Advancing Precision Medicine in Non-Small Cell Lung Cancer Diagnostics in a Southeast Asian Country

Purpose: Next-generation sequencing (NGS) has transformed molecular diagnostics and precision oncology by enabling broad genomic profiling and informed treatment selection for non-small cell lung cancer (NSCLC). However, adoption in Southeast Asia remains limited, particularly in public healthcare settings. This study aimed to assess the landscape of NGS testing for NSCLC in Malaysia, identify barriers, and explore strategies clinicians use to improve patient access. Patients and Methods: A descriptive, cross-sectional survey comprising 18 questions was distributed to clinical oncologists and respiratory physicians across Malaysia over an eight-week period. The survey collected data on clinical experience with NGS, testing practices, perceived barriers, and access strategies. Descriptive statistics were used for analysis, and associations between healthcare sectors (public vs private) and NGS usage frequency were evaluated using the Chi-square test. Results: Seventy-one clinicians participated - 67.6% clinical oncologists and 32.4% respiratory physicians. Private hospitals had the highest NGS uptake (38.5% testing all NSCLC patients), with the lowest in Ministry of Health (MoH) institutions (8.3%) (p<0.0001). Among oncologists, 45.8% used NGS for all or nearly all patients. For respiratory physicians, 35.3%, mainly from MoH, used it most of the time. NGS results were more frequently available in private referrals. Most private clinicians (84.6%) rated NGS accessibility as excellent. Key barriers included cost of testing and therapies, limited availability, long turnaround times, insufficient tissue, and unclear guidelines. Strategies to improve access included industry-subsidized programs, insurance coverage, and clinical trial enrolment. Conclusion: NGS adoption for NSCLC in Malaysia varies significantly across healthcare settings. Public hospitals face substantial barriers, particularly related to cost and access to testing and therapies. Addressing these challenges will require coordinated efforts across policy, infrastructure, clinician training, and public-private partnerships. This study offers key insights into the Malaysian NGS landscape and supports broader access to precision oncology. © 2026 Poh et al.