Genomic Testing Turnaround Times in Non-Small Cell Lung Cancer: A Regional Service Review

Abstract

Introduction Timely genomic results are critical for personalised therapy in non-small cell lung cancer (NSCLC), where treatment decisions depend on predictive biomarkers.1,2 National guidance recommends reflex genomic testing at diagnosis with results within 14 days from sample acquisition for tests required for first line treatment.3 However, with no national or standardised database of end-to-end pathways, performance across hospitals remains variable.4 For the first time, end-to-end turnaround time (TAT) assessment was undertaken in the East Genomic Medicine Service Alliance (GMSA), focusing on NSCLC. Methods Process-mapping and TAT assessment was undertaken across 14 NHS trusts in the East GMSA. Pathology teams submitted data on pre- and post-genomic stages for up to 30 NSCLC patients between June and August 2024, and genomic laboratory hubs provided laboratory metrics. Results 271 end-to-end pathways were reviewed with a median TAT of 26 days (range 14-142). Trusts performing in-house genomic testing had the fastest TATs (median range 14-15) followed by co-located testing (median range 20-27). Longer TATs were associated with the absence of reflex testing, reliance on private providers for immuno-histochemistry, and sample transport distances over 40 miles. Varied access to Cellular Pathology Genomics Centres contributed to inequity as several hospitals lacked in-house immunohistochemistry testing. Conclusions End-to-end genomic TATs for NSCLC vary considerably across the East GMSA, with many pathways exceeding clinically meaningful timeframes. A major barrier is the absence of a national, standardised system to capture and monitor TATs. Without routine data collection, unwarranted variation remains invisible, limiting the ability to benchmark performance, direct improvement efforts, and ensure equitable delivery of precision oncology. Establishing a national dataset will be essential to drive consistency, accountability, and sustained improvement in genomic TATs. Meanwhile, regional Genomic Services must continue to address gaps locally to reduce delays and minimise inequities for patients. Disclosure No significant relationship. Copyright © 2026 Elsevier B.V.