESTI-database (ESTS, Dresden, other societies)
● Establish a European Lung Cancer Screening Alliance
● Establish a joint lung cancer screening training curriculum for radiologists, respiratory physicians, thoracic surgeons and radiation oncologists.

WP 8 aims to ensure that the key findings and messages from SOLACE influence the future of lung cancer screening and are understood by all stakeholders.

This will be achieved by:
● Ensuring we know who we are communicating to, with what methods and using which channels, with input from all stakeholders.
● Giving a strong identity and visibility to the project across Europe and the world.
● Ensuring that the key findings and messages from SOLACE are disseminated and communicated as well as possible using traditional and novel methods.