Lung cancer remains the leading cause of cancer-related mortality in the UK. A recent report from the UK Lung Cancer Coalition (UKLCC) underscores the impact of lengthy genomic testing turnaround times, which may hinder access to life-prolonging targeted therapies for many patients. Professor Robert Rintoul, the UKLCC clinical lead, examines the report’s findings and proposes actionable strategies to optimise the delivery of timely, accurate and high-quality genomic testing across the UK to support more effective and prompt treatment decisions.
Genomic testing identifies the molecular characteristics of cancer, enabling patients to access targeted therapies that can significantly improve survival rates and quality of life. For clinicians, knowledge of mutations is a prerequisite for making optimal treatment decisions, including eligibility for perioperative or neoadjuvant chemo-immunotherapy.
Delays in genomic testing can significantly hinder patient treatment decisions and impact subsequent survival outcomes, especially in cases of rapidly fatal disease such as lung cancer where timely intervention is crucial. Delays not only affect the physical health of patients but also add to their emotional distress as they await critical information.
The UK Lung Cancer Coalition (UKLCC) report, Faster Testing, Better Outcomes: Genomic Testing in Lung Cancer, is a pivotal document for clinicians, policymakers and patients as it underscores the critical role of timely genomic testing in lung cancer care for up to 30,000 lung cancer patients each year.
The report highlights the need for streamlined and expedited processes to ensure clinicians make the right treatment choices for their patients based on receiving accurate and timely genomic test results. Policymakers can use the findings to address systemic inefficiencies, such as staffing shortages and outdated infrastructure, while patients benefit from reduced waiting times and improved access to life-extending treatments.
Aims and recommendations
The report aims to instigate several key changes in the genomic testing pathway via 12 key recommendations, which can be summarised as follows:
- Standardised turnaround times: ensuring genomic test results are delivered within the recommended 14-day target window
- Improved resource allocation: addressing staffing, technology and logistical gaps in genomic testing pathways
- Enhanced transparency: regular publication of turnaround time data to hold the seven genomic laboratory hubs accountable
- Adoption of innovative solutions: encouraging the use of digital tracking systems and artificial intelligence-driven diagnostics to expedite testing
- Dedicated oversight: assigning a named individual responsible for overseeing the entire testing pathway to help ensure accountability and smoother operations.
The report also suggests practical solutions, such as implementing a seven-day working model for genomic labs, improving training for healthcare scientists, and introducing a single digital tracking system for patient samples.
Technology can play a transformative role in expediting genomic testing. The integration of tools such as digital tracking, advanced IT systems and AI diagnostics within the pathway will not only lead to more timely and accurate genomic test results but also ensure more personalised and efficient care and better patient outcomes.
By implementing these and other changes, the report seeks to create a more efficient and equitable system, ultimately improving outcomes for lung cancer patients across the UK.
Barriers to meeting the genomic testing turnaround time
Several barriers are preventing genomic testing from achieving the recommended 14-day turnaround time. These include:
- Inconsistent tissue sample quality: variability in the quality of samples sent for testing can delay results – as well as non-reporting of testing fails
- Non-uniform results reporting: lack of standardised templates for reporting genomic test results leads to inefficiencies
- Inadequate IT systems: outdated or insufficient IT infrastructure hampers the tracking and processing of samples
- Staffing shortages: laboratories face a lack of trained personnel, slowing down the testing process
- Inefficient sample transportation: some tissue samples are sent to labs using second-class post, causing unnecessary delays
- Lack of published turnaround time data: limited transparency in reporting turnaround times across genomic laboratory hubs adds to the challenge, despite the UKLCC persistently campaigning for access to this data.
The good news is that we have observed hospitals and regions employing successful strategies to expedite test results at every stage of the genomics pathway. For example, in terms of the pre-genomics phase – specifically tissue acquisition, sample transportation and tracking – a number of strategies have been adopted to reduce genomic testing turnaround times.
Insight from successful genomic testing strategies
In Northern Ireland, the health system has made significant investments in the lung cancer care pathway by ensuring the presence of a pathologist or cytologist during tissue sample collection for most endobronchial ultrasound procedures.
These specialists provide real-time analysis to assess the quality of the samples and determine if additional samples are required. However, while this approach is commendable, workforce limitations may make it difficult to implement in all regions across the UK. Therefore, it is crucial for local health services and respiratory physicians performing the procedure to prioritise accuracy of tissue sampling and ensure high-quality samples are collected from the outset.
In Wales, all lung cancer tissue samples are systematically tracked from acquisition, through pathology testing and up until the sample reaches the genomics lab. This is via an interconnected IT system, which everyone involved in a lung cancer patient’s care can access.
Another successful strategy that has expedited the pathway can be witnessed in Torbay and South Devon NHS Foundation Trust. Previously, samples were transported from NHS pathology labs to the Bristol genomics hub using Royal Mail tracked delivery – a process that could take up to four days. By switching to an existing hospital transport service, which was already transporting human papillomavirus samples to the Bristol hub, the transit time was reduced to a maximum of one day.
It is clear that it can often be the simplest of changes or strategies which can make the most significant impact. Further examples of best practice covering different stages of the pathway are given in the report.
NHS and Government support for genomic testing
The NHS and Government have made significant strides in supporting genomic testing, but there are still gaps that need addressing to enable quicker turnaround times. While initiatives like the NHS Genomic Medicine Service in England and the National Genomic Test Directory demonstrate commitment to advancing genomic healthcare, challenges remain in areas such as staffing, technology and transport.
It is pleasing that NHS England launched a Cancer Genomic Improvement Programme to assess regional performance of turnaround times from tissue acquisition to genomics reporting – and that the national lung cancer pathways in Scotland and Wales have recently been updated with more ambitious turnaround times in mind. But it is vital that the data that feed into these programmes, or result from them, are published so that learnings can be taken forward and progress made.
With the planned abolition on NHS England, it will be important to ensure that the current focus on improving genomic testing turnaround times in England is maintained.
Improving turnaround via multidisciplinary collaboration
By working collaboratively, multidisciplinary teams (MDTs) can create a more cohesive and efficient testing pathway, ultimately ensuring patients receive timely and accurate results with the potential for better treatment outcomes. MDTs bring together pathologists, oncologists, respiratory physicians and genomic scientists to align on testing priorities and reduce delays caused by miscommunication or fragmented processes.
Collaboration allows for real-time discussions and decision-making, ensuring that tissue samples are collected, processed and analysed efficiently without unnecessary back-and-forth.
MDTs can advocate for and implement shared digital platforms to track samples and results, reducing bottlenecks in the testing pathway. Pathologists and cytologists can provide immediate feedback during procedures, ensuring high-quality samples are obtained, which minimises the need for repeat biopsies.
However, one key recommendation within the UKLCC report is that reflex genomic testing is initiated as soon as a diagnosis of non-small cell lung cancer is made – without waiting for MDT meeting confirmation.
How could a seven-day turnaround for lung cancer samples be met?
The UKLCC recommends that the devolved NHS and Government administrations adjust genomic laboratory turnaround-time targets for lung cancer samples to seven days. Several changes in clinical practice would be necessary to effectively achieve this.
First, the genomic laboratory hubs would need to be sufficiently resourced, operating a seven-day working model. This would require staggered shifts and flexible scheduling to avoid overburdening an already stretched NHS workforce.
Enhanced training would be needed. Increasing the number of training programmes for healthcare scientists and technicians would help address staffing shortages. Upskilling existing staff to take tissue efficiently would also alleviate pressure.
IT systems, such as digital tracking platforms, would also streamline the testing process by reducing administrative burdens and improving sample management.
Conclusion
The UKLCC report serves as a vital call to action, highlighting the transformative impact of timely genomic testing on patient outcomes and quality of life. By addressing systemic challenges, the report paves the way for a more efficient, equitable and personalised approach to lung cancer care across the UK.
Author
Clinical lead for the UKLCC, professor of thoracic oncology at the University of Cambridge, and honorary consultant respiratory physician at Royal Papworth Hospital NHS Foundation Trust
