The Current Status of Circulating Tumor DNA Utilization in Australasia: A Survey of Thoracic Oncology Group Australasia Members.

Abstract

Aim: To evaluate the current status of circulating tumor DNA (ctDNA) utilization for non-small cell lung cancer (NSCLC) among members of the Thoracic Oncology Group Australasia (TOGA), and to identify barriers to its implementation in clinical practice across Australia and New Zealand (ANZ).

Methods: A 31-item electronic survey was distributed to TOGA members between December 2023 and August 2024. Responses were analysed descriptively to assess access, usage patterns, perceived barriers, and clinician attitudes toward ctDNA testing.

Results: Thirty complete responses were analysed. Most respondents were medical oncologists working in metropolitan academic or public hospitals. While respondents estimated 83% of patients have access to molecular testing, only 12% were believed to have access to ctDNA testing. Only 33% reported routine ctDNA use, primarily in advanced disease settings. If more accessible, 83% indicated they would adopt ctDNA in advanced NSCLC. Key barriers to ctDNA utilization included cost (93%), logistical challenges (63%), limited knowledge (50%), and assay confidence (40%). Although over half of clinicians had patients inquire about ctDNA, fewer than 40% routinely discussed it. Most preferred are in-person or virtual workshops for education. Notably, 30% lacked access to a Molecular Tumor Board, and 70% did not provide pre-test counselling regarding incidental germline findings.

Conclusion: Despite limited current use, there is strong interest in ctDNA testing for NSCLC in ANZ. Addressing funding, logistical barriers, and clinician education is essential to enabling equitable, widespread adoption of ctDNA into standard lung cancer care.