Lung Cancer Biopsies: Are Patients and Doctors on the Same Page?
"Discover the key factors influencing decisions about repeat biopsies for lung cancer, and why oncologist recommendations matter most."
In the ever-evolving landscape of cancer treatment, personalized medicine is gaining traction, especially for lung cancer. This approach hinges on understanding the unique molecular characteristics of a tumor, guiding the use of targeted therapies that can significantly improve outcomes. However, this precision often requires repeat biopsies to monitor changes in the cancer and identify resistance mechanisms.
Repeat biopsies aren't always straightforward. They involve potential risks, costs, and patient concerns. To ensure the best possible care, it's essential to understand the perspectives of both patients and physicians on the value and necessity of these procedures.
A recent study published in the Expert Review of Quality of Life in Cancer Care sheds light on the attitudes of patients and physicians toward repeat biopsies in lung cancer. The findings reveal key factors influencing decision-making and highlight the importance of clear communication between oncologists and their patients.
Biopsy Methods and Tradeoffs
Liquid biopsy analyzes circulating tumor DNA (ctDNA) from a blood sample and offers a non-invasive way to detect genomic alterations associated with lung cancer. The ctDNA can be analyzed using targeted polymerase chain reaction assays or broader next-generation sequencing panels. Traditional CT-guided percutaneous lung biopsy is also used to diagnose lung lesions, although multiple scans during the procedure can increase radiation exposure.
The Rise of Repeat Biopsy
Patients are increasingly being asked to undergo repeat biopsies for clinical and research purposes. This shift has accompanied the discovery of targetable resistance mutations and molecular drivers in lung cancer. Repeat biopsy therefore reflects the growing role of molecular information in understanding how lung cancer changes over time.
The Key Factor: Your Doctor's Recommendation
The study, which surveyed both lung cancer patients and physicians, revealed a striking finding: the most important factor influencing a patient's decision to undergo a repeat biopsy was their oncologist's recommendation. A significant 57% of patients cited this as the primary driver behind their choice.
- Whether the biopsy will provide results that change their treatment (14%)
- Understanding how the cancer cells are behaving (14%)
- Opportunity to participate in a clinical trial (11%)
Patient and Physician Perspectives
A prospective survey at a large academic centre in Melbourne examined patients’ and physicians’ attitudes toward repeat biopsies in lung cancer. The study found that 27 of 45 patients, or 60%, would agree to a re-biopsy to participate in a clinical trial, while 32 of 46, or 70%, would agree to one when their disease progressed to check for a resistance mechanism. Patients’ decisions were strongly influenced by their oncologists’ recommendations, highlighting the importance of communication about why another biopsy may be needed.
Bridging the Gap: Communication is Key
The study underscores the critical role of oncologists in guiding patients through complex decisions about repeat biopsies. However, it also reveals a potential gap in understanding between patients and physicians regarding their respective priorities.
Listening to Patients
Research on general practitioners examined perceptions of liquid biopsy alongside current lung cancer diagnostic and treatment practices in their regions. Other research has emphasized that knowledge of and attention to patients’ perspectives, experiences, and expectations during lung cancer diagnostic pathways remain limited. Together, these findings support closer attention to both clinician understanding and patient experience when biopsy decisions are discussed.
Toward More Precise Care
Lung cancer care has been reshaped over the past decade by advances in early detection, treatment, and prevention, including screening and recognition of non-tobacco risk factors. A 2026 review describes artificial intelligence and machine learning as emerging tools for detecting, classifying, and treating lung cancer. At the same time, biomarker testing for precision therapies in non-small cell lung cancer remains frequently underused, delayed, and inequitable, with pulmonologists playing an important role in the initial diagnostic process.
Advocacy and Unmet Needs
Lung cancer patient advocacy is described as an essential force for progress in access to prevention, screening, treatment, and supportive care. Advocates have challenged stigma, underfunding, and neglect, while organizations have expanded, professionalized, and formed national and international coalitions. A 2026 patient-advocacy assessment also focused on fears, concerns, and challenges among people diagnosed with lung cancer in the United States.
Biopsy in the Real World
A 2024 study reported that physicians were the primary decision-makers in lung cancer care, while family members played a significant role, particularly in quality-of-life discussions. The study also described substantial effects of lung cancer on patients’ employment and mental well-being, supporting a multi-stakeholder approach to care. Separately, real-world data from the AURORA cohort showed that re-biopsy at disease progression increased over time among patients with EGFR-, ALK-, and ROS1-positive non-small cell lung cancer receiving multiple lines of therapy.
To bridge this gap, healthcare providers should: <ul><li>Clearly explain the rationale for repeat biopsies, emphasizing the potential impact on treatment decisions.</li> <li>Address patient concerns about risks, pain, anxiety, and time commitment.</li> <li>Discuss the availability of less invasive methods like liquid biopsies (blood tests) where appropriate.</li> <li>Acknowledge and respect patient autonomy in decision-making.</li></ul>
By fostering open communication and shared decision-making, oncologists can empower patients to make informed choices about their care and ensure that repeat biopsies are used effectively to advance personalized lung cancer treatment.