Precision Oncology at Speed: Workflow Design Determines Clinical Utility in Rapid Molecular Testing for Lung Cancer

Matching patients with effective targeted therapies requires timely molecular results, however the challenge today how to embed it into routine clinical workflows in ways that meaningfully affect patient-level treatment decisions.

Building on prior work, the authors systematically reviewed laboratory operations, interdepartmental coordination, and administrative processes from two distinct healthcare settings: a United States based academic tertiary care center and a Canadian community hospital. We identified shared themes, context-specific challenges, and operational elements that distinguished successful integration from assay availability alone.

Across both environments, the comparison revealed that rapid testing consistently accelerated treatment decisions and facilitated biomarker-informed patient management, but its successful implementation depended on re-engineering laboratory workflows, aligning personnel competencies, and establishing turnaround time monitoring; technical availability alone did not ensure clinically meaningful rapid testing. While the academic context integrated rapid testing within comprehensive molecular pipelines and research frameworks, the community hospital context focused on pragmatic adoption for frontline care, especially in urgent clinical settings and based on the organization of the Canadian health system.

Implementing rapid molecular testing in NSCLC is fundamentally an implementation and systems-engineering challenge rather than a technical challenge. Clinical speed depended more on system design than assay availability alone and is influenced, in part, by the larger national healthcare context. Addressing laboratory, operational, and administrative barriers is essential to ensure that rapid testing improves outcomes. Lessons learned from both academic and community practice provide a practical, implementation-focused roadmap for broader adoption and equity in access to precision oncology.