Should supportive care be started before initiating cancer treatment?

This comment proposes that the diagnostic waiting period (DWP), defined as the interval from the first specialist visit to anticancer treatment initiation, should be recognized as an opportunity for early supportive care in patients with advanced lung cancer.

We discuss the clinical rationale for initiating low-burden supportive care at the first specialist visit, drawing on prior observations of clinical deterioration before treatment initiation and feasibility data from a home-based exercise program during the DWP.

The DWP is often necessary for imaging, tissue sampling, staging, molecular testing, and treatment planning, but patients may experience anxiety, inactivity, anorexia, weight loss, and functional decline during this period. A first-visit supportive care model could include patient education, safe physical activity guidance, nutritional screening, symptom assessment, and timely referral to rehabilitation, dietetic, nursing, or palliative care services.

Reframing the DWP from passive waiting to active preparation may help preserve physical reserve, confidence, and treatment readiness before systemic therapy. Future studies should evaluate which patients should be prioritized, which interventions are most useful, and which outcomes best capture the value of this early supportive care approach.