Introduction and Objective Epidemiological modelling suggests there will be excess cancer related mortality as a result of covid-19 and its impact on healthcare delivery and patient behaviour We examined lung cancer presentations at BSUH NHS Trust over two time points to better understand the implications on presentation, diagnosis, staging and treatment Further work is underway to examine the pathway in more detail, including barriers to diagnosis, and overall accessibility for patients and clinicians alike The outcome of our research will influence preparation for the service over a potential second wave, and perhaps how we need to operate indefinitely Methods We performed a retrospective comparative analysis of patients recorded in the Somerset Cancer Register at BSUH between 1st Feb-30th Jun in 2019 and 2020, examining the route of referral, stage of disease, diagnostic pathway and treatment given Results The percentage of emergency referrals, confirmed to be lung cancer, was higher during the pandemic (2020: N=47 [50%] vs 2019: N=40 [36%]) Overall, more patients presented with advanced stage disease (IIIB-IV) in 2020 compared with 2019 (64/94 [68%] vs 57/111 [51 3%])-see figure 1 The overall proportion of emergency referrals with late-presenting disease (stage IV) was 10% higher during the pandemic The proportion that received active anticancer treatment (surgery, radiotherapy or chemotherapy) was lower during the pandemic (46% vs 62%) Access to diagnostic tests were unchanged other than an 11% decrease in cases proceeding to bronchoscopy or EBUS to confirm a cancer diagnosis (n=29 v n=15) Conclusions Our Trust has demonstrated an increase in advanced stage and emergency presentations during the worst peak of Covid-19 which both correlate to worse outcomes and survival in lung cancer This is likely to be replicated nationally and will result in a significant impact on survival statistics in lung cancer, which already lag behind many other countries in Europe This raises the,challenge of how to sustain services in the,next wave of infection, and how to increase earlier diagnosis,more rapidly than the current planned rollout of Lung Health,Checks, taking into account the changes in behaviour of,patients and clinicians alike during this pandemic