Study Highlights Biomarker Testing Delays in Lung Cancer Care

Ordering responsibility, reimbursement rules, and shipping logistics can create bottlenecks that clinicians may not fully see. Although laboratory processes have accelerated, total turnaround often remains longer than expected. New findings demonstrate that median biopsy-to-biomarker results still take 27 days, largely driven by delays in ordering tests.

At the Medical University of South Carolina (MUSC) Hollings Cancer Center, investigators evaluated real-world turnaround for comprehensive genomic profiling across lung and other solid tumors from 2018 to 2024. Working with a biomarker testing company, the team parsed the workflow into three segments: time from biopsy to test order, time to package and ship the specimen, and laboratory testing plus reporting. In this context, biomarker assays provide tumor-specific information that can indicate whether a targeted drug or immunotherapy is likely to benefit an individual patient.

Overall biopsy-to-result time improved from 36 to 27 days, driven almost entirely by faster laboratory processing. However, the ordering step worsened by one day and showed the greatest site-to-site variation. In 2024, median order placement ranged from eight days at the fastest sites to 23 days at the slowest, with some centers taking up to 30 days. Clinicians may also underestimate the interval; prior polling suggested a two-week expectation, while the study median was closer to four weeks. These delays can lead to suboptimal initial therapy, complicate later switches, increase adverse-reaction risks when moving from immunotherapy to targeted therapy, and potentially affect patient fitness or clinical trial eligibility.

Differences by tumor type were mainly driven by the ordering interval. In 2024, median time to order testing was 14 days for non–small cell lung cancer, 22 days for ovarian cancer, and 27 days for other gynecologic cancers, while shipping and laboratory times were similar across indications. The authors note that although MUSC uses reflex testing, with pathologists initiating orders once lung cancer is identified, broader adoption faces barriers including limited pathology expertise in rapidly evolving molecular test menus, lack of in-house testing at many hospitals, complex reimbursement policies such as Medicare’s 14-day inpatient testing rule, and unclear ordering responsibility. The study was published in JCO Oncology Practice on June 18, 2026.

“In lung cancer, in an ideal world, you would prefer to have this testing before any treatment is given to most patients—surgery, chemo, any systemic therapy, radiation—you'd really prefer to have this as soon as possible. You want to get it right the first time. That's what I tell patients. You want to get the right treatment delivered first but still as efficiently as possible,” said Adam Fox, M.D., lung cancer pulmonologist at MUSC Hollings Cancer Center.

“Time is of the essence, and this is a component of time. And my argument is, if it just takes a little bit of logistical work for many places to find a mechanism to order this weeks earlier, then we should put in the effort,” said Fox.

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MUSC Hollings Cancer Center