The National Lung Cancer Audit (NLCA) evaluates how the care received by people diagnosed with lung cancer in England and Wales compares with recommended practice and provides information that supports healthcare providers, commissioners, and regulators to improve the care for patients. The NLCA reports a set of process and outcome measures that cover important aspects of the care pathway for people diagnosed with lung cancer. In the NLCA State of the Nation report 2026, we give an overview of the patterns of care and outcomes for 39,409 people diagnosed with lung cancer in England in 2024. A separate section provides describes results for 2,135 people diagnosed in Wales in 2024. The report describes summarises the performance of lung cancer services in 2024 and compares this to the situation in 2021, 2022 and 2023.