Receiving a lung cancer diagnosis can be one of the most terrifying moments in a person’s life. Many patients are eager to start treatment immediately. Meanwhile, physicians face pressure to act swiftly. However, modern cancer treatment has become significantly more complex than in the past. Today, doctors often require specialized laboratory tests before determining the best course of action.
A recent study led by researchers at the Medical University of South Carolina (MUSC) found that these critical tests are taking much longer than many physicians realize. The study was published in JCO Oncology Practice. Researchers discovered that the time from a patient’s biopsy to receiving biomarker results is roughly twice what many doctors estimate.
Biomarker testing searches for specific features within a tumor. In lung cancer, these tests identify genetic mutations or other biological indicators that guide targeted therapy choices. Over recent years, numerous new medications have been developed to attack specific genetic alterations in cancer cells. These targeted treatments can sometimes be highly effective and may produce fewer side effects compared to traditional chemotherapy. Immunotherapy, which helps activate the body’s immune system against cancer, has also revolutionized lung cancer management.
However, these therapies do not work equally well for every patient. Some individuals may benefit significantly from targeted drugs, while others respond better to immunotherapy. Administering the wrong treatment initially can delay recovery and potentially cause complications.
The MUSC team, led by Dr. Adam Fox and Dr. Gerard Silvestri, examined the timing of biomarker testing across several solid cancer types from 2018 to 2024, with a focus on non-small cell lung cancer, the most common form of the disease. The process involves multiple steps: first, a doctor orders the test after confirming cancer with a biopsy; then, the tissue sample must be prepared and shipped to a lab; finally, the lab performs the testing and sends back the results.
The study noted some progress. Overall waiting times decreased from an average of 36 days in 2018 to 27 days in 2024. Nonetheless, most of this improvement stemmed from labs getting faster at performing tests, while the time to place the order remained unchanged or slightly worsened. There was substantial variation between hospitals: top-performing centers took about eight days from order to test, whereas slower hospitals often took 20-30 days just to initiate testing.
Many doctors underestimate these delays because they typically only see part of the process. A prior survey indicated that several lung specialists believed the total wait was around two weeks, but the study found the actual average was closer to four weeks.
These delays are important because treatment plans depend heavily on biomarker results. Patients and their doctors often feel anxious during diagnosis and may opt to begin treatment before receiving test results. Unfortunately, this can lead to issues, such as starting immunotherapy when a targeted drug would have been more appropriate, which might increase the risk of lung inflammation (pneumonitis). Such side effects can cause long-term breathing problems. Delays can also limit patients’ participation in clinical trials, which might offer new treatment options.
Some hospitals have adopted systems to expedite testing. At MUSC, pathologists automatically order biomarker analysis once lung cancer cells are identified—this process is called reflex testing. However, many other hospitals lack the staffing, expertise, or lab capacity to implement such systems. Insurance and billing rules may also contribute to delays; in the past, some providers remember when testing was not covered by insurance, exposing patients to high out-of-pocket costs. Certain Medicare policies can further complicate reimbursement during hospital stays, adding additional waiting time.
Another challenge involves unclear guidelines on who should order biomarker testing. Sometimes, responsibility falls to whichever doctor first encounters the patient, often leaving the oncologist as the last to request these crucial tests.
The researchers believe this issue extends beyond lung cancer. While biomarker testing isn’t equally vital across all cancer types, its importance is rising throughout oncology. The study underscores an essential lesson: scientific breakthroughs can only benefit patients if healthcare systems are organized efficiently enough to deliver them. Advanced, personalized cancer treatments are not useful if test results arrive too late to guide therapy decisions.
Improvements in communication, establishing standardized procedures, and reducing unnecessary delays could help many patients receive appropriate treatment precisely when they need it. In cancer care, even a few weeks’ difference can have a meaningful impact.
